Illinois General Assembly - Full Text of HB4349
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Full Text of HB4349  102nd General Assembly


Rep. Kathleen Willis

Filed: 2/9/2022





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2    AMENDMENT NO. ______. Amend House Bill 4349 by replacing
3everything after the enacting clause with the following:
4    "Section 5. The State Employees Group Insurance Act of
51971 is 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,



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1356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.51,
2and 356z.53 and 356z.43 of the Illinois Insurance Code. The
3program of health benefits must comply with Sections 155.22a,
4155.37, 355b, 356z.19, 370c, and 370c.1 and Article XXXIIB of
5the Illinois Insurance Code. The Department of Insurance shall
6enforce the requirements of this Section with respect to
7Sections 370c and 370c.1 of the Illinois Insurance Code; all
8other requirements of this Section shall be enforced by the
9Department of Central Management Services.
10    Rulemaking authority to implement Public Act 95-1045, if
11any, is conditioned on the rules being adopted in accordance
12with all provisions of the Illinois Administrative Procedure
13Act and all rules and procedures of the Joint Committee on
14Administrative Rules; any purported rule not so adopted, for
15whatever reason, is unauthorized.
16(Source: P.A. 101-13, eff. 6-12-19; 101-281, eff. 1-1-20;
17101-393, eff. 1-1-20; 101-452, eff. 1-1-20; 101-461, eff.
181-1-20; 101-625, eff. 1-1-21; 102-30, eff. 1-1-22; 102-103,
19eff. 1-1-22; 102-203, eff. 1-1-22; 102-306, eff. 1-1-22;
20102-642, eff. 1-1-22; 102-665, eff. 10-8-21; revised
22    Section 10. The Illinois Insurance Code is amended by
23changing Section 356c and by adding Section 356z.53 as



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1    (215 ILCS 5/356c)  (from Ch. 73, par. 968c)
2    Sec. 356c. (1) No policy of accident and health insurance
3providing coverage of hospital expenses or medical expenses or
4both on an expense incurred basis which in addition to
5covering the insured, also covers members of the insured's
6immediate family, shall contain any disclaimer, waiver or
7other limitation of coverage relative to the hospital or
8medical coverage or insurability of newborn infants from and
9after the moment of birth.
10    (2) Each such policy of accident and health insurance
11shall contain a provision stating that the accident and health
12insurance benefits applicable for children shall be granted
13immediately with respect to a newly born child from the moment
14of birth. The coverage for newly born children shall include
15coverage of illness, injury, congenital defects (including the
16treatment of cleft lip and cleft palate), birth abnormalities
17and premature birth.
18    (3) If payment of a specific premium is required to
19provide coverage for a child, the policy may require that
20notification of birth of a newly born child must be furnished
21to the insurer within 31 days after the date of birth in order
22to have the coverage continue beyond such 31 day period and may
23require payment of the appropriate premium.
24    (4) In the event that no other members of the insured's
25immediate family are covered, immediate coverage for the first
26newborn infant shall be provided if the insured applies for



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1dependent's coverage within 31 days of the newborn's birth.
2Such coverage shall be contingent upon payment of the
3additional premium.
4    (5) The requirements of this Section shall apply, on or
5after the sixtieth day following the effective date of this
6Section, (a) to all such non-group policies delivered or
7issued for delivery, and (b) to all such group policies
8delivered, issued for delivery, renewed or amended. The
9insurers of such non-group policies in effect on the sixtieth
10day following the effective date of this Section shall extend
11to owners of said policies, on or before the first policy
12anniversary following such date, the opportunity to apply for
13the addition to their policies of a provision as set forth in
14paragraph (2) above, with, at the option of the insurer,
15payment of a premium appropriate thereto.
16(Source: P.A. 85-220.)
17    (215 ILCS 5/356z.53 new)
18    Sec. 356z.53. Coverage for cleft lip and cleft palate.
19    (a) As used in this Section, "medically necessary care and
20treatment" to address congenital anomalies associated with a
21cleft lip or palate, or both, includes:
22        (1) oral and facial surgery, including reconstructive
23    services and procedures necessary to improve and restore
24    and maintain vital functions;
25        (2) prosthetic treatment such as obdurators, speech



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1    appliances, and feeding appliances;
2        (3) orthodontic treatment and management;
3        (4) prosthodontic treatment and management; and
4        (5) otolaryngology treatment and management.
5    "Medically necessary care and treatment" does not include
6cosmetic surgery performed to reshape normal structures of the
7lip, jaw, palate, or other facial structures to improve
9    (b) An individual or group policy of accident and health
10insurance amended, delivered, issued, or renewed on or after
11the effective date of this amendatory Act of the 102nd General
12Assembly shall provide coverage for the medically necessary
13care and treatment of cleft lip and palate for children under
14the age of 19. Coverage for cleft lip and palate care and
15treatment may impose the same deductible, coinsurance, or
16other cost-sharing limitation that is imposed on other related
17surgical benefits under the policy.
18    (c) This Section does not apply to a policy that covers
19only dental care.
20    Section 99. Effective date. This Act takes effect January
211, 2024.".