insurers cover general anesthesia for kids’ dental work

The text as introduced · 476 words

89R1426 CJD-F

By: Gervin-Hawkins
H.B. No. 261

A BILL TO BE ENTITLED

AN ACT

relating to health benefit coverage for general anesthesia in

connection with certain pediatric dental services.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:

SECTION 1. Chapter 1367, Insurance Code, is amended by

adding Subchapter G to read as follows:

SUBCHAPTER G. PEDIATRIC DENTISTRY

Sec. 1367.301. APPLICABILITY OF SUBCHAPTER. (a) This

subchapter applies only to a health benefit plan that provides

benefits for medical or surgical expenses incurred as a result of a

health condition, accident, or sickness, including an individual,

group, blanket, or franchise insurance policy or insurance

agreement, a group hospital service contract, or an individual or

group evidence of coverage or similar coverage document that is

offered by:

(1) an insurance company;

(2) a group hospital service corporation operating

under Chapter 842;

(3) a health maintenance organization operating under

Chapter 843;

(4) an approved nonprofit health corporation that

holds a certificate of authority under Chapter 844;

(5) a multiple employer welfare arrangement that holds

a certificate of authority under Chapter 846;

(6) a stipulated premium insurance company operating

under Chapter 884;

(7) a fraternal benefit society operating under

Chapter 885;

(8) a Lloyd's plan operating under Chapter 941; or

(9) an exchange operating under Chapter 942.

(b) Notwithstanding any other law, this subchapter applies

to:

(1) a small employer health benefit plan subject to

Chapter 1501, including coverage provided through a health group

cooperative under Subchapter B of that chapter;

(2) a standard health benefit plan issued under

Chapter 1507;

(3) a basic coverage plan under Chapter 1551;

(4) a basic plan under Chapter 1575;

(5) a primary care coverage plan under Chapter 1579;

(6) a plan providing basic coverage under Chapter

1601;

(7) a regional or local health care program operated

under Section 75.104, Health and Safety Code; and

(8) a self-funded health benefit plan sponsored by a

professional employer organization under Chapter 91, Labor Code.

Sec. 1367.302. COVERAGE FOR GENERAL ANESTHESIA. Subject to

Section 1360.005, a health benefit plan that provides coverage for

general anesthesia may not exclude from coverage medically

necessary general anesthesia services in connection with dental

services provided to a covered individual if:

(1) the individual is:

(A) younger than 13 years of age; and

(B) unable to undergo the dental service without

general anesthesia due to a documented physical, mental, or medical

reason; and

(2) the anesthesia is performed by a qualified

provider of anesthesia services.

Sec. 1367.303. COVERAGE NOT REQUIRED. This subchapter does

not require a health benefit plan to provide coverage for dental

care or procedures.

SECTION 2. Subchapter G, Chapter 1367, Insurance Code, as

added by this Act, applies only to a health benefit plan that is

delivered, issued for delivery, or renewed on or after January 1,

2026.

SECTION 3. This Act takes effect September 1, 2025.