101ST GENERAL ASSEMBLY
State of Illinois
2019 and 2020
SB2781

 

Introduced 2/4/2020, by Sen. Laura Fine

 

SYNOPSIS AS INTRODUCED:
 
215 ILCS 5/356c  from Ch. 73, par. 968c
215 ILCS 5/356z.41 new

    Amends the Illinois Insurance Code. In provisions requiring coverage for newborn infants, provides that coverage for congenital defects shall include treatment of cranial facial anomalies. Provides that an individual or group policy of accident and health insurance amended, delivered, issued, or renewed after the effective date of the amendatory Act shall cover charges incurred and services provided for outpatient and inpatient care in conjunction with services that are provided to a covered individual related to the diagnosis and treatment of a congenital anomaly or birth defect. Provides that the required coverage includes any service to functionally improve, repair, or restore any body part involving the cranial facial area that is medically necessary to achieve normal function or appearance. Provides that any coverage provided may be subject to coverage limits, such as pre-authorization or pre-certification, as required by the plan or issuer that are no more restrictive than the predominant treatment limitations applied to substantially all medical and surgical benefits covered by the plan. Provides that the coverage does not apply to a policy that covers only dental care. Defines "treatment". Effective January 1, 2021.


LRB101 15490 BMS 64833 b

 

 

A BILL FOR

 

SB2781LRB101 15490 BMS 64833 b

1    AN ACT concerning regulation.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Illinois Insurance Code is amended by
5changing Section 356c and by adding Section 356z.41 as follows:
 
6    (215 ILCS 5/356c)  (from Ch. 73, par. 968c)
7    Sec. 356c. (1) No policy of accident and health insurance
8providing coverage of hospital expenses or medical expenses or
9both on an expense incurred basis which in addition to covering
10the insured, also covers members of the insured's immediate
11family, shall contain any disclaimer, waiver or other
12limitation of coverage relative to the hospital or medical
13coverage or insurability of newborn infants from and after the
14moment of birth.
15    (2) Each such policy of accident and health insurance shall
16contain a provision stating that the accident and health
17insurance benefits applicable for children shall be granted
18immediately with respect to a newly born child from the moment
19of birth. The coverage for newly born children shall include
20coverage of illness, injury, congenital defects (including the
21treatment of cranial facial anomalies), birth abnormalities
22and premature birth.
23    (3) If payment of a specific premium is required to provide

 

 

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1coverage for a child, the policy may require that notification
2of birth of a newly born child must be furnished to the insurer
3within 31 days after the date of birth in order to have the
4coverage continue beyond such 31 day period and may require
5payment of the appropriate premium.
6    (4) In the event that no other members of the insured's
7immediate family are covered, immediate coverage for the first
8newborn infant shall be provided if the insured applies for
9dependent's coverage within 31 days of the newborn's birth.
10Such coverage shall be contingent upon payment of the
11additional premium.
12    (5) The requirements of this Section shall apply, on or
13after the sixtieth day following the effective date of this
14Section, (a) to all such non-group policies delivered or issued
15for delivery, and (b) to all such group policies delivered,
16issued for delivery, renewed or amended. The insurers of such
17non-group policies in effect on the sixtieth day following the
18effective date of this Section shall extend to owners of said
19policies, on or before the first policy anniversary following
20such date, the opportunity to apply for the addition to their
21policies of a provision as set forth in paragraph (2) above,
22with, at the option of the insurer, payment of a premium
23appropriate thereto.
24(Source: P.A. 85-220.)
 
25    (215 ILCS 5/356z.41 new)

 

 

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1    Sec. 356z.41. Coverage for congenital anomaly or birth
2defect.
3    (a) An individual or group policy of accident and health
4insurance amended, delivered, issued, or renewed after the
5effective date of this amendatory Act of the 101st General
6Assembly shall cover charges incurred and services provided for
7outpatient and inpatient care in conjunction with services that
8are provided to a covered individual related to the diagnosis
9and treatment of a congenital anomaly or birth defect.
10    (b) Coverage required under this Section includes any
11services to functionally improve, repair, or restore a body
12part involving the cranial facial area that is medically
13necessary to achieve normal function or appearance. Any
14coverage provided may be subject to coverage limits, such as
15pre-authorization or pre-certification, as required by the
16plan or issuer that are no more restrictive than the
17predominant treatment limitations applied to substantially all
18medical and surgical benefits covered by the plan.
19    (c) As used in this Section, "treatment" includes inpatient
20and outpatient care and services performed to improve or
21restore body function, or performed to approximate a normal
22appearance, due to congenital anomaly or birth defect involving
23the cranial facial area and includes treatment to any and all
24missing or abnormal body parts, including teeth, oral cavity,
25and their associated structures, that would otherwise be
26provided under the plan or coverage for any other injury and

 

 

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1sickness, up to the age of 26, including:
2        (1) inpatient and outpatient care;
3        (2) reconstructive services and procedures and
4    complications thereof, including prosthetics and
5    appliances;
6        (3) adjunctive dental, orthodontic, or prosthodontic
7    support, including ongoing or subsequent treatment
8    required to maintain function or approximate a normal
9    appearance;
10        (4) procedures for secondary conditions and follow-up
11    treatment; and
12        (5) anesthetics provided by a dentist with a permit
13    provided under Section 8.1 of the Illinois Dental Practice
14    Act when performed in conjunction with the treatment
15    described in this subsection (c).
16    "Treatment" does not include cosmetic surgery performed to
17reshape normal facial structure or to improve appearance or
18self-esteem.
19    (d) This Section does not apply to a policy that covers
20only dental care.
 
21    Section 99. Effective date. This Act takes effect January
221, 2021.