HD80 - Mandated Coverage for Anesthesia/Hospitalization for Dental Care

  • Published: 2000
  • Author: Special Advisory Commission on Mandated Health Insurance Benefits
  • Enabling Authority: Code of Virginia - § 9-298

Executive Summary:
House Bill 2007 amends the accident and sickness chapter of Title 38.2 of the Code of Virginia by adding a section to require any insurer proposing to issue individual or group accident and sickness insurance policies providing hospital, medical and surgical, or major medical coverage on an expense-incurred basis; each corporation providing individual or group accident and sickness subscription contracts; and each health maintenance organization (HMO) providing a health care plan for health care services to provide coverage for general anesthesia and hospital charges for dental care provided to a covered person who (i) is under the age of five, or (ii) is severely disabled, or (iii) has a medical condition and requires hospitalization or general anesthesia for dental care treatment. The policy, contract, or plan must also provide coverage for general anesthesia and treatment rendered by a dentist for a medical condition covered under the policy, contract, or plan.

Delegate Shuler submitted amended language to the Advisory Commission on June I, 1999.

The amended bill requires individual and group accident and sickness policies providing hospital, medical and surgical or major medical coverage on an expense-incurred basis, individual or group subscription contracts and HMO plans to provide coverage for medically necessary general anesthesia and hospitalization or facility charges for dental care. The facility must be licensed to provide outpatient surgical procedures. The covered person must be determined by a licensed dentist in consultation with the person's treating physician to require general anesthesia and admission to a hospital or outpatient surgery facility to provide dental care safely and effectively. The covered person must also be under the age of five, or severely disabled, or have a medical condition that requires admission to a hospital or outpatient surgery facility and general anesthesia for dental care.

The amended bill provides that the determination of medical necessity must include consideration of whether the age, physical, or mental condition of the person requires the utilization of general anesthesia as the bill provides.

The insurer, corporation, or HMO may require prior authorization in the same manner as required for other benefits. The coverage can be restricted to health care providers licensed to provide anesthesia, and facilities charges can be restricted to facilities licensed to provide surgical services.

The amended bill does not require coverage for dental care that is incident to the section. The bill does not apply to short-term travel, accident-only, limited or specified disease policies, or Medicare supplement contracts or similar coverage under state or federal government plans. The amended bill would apply to policies, contracts, or plans delivered, issued for delivery, or renewed in Virginia on or after July 1, 2000.