GENERAL ASSEMBLY OF NORTH CAROLINA

SESSION 1997

H	1 

HOUSE BILL 868

Short Title:  State Employee TMJ Appliance Benefits. 	(Public)

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Sponsors: Representative Wainwright.

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Referred to:  Public Employees, if favorable, Insurance.

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April 7, 1997

A BILL TO BE ENTITLED
AN ACT TO COVER TEMPOROMANDIBULAR JOINT DYSFUNCTION APPLIANCE THERAPY REGARDLESS OF CAUSE UNDER THE TEACHERS' AND STATE EMPLOYEES' COMPREHENSIVE MAJOR MEDICAL PLAN.
The General Assembly of North Carolina enacts:
Section 1.  G.S. 135-40.6(8)f. reads as rewritten:
"f.	Dental Services: Oral surgery, including extraction of teeth, necessitated because of medical treatment. Dental surgery and appliances for mouth, jaw, and tooth restoration necessitated because of external violent and accidental means, such as the impact of moving body, vehicle collision, or fall occurring while an individual is covered under G.S. 135-40.3. No benefits are provided in connection with injury incurred in the act of chewing, nor for damage or breakage of an appliance such as bridge or denture being cleaned or otherwise not in normal mouth usage at the time of accident, nor for appliances for orthodontic treatment when a class of malocclusion, other than orthognathic, or cross bite has been diagnosed. Benefits for temporomandibular joint (TMJ) dysfunction appliance therapy are covered regardless of whether or not the cause was accidental when the therapy has been certified as medically necessary by the attending practitioner and approved by the Claims Processor.
		Benefits shall include extractions, fillings, crowns, bridges, or other necessary therapeutic and restorative techniques and appliances to reasonably restore condition and function to that existing immediately prior to the accident. Injury or breakage of existing appliances such as bridges and dentures is limited to repair of such appliances unless certified as damaged beyond repair."
Section 2.  This act becomes effective January 1, 1996.