The Vermont Statutes Online
Banking and Insurance
COVERAGE FOR DENTAL PROCEDURES
4100i. Anesthesia coverage for certain dental procedures
(a) A health
insurance plan shall provide coverage for the hospital or ambulatory surgical
center charges and administration of general anesthesia administered by a
licensed anesthesiologist or certified registered nurse anesthetist for dental
procedures performed on a covered person who is:
(1) a child
seven years of age or younger who is determined by a dentist licensed pursuant
to 26 V.S.A. chapter 13 to be unable to receive needed dental treatment in an
outpatient setting, where the provider treating the patient certifies that due
to the patient's age and the patient's condition or problem, hospitalization or
general anesthesia in a hospital or ambulatory surgical center is required in
order to perform significantly complex dental procedures safely and
(2) a child 12
years of age or younger with documented phobias or a documented mental
condition or psychiatric disability, as determined by a physician licensed
pursuant to 26 V.S.A. chapter 23 or by a licensed mental health professional,
whose dental needs are sufficiently complex and urgent that delaying or
deferring treatment can be expected to result in infection, loss of teeth, or
other increased oral or dental morbidity; for whom a successful result cannot
be expected from dental care provided under local anesthesia; and for whom a
superior result can be expected from dental care provided under general
(3) a person who
has exceptional medical circumstances or a developmental disability, as
determined by a physician licensed pursuant to 26 V.S.A. chapter 23, which
place the person at serious risk.
(b) A health
insurance plan may require prior authorization for general anesthesia and
associated hospital or ambulatory surgical center charges for dental care in
the same manner that prior authorization is required for these benefits in
connection with other covered medical care.
(c) A health
insurance plan may restrict coverage for general anesthesia and associated
hospital or ambulatory surgical center charges to dental care that is provided
(1) a fully
accredited specialist in pediatric dentistry;
(2) a fully
accredited specialist in oral and maxillofacial surgery; and
(3) a dentist to
whom hospital privileges have been granted.
provisions of this section shall not be construed to require a health insurance
plan to provide coverage for the dental procedure or other dental care for
which general anesthesia is provided.
provisions of this section shall not be construed to prevent or require
reimbursement by a health insurance plan for the provision of general
anesthesia and associated facility charges to a dentist holding a general
anesthesia endorsement issued by the Vermont Board of Dental Examiners if the
dentist has provided services pursuant to this section on an outpatient basis
in his or her own office and the dentist is in compliance with the
endorsement's terms and conditions.
(f) As used in
"Ambulatory surgical center" shall have the same meaning as in 18
V.S.A. § 9432.
"Anesthesiologist" means a person who is licensed to practice
medicine or osteopathy under 26 V.S.A. chapter 23 or 33 and who either:
completed a residency in anesthesiology approved by the American Board of
Anesthesiology or the American Osteopathic Board of Anesthesiology or their
predecessors or successors; or
credentialed by a hospital to practice anesthesiology and engages in the
practice of anesthesiology at that hospital full-time.
registered nurse anesthetist" means an advanced practice registered nurse
licensed by the Vermont Board of Nursing to practice as a certified registered
insurance plan" means any health insurance policy or health benefit plan
offered by a health insurer, as defined in 18 V.S.A. § 9402, but does not
include policies or plans providing coverage for a specified disease or other
limited benefit coverage.
"Licensed mental health professional" means a licensed physician,
psychologist, social worker, mental health counselor, or nurse with
professional training, experience, and demonstrated competence in the treatment
of a mental condition or psychiatric disability. (Added 2009, No. 128 (Adj.
Sess.), § 34, eff. Oct. 1, 2010; amended 2013, No. 96 (Adj. Sess.), § 20.)