Required provision concerning coverage relating to treatment of temporomandibular joint.
1. Except as otherwise provided in this section, no contract for hospital or medical service may be delivered or issued for delivery in this state if it contains an exclusion of coverage of the treatment of the temporomandibular joint whether by specific language in the contract or by a claims settlement practice. A contract for hospital or medical service may exclude coverage of those methods of treatment which are recognized as dental procedures, including, but not limited to, the extraction of teeth and the application of orthodontic devices and splints.
2. Pursuant to a contract for hospital or medical service, a corporation may limit its liability on the treatment of the temporomandibular joint to:
(a) No more than 50 percent of the usual and customary charges for such treatment actually received by a subscriber, but in no case more than 50 percent of the maximum benefits provided by the contract for such treatment; and
(b) Treatment which is medically necessary.
3. Any provision of a contract subject to the provisions of this chapter and issued or delivered on or after January 1, 1990, which is in conflict with this section is void.
Last modified: February 27, 2006