SENATE BILL REPORT

SSB 5560

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

Senate Hearing Date(s):February 9, 1989; February 14, 1989

Majority Report:  That Substitute Senate Bill No. 5560 be substituted therefor, and the substitute bill do pass.

      Signed by Senators von Reichbauer, Chairman; Johnson, Vice Chairman; Fleming, McCaslin, McMullen, Moore, Rasmussen, Sellar, Smitherman.

Senate Staff:Benson Porter (786-7470)

                  April 11, 1989

House Committe on Financial Institutions & Insurance

AS PASSED SENATE, MARCH 1, 1989

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 by 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 who already offers a self-insured plan not subject to Title 48 RCW, the optional temporomandibular joint 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.

Appropriation:    none

Revenue:    none

Fiscal Note:      available

Senate Committee - Testified: Dennis Martin, WSTLA (pro); Nancy Korb, TMJ Support Group (pro); Nila Gillespie, Independent (pro); Luci Phillips, State Health Coordinating Council (pro) Sue Skillings, Independent (pro); Ken Bertrand, Group Health (con); Mel Sorensen, Washington Physicians Service (con); Basil Badley, HIAA and WDS (con); K. Collins Sprague, AWB (con); Dr. Herb Gordon, WSDA, SKKACA; Pam Brotnen, Independent; Mark D. Carlson, private practice (pro); Dr. Dale Gilsdorf (pro); Kathie Pelley (pro)

HOUSE AMENDMENT:

The Insurance Commissioner must implement rules establishing minimum standard benefits, terms, and conditions on January 1, 1993.

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.