By: Schwertner, et al. S.B. No. 527
A BILL TO BE ENTITLED
AN ACT
relating to health benefit coverage for general anesthesia in
connection with certain pediatric dental services.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Chapter 1367, Insurance Code, is amended by
adding Subchapter G to read as follows:
SUBCHAPTER G. PEDIATRIC DENTISTRY
Sec. 1367.301. APPLICABILITY OF SUBCHAPTER. (a) This
subchapter applies only to a health benefit plan that provides
benefits for medical or surgical expenses incurred as a result of a
health condition, accident, or sickness, including an individual,
group, blanket, or franchise insurance policy or insurance
agreement, a group hospital service contract, or an individual or
group evidence of coverage or similar coverage document that is
offered by:
(1) an insurance company;
(2) a group hospital service corporation operating
under Chapter 842;
(3) a health maintenance organization operating under
Chapter 843;
(4) an approved nonprofit health corporation that
holds a certificate of authority under Chapter 844;
(5) a multiple employer welfare arrangement that holds
a certificate of authority under Chapter 846;
(6) a stipulated premium insurance company operating
under Chapter 884;
(7) a fraternal benefit society operating under
Chapter 885;
(8) a Lloyd's plan operating under Chapter 941; or
(9) an exchange operating under Chapter 942.
(b) Notwithstanding any other law, this subchapter applies
to:
(1) a small employer health benefit plan subject to
Chapter 1501, including coverage provided through a health group
cooperative under Subchapter B of that chapter;
(2) a standard health benefit plan issued under
Chapter 1507;
(3) a basic coverage plan under Chapter 1551;
(4) a basic plan under Chapter 1575;
(5) a primary care coverage plan under Chapter 1579;
(6) a plan providing basic coverage under Chapter
1601;
(7) a regional or local health care program operated
under Section 75.104, Health and Safety Code; and
(8) a self-funded health benefit plan sponsored by a
professional employer organization under Chapter 91, Labor Code.
Sec. 1367.302. COVERAGE FOR GENERAL ANESTHESIA. Subject to
Section 1360.005, a health benefit plan that provides coverage for
general anesthesia may not exclude from coverage medically
necessary general anesthesia services in connection with dental
services provided to a covered individual if:
(1) the individual is:
(A) younger than 13 years of age; and
(B) unable to undergo the dental service without
general anesthesia due to a documented physical, mental, or medical
reason; and
(2) the anesthesia is performed by a qualified
provider of anesthesia services.
Sec. 1367.303. COVERAGE NOT REQUIRED. This subchapter does
not require a health benefit plan to provide coverage for dental
care or procedures.
SECTION 2. Subchapter G, Chapter 1367, Insurance Code, as
added by this Act, applies only to a health benefit plan that is
delivered, issued for delivery, or renewed on or after January 1,
2026.
SECTION 3. This Act takes effect September 1, 2025.