HOUSE BILL REPORT

SSB 5560

As Amended by the House

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.

House Committe on Financial Institutions & Insurance

Majority Report:  Do pass with amendments.  (13)

      Signed by Representatives Dellwo, Chair; Chandler, Ranking Republican Member; Anderson, Baugher, Beck, Crane, Day, Dorn, Inslee, P. King, Nutley, K. Wilson and Winsley.

House Staff:John Conniff (786-7119)

AS PASSED HOUSE APRIL 10, 1989

BACKGROUND:

Generally, health insurance policies do not cover 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 TMJ 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 service contractors, and health maintenance organizations (HMO) must offer optional TMJ coverage on group contracts entered into or renewed after December 31, 1989. An insurer, contractor, or HMO providing coverage for medical expenses may limit TMJ coverage to medical expenses but may not define all TMJ disorders as dental expenses in order to completely eliminate coverage for TMJ. Similarly, dental coverage plans may limit TMJ coverage to dental expenses but may not define all TMJ disorders as medical to completely eliminate coverage for TMJ.

Unless otherwise directed by the Legislature, the Insurance Commissioner may adopt rules that establish minimum standards for TMJ coverage to take effect on January 1, 1993. In adopting rules, the commissioner must consult with a panel comprised of medical and insurance professionals.

Insurers, contractors and HMOs need not offer TMJ coverage to an employer who offers a self insured plan to employees and such plan does not include TMJ coverage.

The commissioner must report to the Legislature by June 1, 1991 on the availability, cost, use, and nature of benefits provided for TMJ as a result of passage of this act.

Fiscal Note:      Available.

House Committee ‑ Testified For:    Senator Lorraine Wojohn, Mark D. Carlson, D.D.S., University of Washington; Pamela Botner, Nancy Korb, George Reis, SHCC; Nila Gillespie, and Sue Skillings.

House Committee - Testified Against:      None Presented.

House Committee - Testimony For:    TMJ disorder is a serious and painful health problem that is rarely covered by insurance companies.  Treatment for TMJ is expensive and the lack of insurance coverage often prevents sufferers from obtaining needed health care.  With appropriate safeguards to prevent unnecessary or improper treatments, insurers should be able to provide coverage in a cost effective manner.  While mandated coverage would be preferable to the mandated offer required by the bill, the offer may cause the development of coverage and increase its availability.

House Committee - Testimony Against:      None Presented.