State		Statute #						Statute Explanation
AK								Arkansas: TMJ disorders must be treated the same as any other illness or injury and not considered dental work
CA
The Contract: General Provisions
		Insurance Code § 10123.21						conditions directly affecting the upper or lower jawbone, or associated bone joints, if each
								procedure is medically-necessary.
CA		Health & Safety Code § 1367.68						Any provision in a health care service plan or contract issued, renewed or delivered after July 1,
Health Care Service Plans: Standards								1995 that excludes coverage for any surgical procedure for any condition directly affecting the
								upper or lower jawbone, or associated bone joints, will have no force of effect as to any enrollee if
								that provision results in any failure to provide medically-necessary basic health care services to the
								enrollee pursuant to the plan's definition of medical necessity.
FL		37 FSA § 627.419(7)						States health insurance policies which provide coverage for any diagnostic or surgical procedure
The Insurance Contract:								involving bones or joints of the skeleton shall not discriminate against coverage for any similar
Construction of Policies								diagnostic or surgical procedure invovling bones or joints of the jaw and facial region if the
								procedure or surgery is medically necessary to treat conditions caused by congenital or
								developmental deformity, disease or injury.
FL		37 FSA § 627.6515(7)						Provides group, franchise, or blanket health insurance policies issued or delivered outside the state
Group, Blanket, & Franchise Health								from which a resident is provided coverage for any diagnostic or surgical procedure involving bones
insurance Policies: Out-of-State								or joints of the skeleton, shall not discriminate against coverage for any similar diagnostic or
								surgical procedure involving bones or joints of the jaw and facial region if such procedure or surgery
								is medically necessary to treat conditions caused by congenital or developmental deformity,
								disease or injury.
FL	37 FSA § 627.65735					Provides group, franchise, or blanket health insurance policies issued or delivered
Group, Blanket, & Franchise Health						from which a resident is provided coverage for any diagnostic or surgical procedure involving bones
insurance Policies: Nondiscrimination of						or joints of the skeleton, shall not discriminate against coverage for any similar diagnostic or
Coverage for Surgical Procedures						surgical procedure involving bones or joints of the jaw and facial region if such procedure or surgery
						is medically necessary to treat conditions caused by congenital or developmental deformity,
						disease or injury.
GA	33 GA ST 29-20					Requires individual accident and sickness insurance policies issued or delivered to
individual Accident & Sickness Insurance						provide medically necessary surgical or nonsurgical treatment for the correction of TMJ
						by physicians or dentists profressionally qualified by training and experience. Further
						requires policies to provide medically necessary surgery for the correction of functional
						deformities of the maxilla and mandible.
GA	33 GA ST 30-14					Requires group or blanket accident and sickness insurance policies issued or delivered
Group or Blanket Accident &						to provide medically necessary surgical or nonsurgical treatment for the correction of
Sickness Insurance						TMJ by physicians or dentists profressionally qualified by training and experience.
						Further requires policies to provide medically necessary surgery for the correction of
						functional deformities of the maxilla and mandible.
						Georgia: Claims for treatment by a physician or dentist for orofacial
						pain including, but not limited to, Tmj and myofascial pain problems must
						be honored under major medical policies of insurers and not-for- profit
						service corporations.
IL				215 ILCS 5/356Q					Requires insurers to offer, for an additional premium, optional coverage for the reasonable and
Accident & Health Insurance									necessary medical treatment of temporomandibular joint disorder and craniomandibular disorder.
									Maximum lifetime benefits for TMJ and craniomandibular treatment shall not be less than $2,500.
KY				25 KRS § 304.17-319					Requires health insurance policies which provide coverage on an expense-incurred basis for
Business and Financial Institutions:									surgical or nonsurgical treatment of skeletal disorders to provide coverage for medically necessary
Health Insurance Contracts									procedures relating to TMJ and craniomandibular jaw disorders. Applies to all policies issued,
									delivered or renewed after 1/1/91.
KY				25 KRS § 304.18-0365					Requires all group or blanket policies of health insurance which provides coverage on an expense-
Business and Financial Institutions:									incurred basis for surgical or nonsurgical treatment of skeletal disorders shall provide coverage for
Group & Blanket health Insurance									medically necessary procedures relating to TMJ and craniomandibualr jaw disorders.
									Applies to all policies issued, delivered or renewed after 1/1/91.
KY				25 KRS § 304.32-1585					Requires all policies of health insurance which provides coverage on an expense-
Business and Financial Institutions:									incurred basis for surgical or nonsurgical treatment of skeletal disroders shall provide coverage for
Nonprofit Hospital, Medical-Surgical,									medically necessary procedures relating to TMJ and craniomandibualr jaw disorders.
Dental & Health Service Corporations									Applies to all policies issued, delivered or renewed after 1/1/91.
									Kentucky: All policies and contracts that provide coverage for surgical
									or non-surgical treatment of skeletal disorders must provide coverage for
									medically necessary procedures relating to TMJ and craniomandibular
									disorders.
