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<law><site_title>Virginia Decoded</site_title><site_url>https://vacode.org</site_url><law_id>81464</law_id><section_number>38.2-3418.12</section_number><catch_line>Coverage for hospitalization and anesthesia for dental procedures</catch_line><edition url="https://vacode.org/2025/" slug="2025" current="TRUE" last_updated="">2025</edition><structure><unit label="title" level="1" order_by="1" identifier="38.2">Insurance</unit><unit label="chapter" level="2" order_by="1" identifier="34">Provisions Relating to Accident and Sickness Insurance</unit><unit label="article" level="3" order_by="1" identifier="2">Mandated Benefits</unit></structure><text>
						<section id="A"><p><span class="prefix-number">A.</span> Notwithstanding the provisions of &#xA7; <a class="law" title="Additional mandated coverage made optional to group policy or contract holder" href="/38.2-3419/">38.2-3419</a>, each <span class="dictionary">insurer</span> proposing to <span class="dictionary">issue</span> individual or group accident and sickness <span class="dictionary">insurance policies</span> providing hospital, medical and surgical, or major medical coverage on an expense-incurred basis; each corporation providing individual or group accident and sickness subscription <span class="dictionary">contracts</span>; and each health maintenance organization providing a health care plan for health care services shall provide coverage for medically necessary general anesthesia and hospitalization or facility charges of a facility licensed to provide outpatient surgical procedures for dental care provided to a covered <span class="dictionary">person</span> who is determined by a licensed dentist in consultation with the covered <span class="dictionary">person</span>&#x2019;s treating physician to require general anesthesia and admission to a hospital or outpatient surgery facility to effectively and safely provide dental care and (i) is under the age of five, or (ii) is severely disabled, or (iii) has a medical condition and requires admission to a hospital or outpatient surgery facility and general anesthesia for dental care treatment. For purposes of this section, a determination of medical necessity shall include but not be limited to a consideration of whether the age, physical condition or mental condition of the covered <span class="dictionary">person</span> requires the utilization of general anesthesia and the admission to a hospital or outpatient surgery facility to safely provide the underlying dental care. <a id="paragraph-291873" class="section-permalink" href="https://vacode.org/38.2-3418.12/#A"><i class="fa fa-link"/></a></p></section>
						<section id="B"><p><span class="prefix-number">B.</span> Such <span class="dictionary">insurer</span>, corporation or health maintenance organization may require prior authorization for general anesthesia and hospitalization or surgical facility charges for dental procedures in the same manner that prior authorization is required for other covered benefits. <a id="paragraph-291874" class="section-permalink" href="https://vacode.org/38.2-3418.12/#B"><i class="fa fa-link"/></a></p></section>
						<section id="C"><p><span class="prefix-number">C.</span> Such <span class="dictionary">insurer</span>, corporation or health maintenance organization shall restrict coverage for general anesthesia expenses to those health care providers who are licensed to provide anesthesia services and shall restrict coverage for facility charges to facilities licensed to provide surgical services. <a id="paragraph-291875" class="section-permalink" href="https://vacode.org/38.2-3418.12/#C"><i class="fa fa-link"/></a></p></section>
						<section id="D"><p><span class="prefix-number">D.</span> The provisions of this section shall not be construed to require coverage for dental care incident to the coverage provided in this section. <a id="paragraph-291876" class="section-permalink" href="https://vacode.org/38.2-3418.12/#D"><i class="fa fa-link"/></a></p></section>
						<section id="E"><p><span class="prefix-number">E.</span> The provisions of this section are applicable to any policy, <span class="dictionary">contract</span> or plan delivered, issued for delivery or renewed in this Commonwealth on and after July 1, 2000. <a id="paragraph-291877" class="section-permalink" href="https://vacode.org/38.2-3418.12/#E"><i class="fa fa-link"/></a></p></section>
						<section id="F"><p><span class="prefix-number">F.</span> The provisions of this section shall not apply to short-term travel, accident-only, limited or specified disease policies, nor to policies or <span class="dictionary">contracts</span> designed for issuance to <span class="dictionary">persons</span> eligible for coverage under Title XVIII of the Social Security Act, known as <span class="dictionary">Medicare</span>, or any other similar coverage under <span class="dictionary">state</span> or federal governmental plans. <a id="paragraph-291878" class="section-permalink" href="https://vacode.org/38.2-3418.12/#F"><i class="fa fa-link"/></a></p></section></text><history>2000, c. 157.</history><metadata></metadata></law>
