§1055. Requirement for coverage of diagnosis and treatment for temporomandibular joint
and associated musculature and neurology
A. Every hospital, health, or medical expense insurance policy in the large group
market as defined in R.S. 22:1091(B), delivered or issued for delivery in this state shall
include coverage for diagnostic, therapeutic, or surgical procedures related to the
temporomandibular joint (TMJ) and associated musculature and neurological conditions.
This Section shall not apply to coverage provided by the Office of Group Benefits.
B. The coverage for diagnostic, therapeutic, or surgical procedures related to
temporomandibular joint and associated musculature and neurological conditions shall be
subject to the same conditions, limitations, precertification, prior authorization, referral
procedures, copayment, and coinsurance provisions that apply to coverage for diagnostic,
therapeutic, or surgical procedures involving other bones or joints of the human skeleton.
C. The provisions of this Section shall apply to all new policies, plans, certificates,
and contracts issued on or after January 1, 2018. Existing policies, plans, certificates, and
contracts shall include the coverage required by this Section on renewal thereof, but in no
case later than January 1, 2019.
Acts 2016, No. 405, §1, eff. June 8, 2016.