(a)
(1) A health benefit plan that is offered, issued, provided, or renewed in this state shall include coverage and benefits for reconstructive surgery and related medical care for a person of any age who is diagnosed as having a craniofacial anomaly if the surgery and treatment are medically necessary to improve a functional impairment that results from the craniofacial anomaly as determined by a nationally approved cleft-craniofacial team, approved by the American Cleft Palate-Craniofacial Association in Chapel Hill, North Carolina.
(2) A nationally approved cleft-craniofacial team for cleft-craniofacial conditions shall:
(A) Evaluate a person with a craniofacial anomaly; and
(B) Coordinate a treatment plan for each person.
(3) After one (1) denial or any limitation of coverage that is based on the lack of medical necessity to improve a functional impairment, the case shall be referred for an external review under State Insurance Department Rule 76, the Arkansas External Review Regulation, if applicable, or under a similar procedure for external review established by a third-party administrator of a health benefit plan.
(b) Medical care coverage required under this section includes coverage for reconstructive surgery, dental care, vision care, and the use of at least one (1) hearing aid.
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