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A BILL TO BE ENTITLED
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AN ACT
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relating to health benefit coverage for general anesthesia in |
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connection with certain pediatric dental services. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Chapter 1367, Insurance Code, is amended by |
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adding Subchapter G to read as follows: |
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SUBCHAPTER G. PEDIATRIC DENTISTRY |
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Sec. 1367.301. APPLICABILITY OF SUBCHAPTER. (a) This |
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subchapter applies only to a health benefit plan that provides |
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benefits for medical or surgical expenses incurred as a result of a |
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health condition, accident, or sickness, including an individual, |
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group, blanket, or franchise insurance policy or insurance |
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agreement, a group hospital service contract, or an individual or |
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group evidence of coverage or similar coverage document that is |
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offered by: |
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(1) an insurance company; |
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(2) a group hospital service corporation operating |
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under Chapter 842; |
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(3) a health maintenance organization operating under |
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Chapter 843; |
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(4) an approved nonprofit health corporation that |
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holds a certificate of authority under Chapter 844; |
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(5) a multiple employer welfare arrangement that holds |
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a certificate of authority under Chapter 846; |
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(6) a stipulated premium insurance company operating |
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under Chapter 884; |
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(7) a fraternal benefit society operating under |
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Chapter 885; |
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(8) a Lloyd's plan operating under Chapter 941; or |
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(9) an exchange operating under Chapter 942. |
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(b) Notwithstanding any other law, this subchapter applies |
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to: |
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(1) a small employer health benefit plan subject to |
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Chapter 1501, including coverage provided through a health group |
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cooperative under Subchapter B of that chapter; |
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(2) a standard health benefit plan issued under |
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Chapter 1507; |
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(3) a basic coverage plan under Chapter 1551; |
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(4) a basic plan under Chapter 1575; |
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(5) a primary care coverage plan under Chapter 1579; |
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(6) a plan providing basic coverage under Chapter |
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1601; |
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(7) a regional or local health care program operated |
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under Section 75.104, Health and Safety Code; and |
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(8) a self-funded health benefit plan sponsored by a |
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professional employer organization under Chapter 91, Labor Code. |
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Sec. 1367.302. COVERAGE FOR GENERAL ANESTHESIA. Subject to |
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Section 1360.005, a health benefit plan that provides coverage for |
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general anesthesia may not exclude from coverage medically |
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necessary general anesthesia services in connection with dental |
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services provided to a covered individual if: |
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(1) the individual is: |
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(A) younger than 13 years of age; and |
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(B) unable to undergo the dental service without |
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general anesthesia due to a documented physical, mental, or medical |
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reason; and |
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(2) the anesthesia is performed by a qualified |
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provider of anesthesia services. |
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Sec. 1367.303. COVERAGE NOT REQUIRED. This subchapter does |
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not require a health benefit plan to provide coverage for dental |
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care or procedures. |
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SECTION 2. Subchapter G, Chapter 1367, Insurance Code, as |
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added by this Act, applies only to a health benefit plan that is |
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delivered, issued for delivery, or renewed on or after January 1, |
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2026. |
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SECTION 3. This Act takes effect September 1, 2025. |