SECTIONS 12693.63-12693.64 - California Statutes

INSURANCE CODE

SECTION 12693.63-12693.64

12693.63. (a) The board shall determine the dental benefits to be
provided to subscribers by the program. These benefits shall be
consistent with those provided to state employees through the
Department of Personnel Administration on July 1, 1997, except that
orthodontia shall only be a benefit when it is determined to be
medically necessary.
(b) The board shall establish the required subscriber copayment
levels for dental benefits. The copayment levels established by the
board shall, to the extent possible, reflect the copayment levels
provided to state employees through the Department of Personnel
Administration on July 1, 1997, except that no copayment shall be
charged for medically necessary orthodontia services. There shall be
no subscriber copayments for preventive and diagnostic services,
including, but not limited to, examinations, teeth cleaning, X-rays,
topical fluoride treatments, space maintainers, and sealants.
(c) No deductible shall be charged to subscribers for dental
benefits.
(d) (1) The board may establish a cap on the amount of dental
coverage provided to a subscriber in a given benefit year effective
on and after the first day of the fifth month following enactment of
the 2008-09 Budget Act. This dental coverage cap shall not be lower
than one thousand five hundred dollars ($1,500) per subscriber per
benefit year.
(2) The board may adopt, and may only one-time readopt,
regulations to implement paragraph (1). The adoption and one-time
readoption of a regulation authorized by this paragraph is deemed to
address an emergency, for purposes of Sections 11346.1 and 11349.6 of
the Government Code, and the board is hereby exempted for this
purpose from the requirements of subdivision (b) of Section 11346.1
of the Government Code.

12693.64. Notwithstanding any other provision of law, for a
subscriber who is determined by the California Children's Services
Program to be eligible for benefits under the program pursuant to
Article 5 (commencing with Section 123800) of Chapter 3 of Part 2 of
Division 106 of the Health and Safety Code, a participating plan
shall not be responsible for the provision of, or payment for, the
particular services authorized by the California Children's Services
Program for the particular subscriber for the treatment of a
California Children's Services Program eligible medical condition.
All other services provided under the participating plan shall be
available to the subscriber.