An Act To Require Insurance Coverage for Temporomandibular Joint Disorders
Maine Legislature, Session 123, LD 1429
Committee Amendment CA_A_H605 (House)
Amends: 24 MRSA §2317-B, 24-A MRSA §2762, 24-A MRSA §2847-M, 24-A MRSA §4253

COMMITTEE AMENDMENT "~,, to H.P. !D03, L.D. 1429, Bill, "An Act To 
Require Insurance Coverage for Temporomandibular Joint Disorders" 
Amend the bill by striking out everything after the enacting clause and before the 
summary and inserting the following: 
'Sec. I. 24 MRSA §2317-B, sub-§12-B is enacted to read: 
12-B. 
Title 24-A, sections 2762, 2847-M and 4253. 
Coverage for 
temporomandibular joint disorders, Title 24-A, sections 2762, 2847-M and 4253; 
Sec. 2. 24-A MRSA §2762 is enacted to read: 
§2762. Coverage for temporomandibular joint disorders 
1. Required coverag:e. If an individual health insurance policy provides coverage 
for musculoskeletal disorders, the policy must provide coverage for musculoskeletal 
disorders affecting any bone or joint in the face, head or neck, including, but not limited 
to, temporomandibular joint disorders as provided in this section. 
A. Coverage must be provided for diagnosis and surgicial and nonsurgical treatment 
determined to be medically necessary health care as defined in section 4301-A, 
subsection lO-A. 
B. Coverage may not be excluded for treatments or services ~rformed by a dentist 
when coverage would be reimbursed under the policy if performed by a licensed 
physician and those treatments or services are within the scope of license of a dentist. 
C. 
Coverage may be excluded for experimental procedures. 
2. 
Limits; coinsurance; deductibles. 
Any policy, contract or certificate that 
provides coverage for services under this section may contain provisions for maximum 
benefits and coinsurance, reasonable limitations, deductibles and exclusions and prior 
authorization to the extent that these provisions are not inconsistent with the requirements 
of this section. 
COMMITTEE AMENDMENT 
:" ;, 
COMMItTEE AMENDMENT·A • t. H.P. 1003, L.D. 142. 
3. Application. The requirements of this section apply to all policies, contracts and 
certificates executed, delivered, issued for delivery, continued or renewed in this State on 
or after the effective date of this section. For purposes of this section, all contracts are 
deemed to be renewed no later than the next yearly anniversary of the contract date. 
Sec. 3. 24-A MRSA §2847-M is enacted to read: 
§2847-M. Coverage for temporomandibnlar joint disorders 
1. Required covera::e. If a group health insurance policy provides coverage for 
musculoskeletal disorders, the policy must provide coverage for musculoskeletal 
disorders affecting any bone or joint in the face, head or neck, including, but not limited 
to, temporomandibular joint disorders as provided in this section. 
A. Coverage must be provided for diagnosis and surgical and nonsurgical treatment 
determined to be medically necessary health care as defined in section 4301-A, 
subsection to-A. 
B. Coverage may not be excluded for treatments or services performed by a dentist 
when coverage would be reimbursed under the policy if performed by a licensed 
physician and those treatments or services are within the scope of license of a dentist. 
C. Coverage may be excluded for experimental procedures. 
2. 
Limits; coinsurance; deductibles. 
Any policy, contract or certificate that 
provides coverage for services under this section may contain provisions for maximum 
benefits and coinsurance and reasonable limitations, deductibles and exclusions and prior 
authorization to the extent that these provisions are not inconsistent with the requirements 
of this section. 
3. Application. The requirements of this section apply to all policies, contracts and 
certificates executed, delivered, issued for delivery, continued or renewed in this State on 
or after the effective date of this section. For purposes of this section, all contracts are 
deemed to be renewed no later than the next yearly anniversary of the contract date. 
Sec. 4. 24-A MRSA §4253 is enacted to read: 
§4253. Coverage for temporomandibular ioint disorders 
1. Required covera::e. If an individual or group health maintenance organization 
contract provides coverage for musculoskeletal disorders, the contract must provide 
coverage for musculoskeletal disorders affecting any bone or joint in the face, head or 
neck, including, but not limited to, temporomandibular joint disorders as provided in this 
section. 
A. Coverage must be provided for diagnosis and surgicial and nonsurgical treatment 
determined to be medically necessary health care as defined in section 4301-A, 
subsection lO-A. 
