| 7 | 3 | | |
|---|
| 8 | 4 | | |
|---|
| 9 | 5 | | |
|---|
| 10 | 6 | | |
|---|
| 11 | 7 | | A BILL TO BE ENTITLED |
|---|
| 12 | 8 | | AN ACT |
|---|
| 13 | 9 | | relating to health benefit coverage for general anesthesia in |
|---|
| 14 | 10 | | connection with certain pediatric dental services. |
|---|
| 15 | 11 | | BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
|---|
| 16 | 12 | | SECTION 1. Chapter 1367, Insurance Code, is amended by |
|---|
| 17 | 13 | | adding Subchapter G to read as follows: |
|---|
| 18 | 14 | | SUBCHAPTER G. PEDIATRIC DENTISTRY |
|---|
| 19 | 15 | | Sec. 1367.301. APPLICABILITY OF SUBCHAPTER. (a) This |
|---|
| 20 | 16 | | subchapter applies only to a health benefit plan that provides |
|---|
| 21 | 17 | | benefits for medical or surgical expenses incurred as a result of a |
|---|
| 22 | 18 | | health condition, accident, or sickness, including an individual, |
|---|
| 23 | 19 | | group, blanket, or franchise insurance policy or insurance |
|---|
| 24 | 20 | | agreement, a group hospital service contract, or an individual or |
|---|
| 25 | 21 | | group evidence of coverage or similar coverage document that is |
|---|
| 26 | 22 | | offered by: |
|---|
| 27 | 23 | | (1) an insurance company; |
|---|
| 28 | 24 | | (2) a group hospital service corporation operating |
|---|
| 29 | 25 | | under Chapter 842; |
|---|
| 30 | 26 | | (3) a health maintenance organization operating under |
|---|
| 31 | 27 | | Chapter 843; |
|---|
| 32 | 28 | | (4) an approved nonprofit health corporation that |
|---|
| 33 | 29 | | holds a certificate of authority under Chapter 844; |
|---|
| 34 | 30 | | (5) a multiple employer welfare arrangement that holds |
|---|
| 35 | 31 | | a certificate of authority under Chapter 846; |
|---|
| 36 | 32 | | (6) a stipulated premium insurance company operating |
|---|
| 37 | 33 | | under Chapter 884; |
|---|
| 38 | 34 | | (7) a fraternal benefit society operating under |
|---|
| 39 | 35 | | Chapter 885; |
|---|
| 40 | 36 | | (8) a Lloyd's plan operating under Chapter 941; or |
|---|
| 41 | 37 | | (9) an exchange operating under Chapter 942. |
|---|
| 42 | 38 | | (b) Notwithstanding any other law, this subchapter applies |
|---|
| 43 | 39 | | to: |
|---|
| 44 | 40 | | (1) a small employer health benefit plan subject to |
|---|
| 45 | 41 | | Chapter 1501, including coverage provided through a health group |
|---|
| 46 | 42 | | cooperative under Subchapter B of that chapter; |
|---|
| 47 | 43 | | (2) a standard health benefit plan issued under |
|---|
| 48 | 44 | | Chapter 1507; |
|---|
| 49 | 45 | | (3) a basic coverage plan under Chapter 1551; |
|---|
| 50 | 46 | | (4) a basic plan under Chapter 1575; |
|---|
| 51 | 47 | | (5) a primary care coverage plan under Chapter 1579; |
|---|
| 52 | 48 | | (6) a plan providing basic coverage under Chapter |
|---|
| 53 | 49 | | 1601; |
|---|
| 54 | 50 | | (7) a regional or local health care program operated |
|---|
| 55 | 51 | | under Section 75.104, Health and Safety Code; and |
|---|
| 56 | 52 | | (8) a self-funded health benefit plan sponsored by a |
|---|
| 57 | 53 | | professional employer organization under Chapter 91, Labor Code. |
|---|
| 58 | 54 | | Sec. 1367.302. COVERAGE FOR GENERAL ANESTHESIA. Subject to |
|---|
| 59 | 55 | | Section 1360.005, a health benefit plan that provides coverage for |
|---|
| 60 | 56 | | general anesthesia may not exclude from coverage medically |
|---|
| 61 | 57 | | necessary general anesthesia services in connection with dental |
|---|
| 62 | 58 | | services provided to a covered individual if: |
|---|
| 63 | 59 | | (1) the individual is: |
|---|
| 64 | 60 | | (A) younger than 13 years of age; and |
|---|
| 65 | 61 | | (B) unable to undergo the dental service without |
|---|
| 66 | 62 | | general anesthesia due to a documented physical, mental, or medical |
|---|
| 67 | 63 | | reason; and |
|---|
| 68 | 64 | | (2) the anesthesia is performed by a qualified |
|---|
| 69 | 65 | | provider of anesthesia services. |
|---|
| 70 | 66 | | Sec. 1367.303. COVERAGE NOT REQUIRED. This subchapter does |
|---|
| 71 | 67 | | not require a health benefit plan to provide coverage for dental |
|---|
| 72 | 68 | | care or procedures. |
|---|
| 73 | 69 | | SECTION 2. Subchapter G, Chapter 1367, Insurance Code, as |
|---|
| 74 | 70 | | added by this Act, applies only to a health benefit plan that is |
|---|
| 75 | 71 | | delivered, issued for delivery, or renewed on or after January 1, |
|---|
| 76 | 72 | | 2026. |
|---|
| 77 | 73 | | SECTION 3. This Act takes effect September 1, 2025. |
|---|