Senate Bill 0792c1
CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 1998 CS for SB 792
By the Committee on Banking and Insurance and Senators
Latvala, Myers, Gutman, Bronson, Casas and Campbell
311-2147-98
1 A bill to be entitled
2 An act relating to dental insurance coverage;
3 creating ss. 627.4295, 627.65755, F.S., and
4 amending ss. 627.6515 and 641.31, F.S.;
5 requiring health insurance policies and health
6 maintenance organization contracts to provide
7 coverage for general anesthesia and
8 hospitalization for certain persons under
9 certain circumstances; providing application;
10 providing exceptions; providing a declaration
11 of important state interest; providing
12 application; providing an effective date.
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14 Be It Enacted by the Legislature of the State of Florida:
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16 Section 1. Section 627.4295, Florida Statutes, is
17 created to read:
18 627.4295 Dental procedures; anesthesia and
19 hospitalization coverage.--For purposes of this section,
20 dental treatment or surgery shall be considered necessary when
21 the dental condition is likely to result in a medical
22 condition if left untreated. Any individual health insurance
23 policy issued or issued for delivery in this state which
24 provides coverage for general anesthesia and hospitalization
25 services to a covered person shall not preclude such coverage
26 in assuring the safe delivery of necessary dental care
27 provided to a covered person who:
28 (1) Is under 8 years of age and is determined by a
29 licensed dentist, in consultation with the child's physician
30 licensed under chapter 458 or chapter 459, to require
31 necessary dental treatment in a hospital or ambulatory
1
CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 1998 CS for SB 792
311-2147-98
1 surgical center due to a significantly complex dental
2 condition or a developmental disability in which patient
3 management in the dental office has proved to be ineffective;
4 or
5 (2) Has one or more medical conditions that would
6 create significant or undue medical risk for the individual in
7 the course of delivery of any necessary dental treatment or
8 surgery if not rendered in a hospital or ambulatory surgical
9 center.
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11 As provided in this section, all terms and conditions of the
12 covered person's health insurance policy shall apply to such
13 services and this section does not require coverage for the
14 diagnosis or treatment of dental disease. An insurer may
15 require prior authorization for general anesthesia and
16 hospital services required under this section in the same
17 manner the insurer requires prior authorization for
18 hospitalization for other covered services. This section does
19 not apply to Medicare supplement, long-term-care, disability,
20 limited benefit, or specified disease policies.
21 Section 2. Subsection (8) is added to section
22 627.6515, Florida Statutes, to read:
23 627.6515 Out-of-state groups.--
24 (8) For purposes of this subsection, dental treatment
25 or surgery shall be considered necessary when the dental
26 condition is likely to result in a medical condition if left
27 untreated. Any group, franchise, or blanket health insurance
28 policy issued or delivered outside this state, under which
29 policy a resident of this state is provided coverage for
30 general anesthesia and hospitalization services to a covered
31 person, shall not preclude such coverage in assuring the safe
2
CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 1998 CS for SB 792
311-2147-98
1 delivery of necessary dental care provided to a covered person
2 who:
3 (a) Is under 8 years of age and is determined by a
4 licensed dentist, in consultation with the child's physician
5 licensed under chapter 458 or chapter 459, to require
6 necessary dental treatment in a hospital or ambulatory
7 surgical center due to a significantly complex dental
8 condition or a developmental disability in which patient
9 management in the dental office has proved to be ineffective;
10 or
11 (b) Has one or more medical conditions that would
12 create significant or undue medical risk for the individual in
13 the course of delivery of any necessary dental treatment or
14 surgery if not rendered in a hospital or ambulatory surgical
15 center.
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17 As provided in this section, all terms and conditions of the
18 covered person's health insurance policy shall apply to such
19 services and this section does not require coverage for the
20 diagnosis or treatment of dental disease. An insurer may
21 require prior authorization for general anesthesia and
22 hospital services required under this section in the same
23 manner the insurer requires prior authorization for
24 hospitalization for other covered services. This section does
25 not apply to Medicare supplement, long-term-care, disability,
26 limited benefit, or specified disease policies.
