House Bill No. 261 amends the Insurance Code by adding a new Subchapter G, which specifically addresses health benefit coverage for general anesthesia related to certain pediatric dental services. The bill stipulates that health benefit plans providing coverage for medical or surgical expenses must include coverage for medically necessary general anesthesia services for individuals under 13 years of age who cannot undergo dental procedures without such anesthesia due to documented physical, mental, or medical reasons. The anesthesia must be administered by a qualified provider.

Additionally, the bill clarifies that while coverage for general anesthesia is mandated under specific conditions, it does not require health benefit plans to cover dental care or procedures themselves. The provisions of this new subchapter will apply to health benefit plans that are delivered, issued for delivery, or renewed on or after January 1, 2026, and the act is set to take effect on September 1, 2025.

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