Illinois General Assembly - Full Text of SB3067
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Full Text of SB3067  102nd General Assembly

SB3067 102ND GENERAL ASSEMBLY

  
  

 


 
102ND GENERAL ASSEMBLY
State of Illinois
2021 and 2022
SB3067

 

Introduced 1/11/2022, by Sen. Laura Fine

 

SYNOPSIS AS INTRODUCED:
 
5 ILCS 375/6.11
215 ILCS 5/356c  from Ch. 73, par. 968c
215 ILCS 5/356z.53 new

    Amends the Illinois Insurance Code. In provisions requiring coverage for newborn infants, provides that coverage for congenital defects shall include the treatment of cleft lip and cleft palate. Provides that an individual or group policy of accident and health insurance amended, delivered, issued, or renewed on or after the effective date of the amendatory Act shall provide coverage for the medically necessary care and treatment of cleft lip and palate for children under the age of 19. Provides that coverage for cleft lip and palate care and treatment may impose the same deductible, coinsurance, or other cost-sharing limitation that is imposed on other related surgical benefits under the policy. Provides that the coverage does not apply to a policy that covers only dental care. Defines "medically necessary care and treatment". Makes conforming changes in the State Employees Group Insurance Act of 1971. Effective January 1, 2024.


LRB102 23028 BMS 32665 b

 

 

A BILL FOR

 

SB3067LRB102 23028 BMS 32665 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 State Employees Group Insurance Act of 1971
5is amended by changing Section 6.11 as follows:
 
6    (5 ILCS 375/6.11)
7    Sec. 6.11. Required health benefits; Illinois Insurance
8Code requirements. The program of health benefits shall
9provide the post-mastectomy care benefits required to be
10covered by a policy of accident and health insurance under
11Section 356t of the Illinois Insurance Code. The program of
12health benefits shall provide the coverage required under
13Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u, 356w, 356x,
14356z.2, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10,
15356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.22,
16356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33,
17356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.51,
18and 356z.53 and 356z.43 of the Illinois Insurance Code. The
19program of health benefits must comply with Sections 155.22a,
20155.37, 355b, 356z.19, 370c, and 370c.1 and Article XXXIIB of
21the Illinois Insurance Code. The Department of Insurance shall
22enforce the requirements of this Section with respect to
23Sections 370c and 370c.1 of the Illinois Insurance Code; all

 

 

SB3067- 2 -LRB102 23028 BMS 32665 b

1other requirements of this Section shall be enforced by the
2Department of Central Management Services.
3    Rulemaking authority to implement Public Act 95-1045, if
4any, is conditioned on the rules being adopted in accordance
5with all provisions of the Illinois Administrative Procedure
6Act and all rules and procedures of the Joint Committee on
7Administrative Rules; any purported rule not so adopted, for
8whatever reason, is unauthorized.
9(Source: P.A. 101-13, eff. 6-12-19; 101-281, eff. 1-1-20;
10101-393, eff. 1-1-20; 101-452, eff. 1-1-20; 101-461, eff.
111-1-20; 101-625, eff. 1-1-21; 102-30, eff. 1-1-22; 102-103,
12eff. 1-1-22; 102-203, eff. 1-1-22; 102-306, eff. 1-1-22;
13102-642, eff. 1-1-22; 102-665, eff. 10-8-21; revised
1410-26-21.)
 
15    Section 10. The Illinois Insurance Code is amended by
16changing Section 356c and by adding Section 356z.53 as
17follows:
 
18    (215 ILCS 5/356c)  (from Ch. 73, par. 968c)
19    Sec. 356c. (1) No policy of accident and health insurance
20providing coverage of hospital expenses or medical expenses or
21both on an expense incurred basis which in addition to
22covering the insured, also covers members of the insured's
23immediate family, shall contain any disclaimer, waiver or
24other limitation of coverage relative to the hospital or

 

 

SB3067- 3 -LRB102 23028 BMS 32665 b

1medical coverage or insurability of newborn infants from and
2after the moment of birth.
3    (2) Each such policy of accident and health insurance
4shall contain a provision stating that the accident and health
5insurance benefits applicable for children shall be granted
6immediately with respect to a newly born child from the moment
7of birth. The coverage for newly born children shall include
8coverage of illness, injury, congenital defects (including the
9treatment of cleft lip and cleft palate), birth abnormalities
10and premature birth.
11    (3) If payment of a specific premium is required to
12provide coverage for a child, the policy may require that
13notification of birth of a newly born child must be furnished
14to the insurer within 31 days after the date of birth in order
15to have the coverage continue beyond such 31 day period and may
16require payment of the appropriate premium.
17    (4) In the event that no other members of the insured's
18immediate family are covered, immediate coverage for the first
19newborn infant shall be provided if the insured applies for
20dependent's coverage within 31 days of the newborn's birth.
21Such coverage shall be contingent upon payment of the
22additional premium.
23    (5) The requirements of this Section shall apply, on or
24after the sixtieth day following the effective date of this
25Section, (a) to all such non-group policies delivered or
26issued for delivery, and (b) to all such group policies

 

 

SB3067- 4 -LRB102 23028 BMS 32665 b

1delivered, issued for delivery, renewed or amended. The
2insurers of such non-group policies in effect on the sixtieth
3day following the effective date of this Section shall extend
4to owners of said policies, on or before the first policy
5anniversary following such date, the opportunity to apply for
6the addition to their policies of a provision as set forth in
7paragraph (2) above, with, at the option of the insurer,
8payment of a premium appropriate thereto.
9(Source: P.A. 85-220.)
 
10    (215 ILCS 5/356z.53 new)
11    Sec. 356z.53. Coverage for cleft lip and cleft palate.
12    (a) As used in this Section, "medically necessary care and
13treatment" to address congenital anomalies associated with a
14cleft lip or palate, or both, includes:
15        (1) oral and facial surgery, including reconstructive
16    services and procedures necessary to improve and restore
17    and maintain vital functions;
18        (2) prosthetic treatment such as obdurators, speech
19    appliances, and feeding appliances;
20        (3) orthodontic treatment and management;
21        (4) prosthodontic treatment and management; and
22        (5) otolaryngology treatment and management.
23    "Medically necessary care and treatment" does not include
24cosmetic surgery performed to reshape normal structures of the
25lip, jaw, palate, or other facial structures to improve

 

 

SB3067- 5 -LRB102 23028 BMS 32665 b

1appearance.
2    (b) An individual or group policy of accident and health
3insurance amended, delivered, issued, or renewed on or after
4the effective date of this amendatory Act of the 102nd General
5Assembly shall provide coverage for the medically necessary
6care and treatment of cleft lip and palate for children under
7the age of 19. Coverage for cleft lip and palate care and
8treatment may impose the same deductible, coinsurance, or
9other cost-sharing limitation that is imposed on other related
10surgical benefits under the policy.
11    (c) This Section does not apply to a policy that covers
12only dental care.
 
13    Section 99. Effective date. This Act takes effect January
141, 2024.