B. Coverage may not be excluded for treatments or services performed by a dentist 
when coverage would be reimbursed under the policy if performed by a licensed 
physician and those treatments or services are within the scope of license of a dentist. 
C. Coverage may be excluded for experimental procedures. 
COMMITTEE AMENDMENT 
COMMITTEE AMENDMENT"~" to H.P. 1003, L.D. 1429 
2. 
Limits; coinsurance; deductibles. 
Any policy, contract or certificate that 
provides coverage for services under this section may contain provisions for maximum 
benefits and coinsurance and reasonable limitations, deductibles and exclusions and prior 
authorization to the extent that these provisions are not inconsistent with the requirements 
of this section. 
3. Application. The requirements of this section apply to all policies, contracts and 
certificates executed, delivered, issued for delivery, continued or renewed in this State on 
or after the effective date of this section. For purposes of this section, all contracts are 
deemed to be renewed no later than the next yearly anniversary of the contract date. 
Sec. 5. Application. The requirements of this Act apply to all policies, contracts 
and certificates executed, delivered, issued for delivery, continued or renewed in this 
State on or after January 1, 2008. For purposes ofthis Act, all contracts are deemed to be 
renewed no later than the next anniversary of the contract date. 
Sec. 6. Appropriations and allocations. The following appropriations and 
allocations are made. 
ADMINISTRATIVE AND FINANCIAL SERVICES, DEPARTMENT OF 
Salary Plan 0305 
Initiative: Appropriates and allocates funds for the additional costs of health insurance to 
the State resulting from the requirement to provide coverage for temporomandibular joint 
disorders. 
GENERAL FUND 
Personal Services 
GENERAL FUND TOTAL 
IDGHWAYFUND 
Personal Services 
HIGHWAY FUND TOTAL 
SUMMARY 
2007-08 
$0 
$0 
2007-08 
$0 
$0 
2008-09 
$93,600 
$93,600 
2008-09 
$36,200 
$36,200 
This amendment replaces the bill. Like the bill, the amendment requires health 
insurance policies, contracts and certificates to provide coverage for temporomandibular 
joint disorders but specifies that such coverage must be provided if coverage would be 
provided under the policy for musculoskeletal disorders affecting other bones or joints in 
the body. The amendment requires that coverage be provided for diagnosis and surgical 
and nonsurgical treatment determined to be medically necessary. The amendment 
requires coverage for services and treatments provided by a dentist if those treatments 
COMMITTEE AMENDMENT 
COMMITIEE AMENDMENT "A "to H.P. 1003, L.D. 1429 
I 
and services would be reimbursed under the policy when perfonned by a licensed 
physician. The amendment excludes coverage for experimental treatment. The provisions 
of this bill apply to all policies, contracts and certificates issued or renewed on or after 
January I, 2008. 
FISCAL NOTE REQUIRED 
(See attached) 
COMMITTEE AMENDMENT 
Approved: 06/15/07 j!;vac.. 
LD 1429 
LR 1647(02) 
An Act To Require Insurance Coverage for Temporomandibular Joint Disorders 
Fiscal Note for Bill as Amended by Committee Amendment·fi .. 
Committee: Insurance and Financial Services 
Fiscal Note Required: Yes 
Net Cost (Savings) 
General Fund 
Highway Fund 
Appropriations/Allocations 
General Fund 
Highway Fund 
Fiscal Detail and Notes 
Fiscal Note 
2007-08 
$0 
$0 
$0 
$0 
2008-09 
$93,600 
$36,200 
$93,600 
$36,200 
Projections 
2009-10 
$98,300 
$38,000 
$98,300 
$38,000 
Projections 
2010-11 
$103,200 
$39,900 
$103,200 
$39,900 
Adding coverage for temporomandibular joint disorders will increase premium costs effective with the contract year 
beginning July 1,2008. The additional employer costs across all funds to the state employee health insurance 
program is estimated to be approximately $228,900 for fiscal year 2008-09. 
A General Fund appropriation of $93,600 and a Highway Fund allocation of $36,200 are included for the salary plan 
reserve accounts to fund increases for General Fund and Highway Fund employees. The costs for employees paid by 
other funds, including a small amount for the Fund for a Healthy Maine, may require increased allotments as 
recommended by the State Budget Officer and approved by the Governor. 
Any additional costs to the Bureau of Insurance in the Department of Professional and Financial Regulation in 
implementing this legislation can be absorbed by the bureau within existing budget resources. This fiscal note does not 
reflect the additional costs to the private health insurance market. 
LR1647(02) - Fiscal Note - Page I of I