Sen. Laura Fine

Filed: 2/28/2020

 

 


 

 


 
10100SB2781sam001LRB101 15490 BMS 70859 a

1
AMENDMENT TO SENATE BILL 2781

2    AMENDMENT NO. ______. Amend Senate Bill 2781 by replacing
3everything after the enacting clause with the following:
 
4    "Section 5. The Illinois Insurance Code is amended by
5changing Section 356c and by adding Section 356z.43 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

 

 

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1insurance benefits applicable for children shall be granted
2immediately with respect to a newly born child from the moment
3of birth. The coverage for newly born children shall include
4coverage of illness, injury, congenital defects (including the
5treatment of cranial facial anomalities, including, but not
6limited to, cleft lip or cleft palate), birth abnormalities and
7premature birth.
8    (3) If payment of a specific premium is required to provide
9coverage for a child, the policy may require that notification
10of birth of a newly born child must be furnished to the insurer
11within 31 days after the date of birth in order to have the
12coverage continue beyond such 31 day period and may require
13payment of the appropriate premium.
14    (4) In the event that no other members of the insured's
15immediate family are covered, immediate coverage for the first
16newborn infant shall be provided if the insured applies for
17dependent's coverage within 31 days of the newborn's birth.
18Such coverage shall be contingent upon payment of the
19additional premium.
20    (5) The requirements of this Section shall apply, on or
21after the sixtieth day following the effective date of this
22Section, (a) to all such non-group policies delivered or issued
23for delivery, and (b) to all such group policies delivered,
24issued for delivery, renewed or amended. The insurers of such
25non-group policies in effect on the sixtieth day following the
26effective date of this Section shall extend to owners of said

 

 

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1policies, on or before the first policy anniversary following
2such date, the opportunity to apply for the addition to their
3policies of a provision as set forth in paragraph (2) above,
4with, at the option of the insurer, payment of a premium
5appropriate thereto.
6(Source: P.A. 85-220.)
 
7    (215 ILCS 5/356z.43 new)
8    Sec. 356z.43. Coverage for congenital anomaly or birth
9defect.
10    (a) An individual or group policy of accident and health
11insurance amended, delivered, issued, or renewed after the
12effective date of this amendatory Act of the 101st General
13Assembly shall cover charges incurred and services provided for
14outpatient and inpatient care in conjunction with services that
15are provided to a covered individual related to the diagnosis
16and treatment of a congenital anomaly or birth defect,
17including, but not limited to, cleft lip and cleft palate.
18    (b) Coverage required under this Section includes any
19services to functionally improve, repair, or restore a body
20part involving the cranial facial area, including cleft lip and
21cleft palate, that is medically necessary to achieve normal
22function or appearance. Any coverage provided may be subject to
23coverage limits, such as pre-authorization or
24pre-certification, as required by the plan or issuer that are
25no more restrictive than the predominant treatment limitations

 

 

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1applied to substantially all medical and surgical benefits
2covered by the plan.
3    (c) As used in this Section, "treatment" includes inpatient
4and outpatient care and services performed to improve or
5restore body function, or performed to approximate a normal
6appearance, due to a congenital anomaly, such as cleft lip or
7cleft palate, involving the cranial facial area and includes
8treatment of gross abnormalities of the lip and palate and any
9condition or illness that is related to or developed as a
10result of cleft lip or cleft palate. "Treatment" does not
11include cosmetic surgery performed to reshape normal facial
12structure or to improve appearance or self-esteem.
13    (d) Coverage shall include, but not be limited to, expenses
14for the following services up to the age of 19:
15        (1) oral surgery of the lip, palate, jaw, and related
16    structures, including bone grafts;
17        (2) facial surgery of the lip, palate, jaw, nose, and
18    related structures, including bone grafts;
19        (3) prosthetic treatment and appliances and
20    prosthodontia, including obturators, speech appliances,
21    and feeding appliances;
22        (4) orthodontic treatment and appliances and
23    orthodontia;
24        (5) preventative and restorative dentistry;
25        (6) otolaryngology treatment and management; and
26        (7) anesthetics provided by a dentist with a permit

 

 

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1    provided under Section 8.1 of the Illinois Dental Practice
2    Act when performed in conjunction with the treatment
3    described in this Section.
4    Coverage shall not be denied solely on the grounds that the
5treatment is for cosmetic purposes or is not for a functional
6defect or impairment as provided in this Section.
7    (e) This Section does not apply to a policy that covers
8only dental care.
 
9    Section 99. Effective date. This Act takes effect January
101, 2021.".