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90_SB1896
215 ILCS 5/356c from Ch. 73, par. 968c
215 ILCS 125/4-8 from Ch. 111 1/2, par. 1409.1
Amends the Illinois Insurance Code and the Health
Maintenance Organization Act. Adds a caption and makes
stylistic changes in Sections concerning coverage for newborn
infants.
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1 AN ACT concerning insurance coverage, amending named
2 Acts.
3 Be it enacted by the People of the State of Illinois,
4 represented in the General Assembly:
5 Section 5. The Illinois Insurance Code is amended by
6 changing Section 356c as follows:
7 (215 ILCS 5/356c) (from Ch. 73, par. 968c)
8 Sec. 356c. Newborn infants.
9 (1) No policy of accident and health insurance providing
10 coverage of hospital expenses or medical expenses or both on
11 an expense incurred basis which in addition to covering the
12 insured, also covers members of the insured's immediate
13 family, shall contain any disclaimer, waiver, or other
14 limitation of coverage relative to the hospital or medical
15 coverage or insurability of newborn infants from and after
16 the moment of birth.
17 (2) Each such policy of accident and health insurance
18 shall contain a provision stating that the accident and
19 health insurance benefits applicable for children shall be
20 granted immediately with respect to a newly born child from
21 the moment of birth. The coverage for newly born children
22 shall include coverage of illness, injury, congenital
23 defects, birth abnormalities and premature birth.
24 (3) If payment of a specific premium is required to
25 provide coverage for a child, the policy may require that
26 notification of birth of a newly born child must be furnished
27 to the insurer within 31 days after the date of birth in
28 order to have the coverage continue beyond such 31 day period
29 and may require payment of the appropriate premium.
30 (4) In the event that no other members of the insured's
31 immediate family are covered, immediate coverage for the
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1 first newborn infant shall be provided if the insured applies
2 for dependent's coverage within 31 days of the newborn's
3 birth. The Such coverage shall be contingent upon payment of
4 the additional premium.
5 (5) The requirements of this Section shall apply, on or
6 after the sixtieth day following the effective date of this
7 Section, (a) to all such non-group policies delivered or
8 issued for delivery, and (b) to all such group policies
9 delivered, issued for delivery, renewed or amended. The
10 insurers of such non-group policies in effect on the sixtieth
11 day following the effective date of this Section shall extend
12 to owners of said policies, on or before the first policy
13 anniversary following such date, the opportunity to apply for
14 the addition to their policies of a provision as set forth in
15 paragraph (2) above, with, at the option of the insurer,
16 payment of a premium appropriate thereto.
17 (Source: P.A. 85-220.)
18 Section 10. The Health Maintenance Organization Act is
19 amended by changing Section 4-8 as follows:
20 (215 ILCS 125/4-8) (from Ch. 111 1/2, par. 1409.1)
21 Sec. 4-8. Newborn Infants.
22 (1) No contract or evidence of coverage issued by a
23 health maintenance organization which provides for coverage
24 of dependents of the principal enrollee shall contain any
25 disclaimer, waiver, or other limitation relative to the
26 eligibility or coverage of newborn infants of a principal
27 enrollee from and after the moment of birth.
28 (2) Each such contract or evidence of coverage shall
29 contain a provision stating that benefits shall be granted
30 immediately with respect to newborn infants from the moment
31 of birth and that the such coverage shall include illness,
32 injury, congenital defects, birth abnormalities and premature
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1 birth.
2 (3) If payment of a specific premium is required under
3 the terms of a contract to provide coverage for a child,
4 there may be requirements that notification of birth of a
5 newly born infant be given to the Health Maintenance
6 Organization within the 31 days following the birth in order
7 to have coverage continued beyond such 31 day period and that
8 such specific premium be paid within 30 days following
9 receipt of such notice.
10 (4) In the event that no other members of the enrollee's
11 immediate family are covered, immediate coverage for the
12 first newborn infant shall be provided if the enrollee
13 applies for dependent's coverage within 31 days of the
14 newborn's birth. The Such coverage shall be contingent upon
15 payment of the additional premium.
16 (5) The requirements of this Section shall apply, on or
17 after the sixtieth day following the effective date of this
18 amendatory Act of 1989, (a) to all such evidences of coverage
19 delivered or issued for delivery, and (b) to all such group
20 contracts delivered, issued for delivery, renewed or amended.
21 The health maintenance organizations which issue such
22 evidences of coverage that are in effect on the sixtieth day
23 following the effective date of this amendatory Act of 1989
24 shall extend to owners of such contracts, on or before the
25 first contract anniversary following such date, the
26 opportunity to apply for the addition to their contracts of a
27 provision as set forth in subsection (2) above, with, at the
28 option of the health maintenance organization, payment of a
29 premium appropriate thereto.
30 (Source: P.A. 86-620.)