HB3942 - Relating to health benefit coverage for general anesthesia in connection with certain pediatric dental services.

  89R1426 CJD-F     By: Oliverson H.B. No. 3942       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.