California Insurance Code

§ 12693.63

INS § 12693.63 Effective Jan 1, 2019Div. 2 · Part 6.2 · Ch. 6

Statute text

(a)The board shall determine the dental benefits to be provided to subscribers by the program. These benefits shall be consistent with those provided to state employees through the Department of Personnel Administration, the predecessor to the Department of Human Resources, on July 1, 1997, except that orthodontia shall only be a benefit when it is determined to be medically necessary.

(b)The board shall establish the required subscriber copayment levels for dental benefits. The copayment levels established by the board shall, to the extent possible, reflect the copayment levels provided to state employees through the Department of Personnel Administration, the predecessor to the Department of Human Resources, on July 1, 1997, except that no copayment shall be charged for medically necessary orthodontia services. There shall be no subscriber copayments for preventive and diagnostic services, including, but not limited to, examinations, teeth cleaning, X-rays, topical fluoride treatments, space maintainers, and sealants.

(c)No deductible shall be charged to subscribers for dental benefits.

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Legislative history

Amended by Stats. 2018, Ch. 903, Sec. 18. (SB 1504) Effective January 1, 2019.