Sec. 38a-517a. Coverage for in-patient, outpatient or one-day dental services in certain instances.
Sec. 38a-517a. Coverage for in-patient, outpatient or one-day dental services
in certain instances. (a) Each group health insurance policy providing coverage of the
type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 delivered,
issued for delivery, renewed or continued in this state on or after January 1, 2000, shall
provide coverage for general anesthesia, nursing and related hospital services provided
in conjunction with in-patient, outpatient or one-day dental services if the following
conditions are met:
(1) The anesthesia, nursing and related hospital services are deemed medically necessary by the treating dentist or oral surgeon and the patient's primary care physician
in accordance with the health insurance policy's requirements for prior authorization
of services; and
(2) The patient is either (A) determined by a licensed dentist, in conjunction with
a licensed physician who specializes in primary care, to have a dental condition of
significant dental complexity that it requires certain dental procedures to be performed
in a hospital, or (B) a person who has a developmental disability, as determined by a
licensed physician who specializes in primary care, that places the person at serious risk.
(b) The expense of such anesthesia, nursing and related hospital services shall be
deemed a medical expense under such health insurance policy and shall not be subject
to any limits on dental benefits under such policy.
(P.A. 99-284, S. 41, 60; P.A. 00-135, S. 14, 21; P.A. 03-58, S. 2.)
History: P.A. 99-284 effective January 1, 2000; P.A. 00-135 added outpatient or one-day dental services, effective May
26, 2000; P.A. 03-58 divided existing provisions into Subsecs. (a) and (b) and deleted "a child under the age of four who
is" from Subsec. (a)(2)(A).
See Sec. 38a-491a for similar provisions re individual policies.