<?xml version='1.0' encoding='utf-8'?>
<section article="gin" article_name="Insurance" number="15-828" title_number="15" title_name="Health Insurance" subtitle_number="8" subtitle_name="Required Health Insurance Benefits">
  <level label="a">
    <text>This section applies to:</text>
    <level label="1">
      <text>insurers and nonprofit health service plans that provide hospital, medical, or surgical benefits to individuals or groups on an expense-incurred basis under health insurance policies that are issued or delivered in the State; and</text>
    </level>
    <level label="2">
      <text>health maintenance organizations that provide hospital, medical, or surgical benefits to individuals or groups under contracts that are issued or delivered in the State.</text>
    </level>
  </level>
  <level label="b">
    <text>An entity subject to this section shall provide coverage for general anesthesia and associated hospital or ambulatory facility charges in conjunction with dental care provided to an enrollee or insured if the enrollee or insured:</text>
    <level label="1">
      <level label="i">
        <text>is 7 years of age or younger or is developmentally disabled;</text>
      </level>
      <level label="ii">
        <text>is an individual for whom a successful result cannot be expected from dental care provided under local anesthesia because of a physical, intellectual, or other medically compromising condition of the enrollee or insured; and</text>
      </level>
      <level label="iii">
        <text>is an individual for whom a superior result can be expected from dental care provided under general anesthesia; or</text>
      </level>
    </level>
    <level label="2">
      <level label="i">
        <text>is an extremely uncooperative, fearful, or uncommunicative child who is 17 years of age or younger with dental needs of such magnitude that treatment should not be delayed or deferred; and</text>
      </level>
      <level label="ii">
        <text>is an individual for whom lack of treatment can be expected to result in oral pain, infection, loss of teeth, or other increased oral or dental morbidity.</text>
      </level>
    </level>
  </level>
  <level label="c">
    <text>An entity subject to this section may require prior authorization for general anesthesia and associated hospital or ambulatory facility charges for dental care in the same manner that prior authorization is required for these benefits in connection with other covered medical care.</text>
  </level>
  <level label="d">
    <text>An entity subject to this section may restrict coverage for general anesthesia and associated hospital or ambulatory facility charges to dental care that is provided by:</text>
    <level label="1">
      <text>a fully accredited specialist in pediatric dentistry;</text>
    </level>
    <level label="2">
      <text>a fully accredited specialist in oral and maxillofacial surgery; and</text>
    </level>
    <level label="3">
      <text>a dentist to whom hospital privileges have been granted.</text>
    </level>
  </level>
  <level label="e">
    <text>The provisions of this section may not be construed to require coverage for the dental care for which the general anesthesia is provided.</text>
  </level>
  <level label="f">
    <text>The provisions of this section do not apply to dental care rendered for temporal mandibular joint disorders.</text>
  </level>
</section>
