Section 1367.68 Of Article 5. Standards From California Health And Safety Code >> Division 2. >> Chapter 2.2. >> Article 5.
1367.68
. (a) Any provision in a health care service plan contract
entered into, amended, or renewed in this state on or after July 1,
1995, that excludes coverage for any surgical procedure for any
condition directly affecting the upper or lower jawbone, or
associated bone joints, shall have no force or effect as to any
enrollee if that provision results in any failure to provide
medically-necessary basic health care services to the enrollee
pursuant to the plan's definition of medical necessity.
(b) For purposes of this section, "plan contract" means every plan
contract, except a specialized health care service plan contract,
that covers hospital, medical, or surgical expenses.
(c) Nothing in this section shall be construed to prohibit a plan
from excluding coverage for dental services provided that any
exclusion does not result in any failure to provide
medically-necessary basic health care services.