27 Section 3. Section 627.65755, Florida Statutes, is
28 created to read:
29 627.65755 Dental procedures; anesthesia and
30 hospitalization coverage.--For purposes of this section,
31 dental treatment or surgery shall be considered necessary when
3
CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 1998 CS for SB 792
311-2147-98
1 the dental condition is likely to result in a medical
2 condition if left untreated. Any group, blanket, or franchise
3 health insurance policy issued or issued for delivery in this
4 state which provides coverage for general anesthesia and
5 hospitalization services to a covered person shall not
6 preclude such coverage in assuring the safe delivery of
7 necessary dental care provided to a covered person who:
8 (1) Is under 8 years of age and is determined by a
9 licensed dentist, in consultation with the child's physician
10 licensed under chapter 458 or chapter 459, to require
11 necessary dental treatment in a hospital or ambulatory
12 surgical center due to a significantly complex dental
13 condition or a developmental disability in which patient
14 management in the dental office has proved to be ineffective;
15 or
16 (2) Has one or more medical conditions that would
17 create significant or undue medical risk for the individual in
18 the course of delivery of any necessary dental treatment or
19 surgery if not rendered in a hospital or ambulatory surgical
20 center.
21
22 As provided in this section, all terms and conditions of the
23 covered person's health insurance policy shall apply to such
24 services and this section does not require coverage for the
25 diagnosis or treatment of dental disease. An insurer may
26 require prior authorization for general anesthesia and
27 hospital services required under this section in the same
28 manner the insurer requires prior authorization for
29 hospitalization for other covered services. This section does
30 not apply to Medicare supplement, long-term-care, disability,
31 limited benefit, or specified disease policies.
4
CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 1998 CS for SB 792
311-2147-98
1 Section 4. Subsection (34) is added to section 641.31,
2 Florida Statutes, to read:
3 641.31 Health maintenance contracts.--
4 (34) For purposes of this subsection, dental treatment
5 or surgery shall be considered necessary when the dental
6 condition is likely to result in a medical condition if left
7 untreated. Any health maintenance organization contract which
8 provides coverage for general anesthesia and hospitalization
9 services to a covered person shall not preclude such coverage
10 in assuring the safe delivery of necessary dental care
11 provided to a covered person who:
12 (a) Is under 8 years of age and is determined by a
13 licensed dentist, in consultation with the child's physician
14 licensed under chapter 458 or chapter 459, to require
15 necessary dental treatment in a hospital or ambulatory
16 surgical center due to a significantly complex dental
17 condition or a developmental disability in which patient
18 management in the dental office has proved to be ineffective;
19 or
20 (b) Has one or more medical conditions that would
21 create significant or undue medical risk for the individual in
22 the course of delivery of any necessary dental treatment or
23 surgery if not rendered in a hospital or ambulatory surgical
24 center.
25
26 As provided in this section, all terms and conditions of the
27 covered person's health maintenance organization contract
28 shall apply to such services and this section does not require
29 coverage for the diagnosis or treatment of dental disease. A
30 health maintenance organization may require prior
31 authorization for general anesthesia and hospital services
5
CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 1998 CS for SB 792
311-2147-98
1 required under this section in the same manner the
2 organization requires prior authorization for hospitalization
3 for other covered services. This section does not apply to
4 Medicare supplement, long-term-care, disability, limited
5 benefit, or specified disease policies.
6 Section 5. The provisions of this act fulfill an
7 important state interest in that they promote the relief,
8 alleviation, and prevention of health, dental, or medical
9 problems associated with inadequate dental care.
10 Section 6. This act shall take effect October 1, 1998,
11 and shall apply to any policy issued, written, or renewed, or
12 contract entered into, on or after that date.
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CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 1998 CS for SB 792
311-2147-98
1 STATEMENT OF SUBSTANTIAL CHANGES CONTAINED IN
COMMITTEE SUBSTITUTE FOR
2 Senate Bill 792
3
4 The bill requires each individual health insurance policy,
group health insurance policy, and health maintenance
5 organization contract to provide coverage for charges for
general anesthesia or hospitalization for dental care provided
6 to a covered person who:
7 1. Is 8 years of age or less and is determined by a licensed
dentist, in consultation with the child's physician
8 licensed under chapter 458 or 459, F.S., to require
necessary dental treatment in a hospital or ambulatory
9 surgical center due to a significantly complex dental
condition or a developmental disability in which patient
10 management in the dental office has proved to be
ineffective; or
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2. Has one or more medical conditions that would create
12 significant undue medical risk for the individual in the
course of delivery of any necessary dental treatment or
13 surgery if not rendered in a hospital or ambulatory
surgical center.
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All terms and conditions of the covered person's health
15 insurance policy or contract would apply to such services and
the provisions of the bill would not require coverage for the
16 diagnosis or treatment of dental disease.
17 The provisions of the bill would not apply to Medicare
supplement, long-term care, disability, limited benefit, or
18 specified disease policies.
19 The bill provides that the provisions of this act fulfill an
important state interest in that they promote the relief,
20 alleviation, and prevention of health, dental, or medical
problems associated with inadequate dental care.
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