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BargainQueen · Marc Jacobs

Need help finding law/regulation for California

cc · Marc Jacobs

I don't know if this applies to everyone in CA or in your situation but check out this regulation. HTH!

California Code of Regulations

Title 10. Investment

Chapter 5.5. Major Risk Medical Insurance Board

Article 3. Minimum Scope of Benefits


§ 10:2698.301. Minimum Scope of Benefits.

  (a) The basic minimum scope of benefits offered by participating health
plans to subscribers, dependent subscribers and enrolled dependents must
comply with all requirements of the Knox-Keene Health Care Service Plan
Act of 1975 including amendments as well as its applicable regulations,
and shall include all of the benefits and services listed in this
section. Except as required by the applicable statute and regulations, no
other benefits shall be permitted to be offered by a participating health
plan unless specifically provided for in the program contract with the
participating health plan. The basic minimum scope of benefits shall be as
follows:

(1) Hospital inpatient care in a hospital licensed pursuant to subdivision (a) of section 1250 of the Health and Safety Code, including all of the following benefits and services:
...
(K) General anesthesia and associated facility charges in connection with dental procedures rendered in a hospital, when the clinical statusor underlying medical condition of a subscriber, enrolled dependent ordependent subscriber requires dental procedures that ordinarily would notrequire general anesthesia to be rendered in a hospital. This benefit is only available to subscribers, enrolled dependents or dependent subscribers under seven years of age; the developmentally disabled,regardless of age; and subscribers, enrolled dependents or dependentsubscribers whose health is compromised and for whom general anesthesiais medically necessary, regardless of age. Nothing in this section shall require a participating health plan tocover any charges for the dental procedure itself, including, but notlimited to, the professional fee of the dentist
....
(2) Medical and surgical services, provided on an outpatient basiswhenever medically appropriate, including all of the following:
...
(G) General anesthesia and associated facility charges in connection with dental procedures rendered in a surgery center setting, when theclinical status or underlying medical condition of a subscriber, enrolled dependent or dependent subscriber requires dental procedures that ordinarily would not require general anesthesia to be rendered in asurgery center setting. This benefit is only available to subscribers,enrolled dependents or dependent subscribers under seven years of age;the develop-mentally disabled, regardless of age; and subscribers,enrolled dependents or dependent subscribers whose health is compromisedand for whom general anesthesia is medically necessary, regardless ofage. Nothing in this section shall require a participating health plan tocover any charges for the dental procedure itself, including, but notlimited to, the professional fee of the dentist.

-- Edited by cc at 22:57, 2008-06-05

BargainQueen · Marc Jacobs

OMG Thank you SO much CC!