HB0235 EngrossedLRB099 03691 MLM 23702 b

1    AN ACT concerning insurance.
 
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 356z.2 as follows:
 
6    (215 ILCS 5/356z.2)
7    Sec. 356z.2. Coverage for adjunctive services in dental
8care.
9    (a) An individual or group policy of accident and health
10insurance amended, delivered, issued, or renewed after the
11effective date of this amendatory Act of the 92nd General
12Assembly shall cover charges incurred, and anesthetics
13provided, in conjunction with dental care that is provided to a
14covered individual in a hospital or an ambulatory surgical
15treatment center if any of 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 disabled.
21    (a-5) An individual or group policy of accident and health
22insurance amended, delivered, issued, or renewed after the
23effective date of this amendatory Act of the 99th General

 

 

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1Assembly shall cover charges incurred, and anesthetics
2provided, in conjunction with dental care that is provided to a
3covered individual in a dental office, oral surgeon's office,
4hospital, or ambulatory surgical treatment center if the
5individual is under age 26 and has been diagnosed with an
6autism spectrum disorder as defined in Section 10 of the Autism
7Spectrum Disorders Reporting Act or a developmental
8disability.
9    For purposes of this subsection, "developmental
10disability" means a disability that is attributable to an
11intellectual disability or a related condition, if the related
12condition meets all of the following conditions:
13        (1) it is attributable to cerebral palsy, epilepsy, or
14    any other condition, other than mental illness, found to be
15    closely related to an intellectual disability because that
16    condition results in impairment of general intellectual
17    functioning or adaptive behavior similar to that of
18    individuals with an intellectual disability and requires
19    treatment or services similar to those required for those
20    individuals; for purposes of this definition, autism is
21    considered a related condition;
22        (2) it is manifested before the individual reaches age
23    22;
24        (3) it is likely to continue indefinitely; and
25        (4) it results in substantial functional limitations
26    in 3 or more of the following areas of major life activity:

 

 

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1    self-care, language, learning, mobility, self-direction,
2    and capacity for independent living.
3    (b) For purposes of this Section, "ambulatory surgical
4treatment center" has the meaning given to that term in Section
53 of the Ambulatory Surgical Treatment Center Act.
6    For purposes of this Section, "disabled" means a person,
7regardless of age, with a chronic disability if the chronic
8disability meets all of the following conditions:
9        (1) It is attributable to a mental or physical
10    impairment or     combination of mental and physical
11    impairments.
12        (2) It is likely to continue.
13        (3) It results in substantial functional limitations
14    in one or more of the following areas of major life
15    activity:
16            (A) self-care;
17            (B) receptive and expressive language;
18            (C) learning;
19            (D) mobility;
20            (E) capacity for independent living; or
21            (F) economic self-sufficiency.
22    (c) The coverage required under this Section may be subject
23to any limitations, exclusions, or cost-sharing provisions
24that apply generally under the insurance policy.
25    (d) This Section does not apply to a policy that covers
26only dental care.

 

 

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1    (e) Nothing in this Section requires that the dental
2services be covered.
3    (f) The provisions of this Section do not apply to
4short-term travel, accident-only, limited, or specified
5disease policies, nor to policies or contracts designed for
6issuance to persons eligible for coverage under Title XVIII of
7the Social Security Act, known as Medicare, or any other
8similar coverage under State or federal governmental plans.
9(Source: P.A. 95-331, eff. 8-21-07.)