Full Text of SB0111 101st General Assembly
SB0111enr 101ST GENERAL ASSEMBLY |
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| 1 | | AN ACT concerning regulation.
| 2 | | Be it enacted by the People of the State of Illinois,
| 3 | | represented in the General Assembly:
| 4 | | Section 5. The Illinois Insurance Code is amended by | 5 | | changing Section 356z.2 as follows:
| 6 | | (215 ILCS 5/356z.2)
| 7 | | Sec. 356z.2. Coverage for adjunctive services in dental | 8 | | care.
| 9 | | (a) An individual or group policy of accident and health | 10 | | insurance
amended, delivered, issued, or renewed after January | 11 | | 1, 2003 (the effective date of Public Act 92-764) shall cover
| 12 | | charges incurred, and anesthetics provided, in
conjunction | 13 | | with dental care that is provided to a covered individual in a
| 14 | | hospital or
an ambulatory surgical treatment center
if any of | 15 | | the
following
applies:
| 16 | | (1) the individual is a child age 6 or under;
| 17 | | (2) the individual has a medical condition that | 18 | | requires
hospitalization or general anesthesia for dental | 19 | | care; or
| 20 | | (3) the individual is a person with a disability.
| 21 | | (a-5) An individual or group policy of accident and health | 22 | | insurance amended, delivered, issued, or renewed after January | 23 | | 1, 2016 (the effective date of Public Act 99-141) shall cover |
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| 1 | | charges incurred, and anesthetics provided by a dentist with a | 2 | | permit provided under Section 8.1 of the Illinois Dental | 3 | | Practice Act, in conjunction with dental care that is provided | 4 | | to a covered individual in a dental office, oral surgeon's | 5 | | office, hospital, or ambulatory surgical treatment center if | 6 | | the individual is under age 26 19 and has been diagnosed with | 7 | | an autism spectrum disorder as defined in Section 10 of the | 8 | | Autism Spectrum Disorders Reporting Act or a developmental | 9 | | disability. A covered individual shall be required to make 2 | 10 | | visits to the dental care provider prior to accessing other | 11 | | coverage under this subsection. | 12 | | For purposes of this subsection, "developmental | 13 | | disability" means a disability that is attributable to an | 14 | | intellectual disability or a related condition, if the related | 15 | | condition meets all of the following conditions: | 16 | | (1) it is attributable to cerebral palsy, epilepsy, or | 17 | | any other condition, other than mental illness, found to be | 18 | | closely related to an intellectual disability because that | 19 | | condition results in impairment of general intellectual | 20 | | functioning or adaptive behavior similar to that of | 21 | | individuals with an intellectual disability and requires | 22 | | treatment or services similar to those required for those | 23 | | individuals; for purposes of this definition, autism is | 24 | | considered a related condition; | 25 | | (2) it is manifested before the individual reaches age | 26 | | 22; |
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| 1 | | (3) it is likely to continue indefinitely; and | 2 | | (4) it results in substantial functional limitations | 3 | | in 3 or more of the following areas of major life activity: | 4 | | self-care, language, learning, mobility, self-direction, | 5 | | and capacity for independent living. | 6 | | (b) For purposes of this Section, "ambulatory surgical | 7 | | treatment center"
has the meaning given to that term in Section | 8 | | 3 of the Ambulatory
Surgical Treatment Center Act.
| 9 | | For purposes of this Section, "person with a disability" | 10 | | means a person, regardless of age,
with a chronic
disability if | 11 | | the chronic disability meets all of the following conditions:
| 12 | | (1) It is attributable to a mental or physical | 13 | | impairment or
combination of mental and physical | 14 | | impairments.
| 15 | | (2) It is likely to continue.
| 16 | | (3) It results in substantial functional limitations | 17 | | in one or more of
the following areas of major life | 18 | | activity:
| 19 | | (A) self-care;
| 20 | | (B) receptive and expressive language;
| 21 | | (C) learning;
| 22 | | (D) mobility;
| 23 | | (E) capacity for independent living; or
| 24 | | (F) economic self-sufficiency.
| 25 | | (c) The coverage required under this Section may be subject | 26 | | to any
limitations, exclusions, or cost-sharing provisions |
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| 1 | | that apply generally under
the insurance policy.
| 2 | | (d) This Section does not apply to a policy that covers | 3 | | only dental care.
| 4 | | (e) Nothing in this Section requires that the dental | 5 | | services be
covered.
| 6 | | (f) The provisions of this Section do not apply to | 7 | | short-term travel,
accident-only, limited, or specified | 8 | | disease policies, nor to policies or
contracts designed for | 9 | | issuance to persons eligible for coverage under Title
XVIII of | 10 | | the Social Security Act, known as Medicare, or any other | 11 | | similar
coverage under State or federal governmental plans.
| 12 | | (Source: P.A. 99-141, eff. 1-1-16; 99-143, eff. 7-27-15; | 13 | | 99-642, eff. 7-28-16.)
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