KY	25 KRS § 304.38-1937					Requires all contracts or agreements of health care services which provide coverage for surgical or
Business and Financial Institutions:						nonsurgical treatment of skeletal disorders to provide coverage for medically necessary procedures
Health Maintenance Organizations						relating to TMJ and craniomandibular jaw disorders. Applies to all policies issued, delivered or
						renewed after 1/1/91.
MD	ST				MSC § 15-821	States insurance policies that provide coverage on a group or individual basis for a diagnostic or
Insurance						surgical procedure involving a bone or joint of the skeletal structure may not exclude or deny coverage
						for the same diagnostic or surgical procedure involving a bone or joint of the face, neck, or head
						if the procedure is medically necessary to treat a condition caused by a congenital deformity,
						disease, or injury.
						Maryland: Group and individual insurers and non-profit health-service
						plans that provide coverage for diagnostic or surgical procedures
						involving a bone or a joint of the skeletal structure must provide
						coverage for the same procedure involving a bone or joint of the face,
						neck, or head if medically necessary to treat a congentital deformity,
						disease, or injury.
MN	MSA § 62A.043(3)					Requires all health policies issued or delivered after 8/1/87 to provide coverage for surgical and
Accident & Health Insurance:						nonsurgical treatment of TMJ and craniomandibular disorders.
Dental Procedures and Coverage of Podiatry
						Minnesota: Insurers, HMO's, and subscriber contracts must provide
						coverage for treatment of TMJ disorders when adminstered by doctors or
						dentists.
MS			83 MS Code of 1972 § 9-45				Requires all policies issued, delivered or renewed after 1/1/91 to specifically offer coverage for
Accident, Health & Medicare							diagnostic and surgical treatment of TMJ and craniomandibular disorders. Requires coverage for
Supplement Insurance							diagnostic services and surgery to be the same as that for treatment to any other joint in the body
							and shall apply if the treatment is administered or prescribed by a physician or dentist. The
							minimum lifetime coverage for TMJ and craniomandibular treatment shall be no less than $5,000.
NC			58 NCGSA § 3-121				Prohibits discrimination, in any health benefit plan, against coverage of procedures involving bones
Insurance							or joints of the jaw, face or head. Authorizes therapeutic procedures to include splinting and use
							of intraoral prosthetic appliances to reposition the bones.
ND			26.1 NDCC 36-09.3				Requires all health, medical, hospitalization or accident and sickness insurance policies may not
Accident & Health Insuurance							be issued, renewed or delivered after 1/1/91 unless the policy specifically provides coverage for
							surgical and nonsurgical treatment of TMJ and craniomandibular disorders. Benefits for coverage
							may be limited to a lifetime maximum of $10,000 per person for surgery, and $2,500 for
							nonsurgical treatment.

ND	54 NDCC 52.1-.4.6	Requires the board to provide coverage under either a contract for insurance or under a self-
Uniform Group Insurance Program		insurance plan for coverage for surgical and nonsurgical treatment of TMJ and craniomandibular
		disorders. Benefits for coverage may be limited to a lifetime maximum of $10,000 per person for
		surgery, and $2,500 for nonsurgical treatment.
		North Dakota: Coverage of TMJ disorders must be provided in all but
		special disease policies. Coveage applies if treatment is administered or
		prescribed by a physician, dentist, or surgeon. Benefits my be limited to
		a lifetime maimum of $8,000 per person for surgery and $2000 for
		non-surgical treatment.
NM	59A NMSA § 16-13.1	Requires all health insurance policies issued or delivered in the state to provide coverage for
Trade Practices & Frauds		surgical and nonsurgical treatment of TMJ and craniomandibular disorders.
NV	57 NRS 689A.0465	Requires no policy of health insurance may be delivered or issued for delivery if it contains an
individual Health Insurance		exclusion of coverage of treatment of TMJ. Holds insurers may limit liability on treatment to:
Required Provisions		1.) No more than 50% of the usual and customary charges for treatment actually received by an
		insured; and 2.) Treatment which is medically necessary.
NV	57 NRS 689B.0379	Requires no policy of group health insurance may be delivered or issued for delivery if it contains an
Group & Blanket Health Insurance		exclusion of coverage of treatment of TMJ. Holds insurers may limit liability on treatment to:
Group Policies		1.) No more than 50% of the usual and customary charges for treatment actually received by an
		insured; and 2.) Treatment which is medically necessary.
NV	57 NRS 695C.1755		Requires no health maintenance organization policies may be delivered or issued for delivery if it
Health Maintenance Organizations			contains an exclusion of coverage of treatment of TMJ. Holds insurers may limit liability on
			treatment to: 1.) No more than 50% of the usual and customary charges for treatment actually
			received by an insured; and 2.) Treatment which is medically necessary.
			Nevada: Legislation prohibits insurance policies and contracts from
			excluding, either by specific language or settlement practices, coverage
			of the temporomandibular joint. Methods of treatment that are recognized
			as dental procedures, however, mayb be excluded, and insurers may limit
			TMJ benefits to 50% of the usual charges and to treatment that is
			medically necessary
NM			New Mexico: All insurers must provide coverage for surgical and
			non-surgical treatment of TMJ and cranosmandibular disorders, subject to
			the same conditions, limitations, prior review, and referral procedures
			that are applicable to the treatment of any other body joint.
