38.2-3418.12 - Coverage for hospitalization and anesthesia for dental procedures.
§ 38.2-3418.12. Coverage for hospitalization and anesthesia for dentalprocedures.
A. Notwithstanding the provisions of § 38.2-3419, each insurer proposing toissue individual or group accident and sickness insurance policies providinghospital, medical and surgical, or major medical coverage on anexpense-incurred basis; each corporation providing individual or groupaccident and sickness subscription contracts; and each health maintenanceorganization providing a health care plan for health care services shallprovide coverage for medically necessary general anesthesia andhospitalization or facility charges of a facility licensed to provideoutpatient surgical procedures for dental care provided to a covered personwho is determined by a licensed dentist in consultation with the coveredperson's treating physician to require general anesthesia and admission to ahospital or outpatient surgery facility to effectively and safely providedental care and (i) is under the age of five, or (ii) is severely disabled,or (iii) has a medical condition and requires admission to a hospital oroutpatient surgery facility and general anesthesia for dental care treatment.For purposes of this section, a determination of medical necessity shallinclude but not be limited to a consideration of whether the age, physicalcondition or mental condition of the covered person requires the utilizationof general anesthesia and the admission to a hospital or outpatient surgeryfacility to safely provide the underlying dental care.
B. Such insurer, corporation or health maintenance organization may requireprior authorization for general anesthesia and hospitalization or surgicalfacility charges for dental procedures in the same manner that priorauthorization is required for other covered benefits.
C. Such insurer, corporation or health maintenance organization shallrestrict coverage for general anesthesia expenses to those health careproviders who are licensed to provide anesthesia services and shall restrictcoverage for facility charges to facilities licensed to provide surgicalservices.
D. The provisions of this section shall not be construed to require coveragefor dental care incident to the coverage provided in this section.
E. The provisions of this section are applicable to any policy, contract orplan delivered, issued for delivery or renewed in this Commonwealth on andafter July 1, 2000.
F. The provisions of this section shall not apply to short-term travel,accident-only, limited or specified disease policies, nor to policies orcontracts designed for issuance to persons eligible for coverage under TitleXVIII of the Social Security Act, known as Medicare, or any other similarcoverage under state or federal governmental plans.
(2000, c. 157.)