Bill Text: TX SB1178 | 2023-2024 | 88th Legislature | Introduced
Bill Title: Relating to health benefit coverage for general anesthesia in connection with certain pediatric dental services.
Spectrum: Slight Partisan Bill (Democrat 2-1)
Status: (Introduced - Dead) 2023-03-09 - Referred to Health & Human Services [SB1178 Detail]
Download: Texas-2023-SB1178-Introduced.html
| 88R3496 CJD-F | ||
| By: LaMantia, Sparks, Zaffirini | S.B. No. 1178 | |
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| relating to health benefit coverage for general anesthesia in | ||
| connection with certain pediatric dental services. | ||
| BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
| SECTION 1. Chapter 1367, Insurance Code, is amended by | ||
| adding Subchapter G to read as follows: | ||
| SUBCHAPTER G. PEDIATRIC DENTISTRY | ||
| Sec. 1367.301. APPLICABILITY OF SUBCHAPTER. (a) This | ||
| subchapter applies only to a health benefit plan that provides | ||
| benefits for medical or surgical expenses incurred as a result of a | ||
| health condition, accident, or sickness, including an individual, | ||
| group, blanket, or franchise insurance policy or insurance | ||
| agreement, a group hospital service contract, or an individual or | ||
| group evidence of coverage or similar coverage document that is | ||
| offered by: | ||
| (1) an insurance company; | ||
| (2) a group hospital service corporation operating | ||
| under Chapter 842; | ||
| (3) a health maintenance organization operating under | ||
| Chapter 843; | ||
| (4) an approved nonprofit health corporation that | ||
| holds a certificate of authority under Chapter 844; | ||
| (5) a multiple employer welfare arrangement that holds | ||
| a certificate of authority under Chapter 846; | ||
| (6) a stipulated premium insurance company operating | ||
| under Chapter 884; | ||
| (7) a fraternal benefit society operating under | ||
| Chapter 885; | ||
| (8) a Lloyd's plan operating under Chapter 941; or | ||
| (9) an exchange operating under Chapter 942. | ||
| (b) Notwithstanding any other law, this subchapter applies | ||
| to: | ||
| (1) a small employer health benefit plan subject to | ||
| Chapter 1501, including coverage provided through a health group | ||
| cooperative under Subchapter B of that chapter; | ||
| (2) a standard health benefit plan issued under | ||
| Chapter 1507; | ||
| (3) a basic coverage plan under Chapter 1551; | ||
| (4) a basic plan under Chapter 1575; | ||
| (5) a primary care coverage plan under Chapter 1579; | ||
| (6) a plan providing basic coverage under Chapter | ||
| 1601; | ||
| (7) health benefits provided by or through a church | ||
| benefits board under Subchapter I, Chapter 22, Business | ||
| Organizations Code; | ||
| (8) a regional or local health care program operated | ||
| under Section 75.104, Health and Safety Code; and | ||
| (9) a self-funded health benefit plan sponsored by a | ||
| professional employer organization under Chapter 91, Labor Code. | ||
| (c) This subchapter applies to coverage under a group health | ||
| benefit plan described by Subsection (a) provided to a resident of | ||
| this state, regardless of whether the group policy, agreement, or | ||
| contract is delivered, issued for delivery, or renewed in this | ||
| state. | ||
| Sec. 1367.302. COVERAGE FOR GENERAL ANESTHESIA. Subject to | ||
| Section 1360.005, a health benefit plan that provides coverage for | ||
| general anesthesia may not exclude from coverage general anesthesia | ||
| services in connection with dental services provided to a covered | ||
| individual if: | ||
| (1) the individual is: | ||
| (A) younger than 13 years of age; and | ||
| (B) unable to undergo the dental service without | ||
| general anesthesia due to a documented physical, mental, or medical | ||
| reason determined by the individual's physician or by the dentist | ||
| providing the dental care; and | ||
| (2) the anesthesia is performed and billed separately | ||
| by: | ||
| (A) a physician anesthesiologist licensed by the | ||
| Texas Medical Board; or | ||
| (B) a dentist anesthesiologist licensed by the | ||
| State Board of Dental Examiners who holds the permit to administer | ||
| general anesthesia under Chapter 258, Occupations Code. | ||
| Sec. 1367.303. COVERAGE NOT REQUIRED. This subchapter does | ||
| not require a health benefit plan to provide coverage for dental | ||
| care or procedures. | ||
| SECTION 2. Subchapter G, Chapter 1367, Insurance Code, as | ||
| added by this Act, applies only to a health benefit plan that is | ||
| delivered, issued for delivery, or renewed on or after January 1, | ||
| 2024. | ||
| SECTION 3. This Act takes effect September 1, 2023. | ||
