§ 27-8-5-27 — Dental care provisions required

(a) As used in this section, "accident and
sickness insurance policy" means an insurance policy that provides at
least one (1) of the types of insurance described in IC 27-1-5-1, Classes
1(b) and 2(a), and is issued on a group basis. The term does not include
the following:
(1) Accident only, credit, dental, vision, Medicare supplement,
long term care, or disability income insurance.
(2) Coverage issued as a supplement to liability insurance.
(3) Automobile medical payment insurance.
(4) A specified disease policy.
(5) A short term insurance plan that:
(A) may be renewed for the greater of:
(i) thirty-six (36) months; or
(ii) the maximum period permitted under federal law;
(B) has a term of not more than three hundred sixty-four (364)
days; and
(C) has an annual limit of at least two million dollars
($2,000,000).
(6) A policy that provides indemnity benefits not based on any
expense incurred requirement, including a plan that provides
coverage for:
(A) hospital confinement, critical illness, or intensive care; or
(B) gaps for deductibles or copayments.
(7) Worker's compensation or similar insurance.
(8) A student health plan.
(9) A supplemental plan that always pays in addition to other
coverage.
(10) An employer sponsored health benefit plan that is:
(A) provided to individuals who are eligible for Medicare; and
(B) not marketed as, or held out to be, a Medicare supplement
policy.
(b) As used in this section, "insured" means a child or an individual
with a disability who is entitled to coverage under an accident and
sickness insurance policy.
(c) As used in this section, "child" means an individual who is less
than nineteen (19) years of age.
(d) As used in this section, "individual with a disability" means an
individual:
(1) with a physical or mental impairment that substantially limits
one (1) or more of the major life activities of the individual; and
(2) who:
(A) has a record of; or
(B) is regarded as;
having an impairment described in subdivision (1).
(e) A policy of accident and sickness insurance must include
coverage for anesthesia and hospital charges for dental care for an
insured if the mental or physical condition of the insured requires
dental treatment to be rendered in a hospital or an ambulatory
outpatient surgical center. The Indications for General Anesthesia, as
published in the reference manual of the American Academy of
Pediatric Dentistry, are the utilization standards for determining
whether performing dental procedures necessary to treat the insured's
condition under general anesthesia constitutes appropriate treatment.
(f) An insurer that issues a policy of accident and sickness insurance
may:
(1) require prior authorization for hospitalization or treatment in
an ambulatory outpatient surgical center for dental care
procedures in the same manner that prior authorization is required
for hospitalization or treatment of other covered medical
conditions; and
(2) restrict coverage to include only procedures performed by a
licensed dentist who has privileges at the hospital or ambulatory
outpatient surgical center.
(g) This section does not apply to treatment rendered for temporal
mandibular joint disorders (TMJ).

Legislative History

As added by P.L.189-1999, SEC.2. Amended by P.L.173-2007, SEC.27; P.L.288-2019, SEC.4.