South Carolina Code 38-71-240. Coverage required for cleft lip and palate; certain policies exempt
(1) "Cleft lip and palate" means a congenital cleft in the lip or palate, or both.
Terms Used In South Carolina Code 38-71-240
- Dependent: A person dependent for support upon another.
- Person: means a corporation, agency, partnership, association, voluntary organization, individual, or another entity, organization, or aggregation of individuals. See South Carolina Code 38-1-20
- Policy: means a contract of insurance. See South Carolina Code 38-1-20
(2) "Medically necessary care and treatment" shall include, but not be limited to:
(a) oral and facial surgery, surgical management, and follow-up care made necessary because of a cleft lip and palate;
(b) prosthetic treatment such as obdurators, speech appliances, and feeding appliances;
(c) medically necessary orthodontic treatment and management;
(d) medically necessary prosthodontic treatment and management;
(e) otolaryngology treatment and management;
(f) audiological assessment, treatment, and management performed by or under the supervision of a licensed doctor of medicine, including surgically implanted amplification devices; and
(g) medically necessary physical therapy assessment and treatment.
(B)(1) Any individual or group accident and health policy which provides dependent coverage shall provide coverage for the medically necessary care and treatment of cleft lip and palate and any condition or illness which is related to or developed as a result of a cleft lip and palate. Such a policy may contain the same copayment provisions for the coverage of cleft lip and palate as apply to other conditions or procedures covered by the policy.
(2) Any individual or group dental policy which provides dependent coverage shall provide coverage for teeth capping, prosthodontics, and orthodontics necessary for the care and treatment of cleft lip and palate. Such a policy may contain the same copayment provisions for the coverage of cleft lip and palate as apply to other conditions or procedures covered by the policy.
(C) If a person with a cleft lip and palate is covered by an accident and health policy described in subsection (B)(1) and is also covered by a dental policy described in subsection (B)(2), teeth capping, prosthodontics, and orthodontics shall be covered by the dental policy to the limit of coverage provided and any excess thereafter shall be provided by the individual or group accident and health policy.
(D) The provisions of this section do not apply to a policy which provides disability or income protection coverage, hospital confinement indemnity coverage, accident only coverage, specified disease or specified accident coverage, long-term care coverage, vision only coverage, or coverage issued as a supplement to Medicare.