A. Group health care coverage, including any form of self-insurance, offered, issued or renewed under the Health Care Purchasing Act shall provide coverage for hospitalization and general anesthesia provided in a hospital or ambulatory surgical center for dental surgery for the following:
(1) insureds exhibiting physical, intellectual or medically compromising conditions for which dental treatment under local anesthesia, with or without additional adjunctive techniques and modalities, cannot be expected to provide a successful result and for which dental treatment under general anesthesia can be expected to produce superior results;
(2) insureds for whom local anesthesia is ineffective because of acute infection, anatomic variation or allergy;
(3) insured children or adolescents who are extremely uncooperative, fearful, anxious or uncommunicative with dental needs of such magnitude that treatment should not be postponed or deferred and for whom lack of treatment can be expected to result in dental or oral pain or infection, loss of teeth or other increased oral or dental morbidity;
(4) insureds with extensive oral-facial or dental trauma for which treatment under local anesthesia would be ineffective or compromised; or
(5) other procedures for which hospitalization or general anesthesia in a hospital or ambulatory surgical center is medically necessary.
B. The provisions of this section do not apply to short-term travel, accident-only or limited or specified disease policies.
C. Coverage for dental surgery may be subject to copayments, deductibles and coinsurance subject to network and prior authorization requirements consistent with those imposed on other benefits under the same group health care coverage, including any form of self-insurance.
History: Laws 2007, ch. 218, § 1.
Effective dates. — Laws 2007, ch. 218, § 6 made this section effective July 1, 2007.
Structure New Mexico Statutes
Chapter 13 - Public Purchases and Property
Article 7 - Health Care Purchasing
Section 13-7-2 - Purpose of act.
Section 13-7-4 - Mandatory consolidated purchasing.
Section 13-7-5 - Consolidated purchasing for other persons.
Section 13-7-6 - Use of social security numbers.
Section 13-7-7 - Consolidated administrative functions; benefit.
Section 13-7-8 - Maximum age of dependent.
Section 13-7-9 - General anesthesia and hospitalization for dental surgery.
Section 13-7-10 - Hearing aid coverage for children required.
Section 13-7-11 - Required coverage of patient costs incurred in cancer clinical trials.
Section 13-7-12 - Coverage for orally administered anticancer medications; limits on patient costs.
Section 13-7-13 - Coverage of prescription eye drop refills.
Section 13-7-14 - Coverage for telemedicine services.
Section 13-7-15 - Prescription drugs; prohibited formulary changes; notice requirements.
Section 13-7-17 - Pharmacy benefits; prescription synchronization.
Section 13-7-19 - Prior authorization for gynecological or obstetrical ultrasounds prohibited.
Section 13-7-20 - Prior Authorization Act.
Section 13-7-21 - Physical rehabilitation services; limits on cost sharing.
Section 13-7-22 - Coverage for contraception.
Section 13-7-23 - Pharmacist prescriptive authority services; reimbursement parity.
Section 13-7-24 - Heart artery calcium scan coverage.