Rep. Kathleen Willis

Filed: 5/17/2019





10100SB0659ham001LRB101 04420 SMS 60839 a


2    AMENDMENT NO. ______. Amend Senate Bill 659 by replacing
3everything after the enacting clause with the following:
4    "Section 5. The Illinois Insurance Code is amended by
5adding Section 356z.33 as follows:
6    (215 ILCS 5/356z.33 new)
7    Sec. 356z.33. Coverage for congenital anomaly or birth
9    (a) As used in this Section, "treatment" includes inpatient
10and outpatient care and services performed to improve or
11restore body function, or performed to approximate a normal
12appearance, due to congenital anomaly or birth defect and
13includes treatment to any and all missing or abnormal body
14parts, including teeth, the oral cavity, and their associated
15structures, that would otherwise be provided under the plan or
16coverage for any other injury and sickness, including:



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1        (1) inpatient and outpatient care, reconstructive
2    services and procedures, and complications thereof,
3    including prosthetics and appliances;
4        (2) adjunctive dental, orthodontic, or prosthodontic
5    support from birth until the medical or surgical treatment
6    of the defect or anomaly has been completed, including
7    ongoing or subsequent treatment required to maintain
8    function or approximate a normal appearance;
9        (3) procedures that do not materially restore or
10    improve the function of the body part being treated;
11        (4) procedures for secondary conditions and follow-up
12    treatment; and
13        (5) anesthetics provided by a dentist with a permit
14    provided under Section 8.1 of the Illinois Dental Practice
15    Act.
16    "Treatment" does not include cosmetic surgery performed to
17reshape normal structures of the body to improve appearance or
19    (b) An individual or group policy of accident and health
20insurance amended, delivered, issued, or renewed after the
21effective date of this amendatory Act of the 101st General
22Assembly shall cover charges incurred and services provided for
23outpatient and inpatient care in conjunction with services that
24are provided to a covered individual related to the diagnosis
25and treatment of a congenital anomaly or birth defect.
26    (c) Coverage required under this Section includes any



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1service to functionally improve, repair, or restore any body
2part that is medically necessary to achieve normal body
3function or appearance, as determined by the treating physician
4or dentist. Any coverage provided may be subject to coverage
5limits, such as pre-authorization or pre-certification, as
6required by the plan or issuer that are no more restrictive
7than the predominant treatment limitations applied to
8substantially all medical and surgical benefits covered by the
10    Section 99. Effective date. This Act takes effect upon
11becoming law.".