SCORC/SB 776
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AN ACT
RELATING TO INSURANCE; REQUIRING INSURANCE COVERAGE FOR
GENERAL ANESTHESIA AND HOSPITALIZATION FOR DENTAL SURGERY.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO:
Section 1. A new section of the Health Care Purchasing
Act is enacted to read:
"GENERAL ANESTHESIA AND HOSPITALIZATION FOR DENTAL
SURGERY.--
A. Group health care coverage, including any form
of self-insurance, offered, issued or renewed under the
Health Care Purchasing Act shall provide coverage for
hospitalization and general anesthesia provided in a hospital
or ambulatory surgical center for dental surgery for the
following:
(1) insureds exhibiting physical,
intellectual or medically compromising conditions for which
dental treatment under local anesthesia, with or without
additional adjunctive techniques and modalities, cannot be
expected to provide a successful result and for which dental
treatment under general anesthesia can be expected to produce
superior results;
(2) insureds for whom local anesthesia is
ineffective because of acute infection, anatomic variation or
allergy;
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(3) insured children or adolescents who are
extremely uncooperative, fearful, anxious or uncommunicative
with dental needs of such magnitude that treatment should not
be postponed or deferred and for whom lack of treatment can
be expected to result in dental or oral pain or infection,
loss of teeth or other increased oral or dental morbidity;
(4) insureds with extensive oral-facial or
dental trauma for which treatment under local anesthesia
would be ineffective or compromised; or
(5) other procedures for which
hospitalization or general anesthesia in a hospital or
ambulatory surgical center is medically necessary.
B. The provisions of this section do not apply to
short-term travel, accident-only or limited or specified
disease policies.
C. Coverage for dental surgery may be subject to
copayments, deductibles and coinsurance subject to network
and prior authorization requirements consistent with those
imposed on other benefits under the same group health care
coverage, including any form of self-insurance."
Section 2. A new section of Chapter 59A, Article 22
NMSA 1978 is enacted to read:
"GENERAL ANESTHESIA AND HOSPITALIZATION FOR DENTAL
SURGERY.--
A. An individual or group health insurance policy,
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health care plan or certificate of health insurance that is
delivered, issued for delivery or renewed in this state shall
provide coverage for hospitalization and general anesthesia
provided in a hospital or ambulatory surgical center for
dental surgery for the following:
(1) insureds exhibiting physical,
intellectual or medically compromising conditions for which
dental treatment under local anesthesia, with or without
additional adjunctive techniques and modalities, cannot be
expected to provide a successful result and for which dental
treatment under general anesthesia can be expected to produce
superior results;
(2) insureds for whom local anesthesia is
ineffective because of acute infection, anatomic variation or
allergy;
(3) insured children or adolescents who are
extremely uncooperative, fearful, anxious or uncommunicative
with dental needs of such magnitude that treatment should not
be postponed or deferred and for whom lack of treatment can
be expected to result in dental or oral pain or infection,
loss of teeth or other increased oral or dental morbidity;
(4) insureds with extensive oral-facial or
dental trauma for which treatment under local anesthesia
would be ineffective or compromised; or
(5) other procedures for which
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hospitalization or general anesthesia in a hospital or
ambulatory surgical center is medically necessary.
B. The provisions of this section do not apply to
short-term travel, accident-only or limited or specified
disease policies.
C. Coverage for dental surgery may be subject to
copayments, deductibles and coinsurance subject to network
and prior authorization requirements consistent with those
imposed on other benefits under the same policy, plan or
certificate."
Section 3. A new section of Chapter 59A, Article 23
NMSA 1978 is enacted to read:
"GENERAL ANESTHESIA AND HOSPITALIZATION FOR DENTAL
SURGERY.--
A. A blanket or group health insurance policy,
health care plan or certificate of health insurance that is
delivered, issued for delivery or renewed in this state shall
provide coverage for hospitalization and general anesthesia
provided in a hospital or ambulatory surgical center for
dental surgery for the following:
(1) insureds exhibiting physical,
intellectual or medically compromising conditions for which
dental treatment under local anesthesia, with or without
additional adjunctive techniques and modalities, cannot be
expected to provide a successful result and for which dental
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treatment under general anesthesia can be expected to produce
superior results;
(2) insureds for whom local anesthesia is
ineffective because of acute infection, anatomic variation or
allergy;
(3) insured children or adolescents who are
extremely uncooperative, fearful, anxious or uncommunicative
with dental needs of such magnitude that treatment should not
be postponed or deferred and for whom lack of treatment can
be expected to result in dental or oral pain or infection,
loss of teeth or other increased oral or dental morbidity;
(4) insureds with extensive oral-facial or
dental trauma for which treatment under local anesthesia
would be ineffective or compromised; or
(5) other procedures for which
hospitalization or general anesthesia in a hospital or
ambulatory surgical center is medically necessary.
