| | |
facility or setting in which the services are rendered if those | | same dental services would be covered when provided by a dental | | hygienist in a dental office. |
|
| | | 2.__Limits; coinsurance; deductibles.__A contract that | | provides coverage for the services required by this section may | | contain provisions for maximum benefits and coinsurance and | | reasonable limitations, deductibles and exclusions to the extent | | that these provisions are not inconsistent with the requirements | | of this section. |
|
| | | 3. Coordination of benefits with dental insurance. If an | | enrollee eligible for coverage under this section is also | | eligible for coverage for general anesthesia and associated | | facility charges under a dental insurance policy or contract, the | | nonprofit health care service organization or insurer providing | | dental insurance is the primary payer responsible for those | | charges and the insurer providing individual health insurance is | | the secondary payer. |
|
| | | 4. Application.__ The requirements of this section apply to | | all policies, contracts and certificates executed, delivered, | | issued for delivery, continued or renewed in this State. For | | purposes of this section, all contracts are deemed to be renewed | | no later than the next yearly anniversary of the contract date. |
|
| | | Sec. 4. 24-A MRSA §4252 is enacted to read: |
|
| | | §4252.__Coverage for services provided by dental hygienist |
|
| | | 1.__Services provided by dental hygienist.__All individual and | | group health maintenance organization contracts must provide | | coverage for dental services provided by a dental hygienist | | within the scope of that dental hygienist's license regardless of | | the facility or setting in which the services are rendered if | | those same dental services would be covered when provided by a | | dental hygienist in a dental office. |
|
| | | 2.__Limits; coinsurance; deductibles.__A contract that | | provides coverage for the services required by this section may | | contain provisions for maximum benefits and coinsurance and | | reasonable limitations, deductibles and exclusions to the extent | | that these provisions are not inconsistent with the requirements | | of this section. |
|
| | | 3. Coordination of benefits with dental insurance. If an | | enrollee eligible for coverage under this section is also | | eligible for coverage for general anesthesia and associated | | facility charges under a dental insurance policy or contract, the | | nonprofit health care service organization or insurer providing |
|
|