TN	Department of Commerce &		States an accident and health policy must cover treatment of TMJ by a licensed dentist when such
	Insurance Bulletin		treatment could also be performed by a physician. The Department also adopted the ADA
			categorization of TMJ treatment into Phase I and Phase II treatment. Further maintains that
			exclusion of TMJ in a major medical policy will not be permitted nor will any exclusion of
			treatment by a dentist.
			Tennessee: Accident and health policies must cover treatment of TMJ
			disorders by a dentist when such treatment also could be performed by a
			physician.
TX	1 Insurance Code of 1951 21.53A		Requires each health benefit plan delivered or issued that provides benefits for the medically
Insurance Code			necessary diagnostic or surgical treatment of skeletal joints must provide comparable coverage
			for the medically necessary diagnostic or surgical treatment of conditions affecting the
			temporomandibular joint.
			Texas: Orthodontic coverage may not be excluded on grounds that overbite,
			overjet, openbite, or arch lenght discrepanies measure less than 4
			millimeters. Also, HMOs must provide treatment for the tempormandibular
			and craniomandibular joints when comparable to disagnostic and /or
			surgical treatment of skeletal joints in other parts of the body.
VA	38.2 VSA § 3418.2		Requires insurance policies issued, renewed or delivered for diagnostic and surgical treatment
Insurance			involving any bone or joint of the skeletal structure after 4/1/95 to include coverage for diagnostic
			and surgical treatment involving any bone or joint of the head, neck, face or jaw and may not
			impose limits that are more restrictive than limits on coverage applicable to treatment of any bone
			or joint of the skeletal structure if treatment is medically necessary.
VT	8 VSA § 4089g		States health plans shall provide coverage for diagnosis and medically necessary treatment,
Banking and Insurance			including surgical and nonsurgical procedures, for a musculoskeletal disorder that affects any bone
			or joint in the face, neck or head and is the result of accident, trauma, congenital defect,
			developmental defect, or pathology. Further states the coverage shall be the same as that
			provided under the health insurance plan for any other musculoskeletal disorder in the body and
			may be provided when prescribed or administered by a physician or a dentist.
			Vermont: Treatment of TMJ disorders does not come within standard dental
			care and treatment exclusion and must be honored under the medical
			expense portion of the policy.
WA	48 RCWA § 48.21.320		Provides a group disability policy entered into or renewed after 12/31/89, shall offer
Group or Blanket Diability Insurance			optional coverage for the treatment of TMJ.
WA	48 RCWA § 48.44.460		Provides a group health care service contract entered into or renewed after 12/31/89,
Health Care Services			shall offer optional coverage for the treatment of TMJ.
WA	48 RCWA § 48.46.530		Provides a health maintenance agreement entered into or renewed after 12/31/89, shall
Health Maintenance Organizations			offer optional coverage for the treatment of TMJ.
			Washington: Surgical and non-surgical TMJ benefits must be offered as
			optional coverage in medical and dental group insurance contracts
WV			West Virginia: Insurers must make coverage available for TMJ and
			craniomandibular disorders pursuant to the standards developed by teh
			insurance commissioner.
WI	WSA 632.895(11)		Provides every disability insurance policy and every self-insured health plan that provides coverage
Insurance Contracts in Specific Lines			of any diagnostic or surgical procedure invovling a bone, joint, muscle or tissue shall provide
			coverage for diagnostic procedures and medically necessary surgical or nonsurgical treatment for
			the correction of temporomandibular disorders if: 1.) The condition is caused by congenital,
			developmental or acquired deformity, disease or injury; and 2.) the procedure or device is
			reasonable and appropriate for the diagnosis or treatment of the condition; and 3.) The purpose of
			the procedure or device is to control or eliminate infection, pain, disease or dysfunction.
			Diagnostic procedures and medically necessary nonsurgical treatment for the correction of
			temporomandibular disorders may not exceed $1,250 annually. Prior authorization may be
			requried by the health-plans or self-insured health plans for treatment.
WI	WSA 609.78		Provides Limited service health organizations, preferred provider plans and managed care plans are
Managed Care Plans			subject to ST 632.895
WV	33 WVA § 16-3f		Requires the insurance commissioner to develop standards regarding TMJ and craniomandibular
Group Accident & Sickness Insurance			disorders and to require all health insurers to make this coverage to policyholders. Further states
			The regulations shall be developed by the insurance commissioner with the advice of a six-member
			panel to be appointed by the commissioner. Such panel shall consist of a general practicing
			dentist who shall be recommended by the West Virginia Dental Association, an oral and
			maxillofacial surgeon who shall be recommended by the West Virginia Society for Oral and
			Maxillofacial Dentists, a physician who shall be recommended by the West Virginia State Medical
			Association, a member from a Health Services Corporation who shall be recommended by the
			Health Services Corporation in this state, a member representing commercial health insurers who
			shall be recommended by the association representing accident and sickness insurance, and a
			representative of the Public Employees Insurance Association.