Brief(1)
S.B. 3, as amended, would create new health insurance law regarding coverage for general anesthesia and medical care facility charges for certain dental care. The bill would require individual and group health insurance companies, health maintenance organizations, and others providing health care benefits, to provide coverage for the administration of general anesthesia and medical care facility charges for dental care to the following persons:
The bill makes clear that deductibles, coinsurance, network requirements, and other limitations, including medical necessity determinations, may apply to such dental coverage as they apply to other covered benefits.
A House Committee amendment would create another new health insurance law regarding coverage for reconstructive breast surgery. Individual and group health insurance companies, health maintenance organizations (HMOs), and others providing health care benefits which provide medical and surgical benefits with respect to a mastectomy, would be required to provide coverage for:
Coverage required by this amendment to the bill may be subject to annual deductibles and coinsurance provisions as they apply to other covered services. Insurers, health plans, and HMOs are required to give notice of this new coverage to their insureds, enrollees, and subscribers.
A second House Committee amendment would add to the bill the provisions of H.B. 2005, with further amendments, to require any new health insurance mandate enacted by the Legislature after July 1, 1999, to be applicable only to the state employee health care program for a period of at least one year beginning with the first anniversary date of implementation of the mandate following its approval by the Legislature.
On or before March 1, after the one-year period for which the mandate was applied, the State Employee Health Care Commission is to report to the President of the Senate and the Speaker of the House of Representatives the impact the mandated coverage has had on the state health care benefits program, including data on the utilization and costs of the mandated coverage. The report also is to include a recommendation whether the mandated coverage should be continued by the Legislature to apply to the state health care program.
Finally, this amendment to the bill directs the Legislature to review periodically all current and any future mandated health insurance coverages.
Background
S.B. 3, as amended, was recommended by the Special Committee on Financial Institutions and Insurance that reviewed the issues of dental care and reconstructive breast surgery in the 1998 interim (see Committee Reports to the 1999 Legislature, Part I, pp. 3-4 through 3-11).
The interim Special Committee also concluded that the Legislature should provide a trial period for new mandates from which could be determined the financial impact of the mandates as well as any benefit derived from the mandates. With the cost and utilization data in hand, the Legislature could then better determine whether the mandate should be continued in the state plan and extended to other persons in the health insurance marketplace.
1. *Supplemental notes are prepared by the Legislative Research Department and do not express legislative intent. The supplemental note and fiscal note for this bill may be accessed on the Internet at http://www.ink.org/public/legislative/bill_search.html.