BILL REQ. #:  H-1766.1 

Read first time 02/09/2007.   Referred to Committee on Health Care & Wellness.

     AN ACT Relating to oral health parity; adding a new section to chapter 48.21 RCW; adding a new section to chapter 48.44 RCW; and adding a new section to chapter 48.46 RCW.

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

NEW SECTION.  Sec. 1   A new section is added to chapter 48.21 RCW to read as follows:
     (1) For the purposes of this section, "oral health services" means necessary outpatient and inpatient services provided to treat oral health disorders covered by the diagnostic categories listed in the most current version of the current dental terminology, published by the American dental association, on the effective date of this section, or such subsequent date as may be provided by the insurance commissioner by rule, consistent with the purposes of this act, but limited to the following categories and services: Restorative treatment, exams, radiographs, preventive services, tobacco cessation, restorations, crowns, endodontics, periodontics, removable prosthodontics, relines, repair of partial or complete dentures, tissue conditioning, cast partial dentures, denture rebase procedures, maxillofacial prosthetics, oral surgery, orthodontia, and anesthesia.
     (2) All group disability insurance contracts and blanket disability insurance contracts providing health benefit plans that provide coverage for medical and surgical services shall provide, for all health benefit plans established or renewed on or after January 1, 2008, for groups of more than one and less than fifty employees, coverage for:
     (a) Oral health services. The copayment or coinsurance for oral health services may be no more than the copayment or coinsurance for medical and surgical services otherwise provided under the health benefit plan. Wellness and preventive services that are provided or reimbursed at a lesser copayment, coinsurance, or other cost sharing than other medical and surgical services are excluded from this comparison; and
     (b) Prescription drugs intended to treat any of the disorders covered in subsection (1) of this section to the same extent, and under the same terms and conditions, as other prescription drugs covered by the health benefit plan.

NEW SECTION.  Sec. 2   A new section is added to chapter 48.44 RCW to read as follows:
     (1) For the purposes of this section, "oral health services" means necessary outpatient and inpatient services provided to treat oral health disorders covered by the diagnostic categories listed in the most current version of the current dental terminology, published by the American dental association, on the effective date of this section, or such subsequent date as may be provided by the insurance commissioner by rule, consistent with the purposes of this act, but limited to the following categories and services: Restorative treatment, exams, radiographs, preventive services, tobacco cessation, restorations, crowns, endodontics, periodontics, removable prosthodontics, relines, repair of partial or complete dentures, tissue conditioning, cast partial dentures, denture rebase procedures, maxillofacial prosthetics, oral surgery, orthodontia, and anesthesia.
     (2) All health care service contracts providing health benefit plans that provide coverage for medical and surgical services shall provide, for all health benefit plans established or renewed on or after January 1, 2008, for groups of more than one and less than fifty employees, coverage for:
     (a) Oral health services. The copayment or coinsurance for oral health services may be no more than the copayment or coinsurance for medical and surgical services otherwise provided under the health benefit plan. Wellness and preventive services that are provided or reimbursed at a lesser copayment, coinsurance, or other cost sharing than other medical and surgical services are excluded from this comparison; and
     (b) Prescription drugs intended to treat any of the disorders covered in subsection (1) of this section to the same extent, and under the same terms and conditions, as other prescription drugs covered by the health benefit plan.

NEW SECTION.  Sec. 3   A new section is added to chapter 48.46 RCW to read as follows:
     (1) For the purposes of this section, "oral health services" means necessary outpatient and inpatient services provided to treat oral health disorders covered by the diagnostic categories listed in the most current version of the current dental terminology, published by the American dental association, on the effective date of this section, or such subsequent date as may be provided by the insurance commissioner by rule, consistent with the purposes of this act, but limited to the following categories and services: Restorative treatment, exams, radiographs, preventive services, tobacco cessation, restorations, crowns, endodontics, periodontics, removable prosthodontics, relines, repair of partial or complete dentures, tissue conditioning, cast partial dentures, denture rebase procedures, maxillofacial prosthetics, oral surgery, orthodontia, and anesthesia.
     (2) All health benefit plans providing health benefit plans that provide coverage for medical and surgical services shall provide, for all health benefit plans established or renewed on or after January 1, 2008, for groups of more than one and less than fifty employees, coverage for:
     (a) Oral health services. The copayment or coinsurance for oral health services may be no more than the copayment or coinsurance for medical and surgical services otherwise provided under the health benefit plan. Wellness and preventive services that are provided or reimbursed at a lesser copayment, coinsurance, or other cost sharing than other medical and surgical services are excluded from this comparison; and
     (b) Prescription drugs intended to treat any of the disorders covered in subsection (1) of this section to the same extent, and under the same terms and conditions, as other prescription drugs covered by the health benefit plan.