40-2,165. Coverage of general anesthesia in conjunction with dental care for certain individuals. - Kansas Statutes

40-2,165

Chapter 40.--INSURANCE Article 2.--GENERAL PROVISIONS

      40-2,165.   Coverage of general anesthesia inconjunction with dental care for certain individuals.(a) Any individual or group health insurance policy,medical service plan, contract, hospital service corporation contract, hospitaland medical service corporation contract, fraternal benefit society or healthmaintenance organization which provides coverage for accident and healthservices and which is delivered, issued for delivery, amended or renewed on orafter July 1, 1999, also, shall provide coverage for the administration ofgeneral anesthesia and medical care facility charges for dental care providedto thefollowing covered persons:

      (1)   A child five years of age and under; or

      (2)   a person who is severely disabled; or

      (3)   a person has a medical or behavioral condition which requireshospitalization or general anesthesia when dental care is provided.

      (b)   A policy, provision, contract, plan or agreement may:

      (1)   Apply tothe covered procedures under this section the same deductibles, coinsurance,network requirements and other limitations, including but not limited tomedical necessity determinations, as apply to other covered services;

      (2)   require prior authorization for hospitalization for the coveredprocedures under this section in the same manner that prior authorization isrequired for hospitalization for other covered diseases or conditions.

      (c)   The provisions of this section shall not apply to any policy orcertificate providing coverage for any specified disease, specified accident oraccident-only coverage, credit, dental, disability income, hospital indemnity,long-term care, as defined by K.S.A. 40-2227, and amendments thereto, medicaresupplement, as defined by the commissioner of insurance by rules andregulations, vision care or other limited-benefit supplemental insurance, norany coverage issued as a supplement to liability insurance, workers'compensation or similar insurance, automobile medical-payment insurance, or anyinsurance under which benefits are payable with or without regard to fault,whether written on a group, blanket or individual basis.

      (d)   Nothing herein shall be construed to require any individual or grouphealth insurance policy, medical service plan, contract, hospital servicecorporation contract, fraternal benefit society or health maintenanceorganization to provide benefits for any dental procedures.

      (e)   The provisions of this section shall apply to the state health carebenefits program and municipal self-funded pools.

      (f)   As used in this section "medical care facility" shall have the meaningascribed to the term in K.S.A. 65-425, and amendments thereto.

      History:   L. 1999, ch. 162, § 1; July 1.