B. The provisions of this section do not apply to
short-term travel, accident-only or limited or specified
disease policies.
C. Coverage for dental surgery may be subject to
copayments, deductibles and coinsurance subject to network
and prior authorization requirements consistent with those
imposed on other benefits under the same policy, plan or
certificate."
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Section 4. A new section of Chapter 59A, Article 46
NMSA 1978 is enacted to read:
"GENERAL ANESTHESIA AND HOSPITALIZATION FOR DENTAL
SURGERY.--
A. An individual or group health maintenance
organization contract delivered, issued for delivery or
renewed in this state shall provide coverage for
hospitalization and general anesthesia provided in a hospital
or ambulatory surgical center for dental surgery for the
following:
(1) insureds exhibiting physical,
intellectual or medically compromising conditions for which
dental treatment under local anesthesia, with or without
additional adjunctive techniques and modalities, cannot be
expected to provide a successful result and for which dental
treatment under general anesthesia can be expected to produce
superior results;
(2) insureds for whom local anesthesia is
ineffective because of acute infection, anatomic variation or
allergy;
(3) insured children or adolescents who are
extremely uncooperative, fearful, anxious or uncommunicative
with dental needs of such magnitude that treatment should not
be postponed or deferred and for whom lack of treatment can
be expected to result in dental or oral pain or infection,
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loss of teeth or other increased oral or dental morbidity;
(4) insureds with extensive oral-facial or
dental trauma for which treatment under local anesthesia
would be ineffective or compromised; or
(5) other procedures for which
hospitalization or general anesthesia in a hospital or
ambulatory surgical center is medically necessary.
B. The provisions of this section do not apply to
short-term travel, accident-only or limited or specified
disease policies.
C. Coverage for dental surgery may be subject to
copayments, deductibles and coinsurance subject to network
and prior authorization requirements consistent with those
imposed on other benefits under the same policy, plan or
certificate."
Section 5. A new section of Chapter 59A, Article 47
NMSA 1978 is enacted to read:
"GENERAL ANESTHESIA AND HOSPITALIZATION FOR DENTAL
SURGERY.--
A. An individual or group health insurance policy,
health care plan or certificate of health insurance delivered
or issued for delivery in this state shall provide coverage
for hospitalization and general anesthesia provided in a
hospital or ambulatory surgical center for dental surgery for
the following:
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(1) insureds exhibiting physical,
intellectual or medically compromising conditions for which
dental treatment under local anesthesia, with or without
additional adjunctive techniques and modalities, cannot be
expected to provide a successful result and for which dental
treatment under general anesthesia can be expected to produce
superior results;
(2) insureds for whom local anesthesia is
ineffective because of acute infection, anatomic variation or
allergy;
(3) insured children or adolescents who are
extremely uncooperative, fearful, anxious or uncommunicative
with dental needs of such magnitude that treatment should not
be postponed or deferred and for whom lack of treatment can
be expected to result in dental or oral pain or infection,
loss of teeth or other increased oral or dental morbidity;
(4) insureds with extensive oral-facial or
dental trauma for which treatment under local anesthesia
would be ineffective or compromised; or
(5) other procedures for which
hospitalization or general anesthesia in a hospital or
ambulatory surgical center is medically necessary.
B. The provisions of this section do not apply to
short-term travel, accident-only or limited or specified
disease policies.
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C. Coverage for dental surgery may be subject to
copayments, deductibles and coinsurance subject to network
and prior authorization requirements consistent with those
imposed on other benefits under the same policy, plan or
certificate."
Section 6. EFFECTIVE DATE.--The effective date of the
provisions of this act is July 1, 2007.