FINAL BILL REPORT

SSB 5560

                              C 331 L 89

BYSenate Committee on Financial Institutions & Insurance (originally sponsored by Senators von Reichbauer, Wojahn, Johnson, Vognild, Moore, Bauer, Warnke, Smitherman, Rasmussen, Sutherland, Fleming, Stratton, Matson, McMullen and Sellar)

Providing for insurance coverage for temporomandibular joint disorders.

Senate Committee on Financial Institutions & Insurance

House Committe on Financial Institutions & Insurance

SYNOPSIS AS ENACTED

BACKGROUND:

Insurers are not required to offer or provide coverage for temporomandibular joint (TMJ) disorders.  The TMJ is the hinged joint between the skull and the lower jaw bone. 

TMJ disorders can be accompanied by a variety of symptoms including:  headaches, pain in or around the joint, difficulty in opening the mouth, sticking of the joint, and pain from joint movement associated with eating and speaking.

SUMMARY:

The Legislature recognizes that temporomandibular joint disorder treatments are often not covered in group insurance contracts and a need for public awareness of the disorder exists.

Group disability insurers, health care contractors, and health maintenance organizations (HMO) must offer optional temporomandibular joint disorder coverage on group contracts entered into and renewed after December 31, 1989.  If an employer declines the optional coverage, temporomandibular joint coverage still may be included in a basic group contract.

Coverage flexibility is encouraged.  The Insurance Commissioner is granted rule-making authority to establish minimum standard benefits, terms, and conditions on January 1, 1993.  The use of gatekeepers, copayments, and deductibles is allowed.  In the preparation of rules, the commissioner shall consult with a panel of experts.  The panel shall be comprised of medical and dental experts specializing in temporomandibular joint disorders, an employer purchasing a group policy, and a representative of the insurers, health care contractors, or health maintenance organizations.

If a group disability insurer, health care contractor or HMO offers a group contract to an employer or group who offers to its eligible enrollees a self-insured health plan that does not provide TMJ coverage, the optional TMJ coverage may not be offered.

An insurer, health care contractor, or HMO offering medical coverage only may limit coverages to medical treatments.  Similarly, an insurer or health care contractor offering dental coverage only may limit coverages to dental treatments.  A HMO offering medical and dental coverage may not limit benefits to only dental services.

The Insurance Commissioner is to deliver a report on the offered insurance coverage for TMJ disorders to the Legislature by January 1, 1991.

VOTES ON FINAL PASSAGE:

     Senate   45    1

     House 92  0 (House amended)

     Senate   45    0 (Senate concurred)

EFFECTIVE:January 1, 1990