§ 5-10-8-10.5 — Dental care provisions required

Indiana § 5-10-8-10.5

• Jurisdiction: Indiana
• Title 5: STATE AND LOCAL ADMINISTRATION
• Art. 10: PUBLIC EMPLOYEE BENEFITS
• Ch. 8: Group Insurance for Public Employees

Text

5. (a) As used in this section, "child" means
an individual who is less than nineteen (19) years of age.
(b) As used in this section, "covered individual" means a child or an
individual:
(1) with a physical or mental impairment that substantially limits
one (1) or more of the major life activities of the individual; or
(2) who:
(A) has a record of; or
(B) is regarded as;
having an impairment described in subdivision (1).
(c) If the state enters into a contract for basic health care services (as
defined in IC 27-13-1-4) through prepaid health care delivery plans,
medical self-insurance, or group health insurance for state employees,
the contract must include coverage for anesthesia and hospital charges
for dental care for a covered individual if the mental or physical
condition of the covered individual 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 covered individual's condition under
general anesthesia constitutes appropriate treatment.
(d) A health care contractor that issues a contract for basic health
care services as described in subsection (c) 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.
(e) This section does not apply to treatment rendered for temporal
mandibular joint disorders (TMJ).

Legislative History

As added by P.L.189-1999, SEC.1.