26:2J-4.19 Coverage for certain dental procedures for the severely disabled or child age five or under by HMO.
6. a. A certificate of authority to establish and operate a health maintenance organization in this State pursuant to P.L.1973, c.337 (C.26:2J-1 et seq.), shall not be issued or continued by the Commissioner of Banking and Insurance on or after the effective date of this amendatory and supplementary act unless the health maintenance organization provides health care services to an enrollee who is severely disabled or a child age five or under for: (1) general anesthesia and hospitalization for dental services; or (2) a medical condition covered by the enrollee agreement which requires hospitalization or general anesthesia for dental services rendered by a participating dentist regardless of where the dental services are provided.
b.A health maintenance organization may require prior authorization of hospitalization for dental services in the same manner that prior authorization is required for hospitalization for other covered diseases or conditions.
c.This section shall apply to all contracts for health care services in which the health maintenance organization has reserved the right to change the schedule of charges.
L.1999, c.49, s.6; amended 2012, c.17, s.270.
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Last modified: October 11, 2016