Section 1367.71 Of Article 5. Standards From California Health And Safety Code >> Division 2. >> Chapter 2.2. >> Article 5.
1367.71
. (a) Every health care service plan contract, other than a
specialized health care service plan contract, that is issued,
amended, renewed, or delivered on or after January 1, 2000, shall be
deemed to cover general anesthesia and associated facility charges
for dental procedures rendered in a hospital or surgery center
setting, when the clinical status or underlying medical condition of
the patient requires dental procedures that ordinarily would not
require general anesthesia to be rendered in a hospital or surgery
center setting. The health care service plan may require prior
authorization of general anesthesia and associated charges required
for dental care procedures in the same manner that prior
authorization is required for other covered diseases or conditions.
(b) This section shall apply only to general anesthesia and
associated facility charges for only the following enrollees, and
only if the enrollees meet the criteria in subdivision (a):
(1) Enrollees who are under seven years of age.
(2) Enrollees who are developmentally disabled, regardless of age.
(3) Enrollees whose health is compromised and for whom general
anesthesia is medically necessary, regardless of age.
(c) Nothing in this section shall require the health care service
plan to cover any charges for the dental procedure itself, including,
but not limited to, the professional fee of the dentist. Coverage
for anesthesia and associated facility charges pursuant to this
section shall be subject to all other terms and conditions of the
plan that apply generally to other benefits.
(d) Nothing in this section shall be construed to allow a health
care service plan to deny coverage for basic health care services, as
defined in Section 1345.
(e) A health care service plan may include coverage specified in
subdivision (a) at any time prior to January 1, 2000.