Rep. Kathleen Willis

Filed: 5/28/2019





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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
5changing Section 356c and by adding Section 356z.33 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 anomalies), birth abnormalities
6and premature birth.
7    (3) If payment of a specific premium is required to provide
8coverage for a child, the policy may require that notification
9of birth of a newly born child must be furnished to the insurer
10within 31 days after the date of birth in order to have the
11coverage continue beyond such 31 day period and may require
12payment of the appropriate premium.
13    (4) In the event that no other members of the insured's
14immediate family are covered, immediate coverage for the first
15newborn infant shall be provided if the insured applies for
16dependent's coverage within 31 days of the newborn's birth.
17Such coverage shall be contingent upon payment of the
18additional premium.
19    (5) The requirements of this Section shall apply, on or
20after the sixtieth day following the effective date of this
21Section, (a) to all such non-group policies delivered or issued
22for delivery, and (b) to all such group policies delivered,
23issued for delivery, renewed or amended. The insurers of such
24non-group policies in effect on the sixtieth day following the
25effective date of this Section shall extend to owners of said
26policies, on or before the first policy anniversary following



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1such date, the opportunity to apply for the addition to their
2policies of a provision as set forth in paragraph (2) above,
3with, at the option of the insurer, payment of a premium
4appropriate thereto.
5(Source: P.A. 85-220.)
6    (215 ILCS 5/356z.33 new)
7    Sec. 356z.33. Coverage for congenital anomaly or birth
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 101st General
12Assembly shall cover charges incurred and services provided for
13outpatient and inpatient care in conjunction with services that
14are provided to a covered individual related to the diagnosis
15and treatment of a congenital anomaly or birth defect.
16    (b) Coverage required under this Section includes any
17services to functionally improve, repair, or restore a body
18part involving the cranial facial area that is medically
19necessary to achieve normal function or appearance. Any
20coverage provided may be subject to coverage limits, such as
21pre-authorization or pre-certification, as required by the
22plan or issuer that are no more restrictive than the
23predominant treatment limitations applied to substantially all
24medical and surgical benefits covered by the plan.
25    (c) As used in this Section, "treatment" includes inpatient



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1and outpatient care and services performed to improve or
2restore body function, or performed to approximate a normal
3appearance, due to congenital anomaly or birth defect involving
4the cranial facial area and includes treatment to any and all
5missing or abnormal body parts, including teeth, oral cavity,
6and their associated structures, that would otherwise be
7provided under the plan or coverage for any other injury and
8sickness, up to the age of 26, including:
9        (1) inpatient and outpatient care, reconstructive
10    services and procedures, and complications thereof,
11    including prosthetics and appliances;
12        (2) adjunctive dental, orthodontic, or prosthodontic
13    support, including ongoing or subsequent treatment
14    required to maintain function or approximate a normal
15    appearance;
16        (3) procedures for secondary conditions and follow-up
17    treatment; and
18        (4) anesthetics provided by a dentist with a permit
19    provided under Section 8.1 of the Illinois Dental Practice
20    Act when performed in conjunction with the treatment
21    described in this subsection (c).
22    "Treatment" does not include cosmetic surgery performed to
23reshape normal facial structure or to improve appearance or
25    (d) This Section does not apply to a policy that covers
26only dental care.



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1    Section 99. Effective date. This Act takes effect January
21, 2020.".