Public Act 099-0141
 
HB0235 EnrolledLRB099 03691 MLM 23702 b

    AN ACT concerning insurance.
 
    Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
 
    Section 5. The Illinois Insurance Code is amended by
changing Section 356z.2 as follows:
 
    (215 ILCS 5/356z.2)
    Sec. 356z.2. Coverage for adjunctive services in dental
care.
    (a) An individual or group policy of accident and health
insurance amended, delivered, issued, or renewed after the
effective date of this amendatory Act of the 92nd General
Assembly shall cover charges incurred, and anesthetics
provided, in conjunction with dental care that is provided to a
covered individual in a hospital or an ambulatory surgical
treatment center if any of the following applies:
        (1) the individual is a child age 6 or under;
        (2) the individual has a medical condition that
    requires hospitalization or general anesthesia for dental
    care; or
        (3) the individual is disabled.
    (a-5) An individual or group policy of accident and health
insurance amended, delivered, issued, or renewed after the
effective date of this amendatory Act of the 99th General
Assembly shall cover charges incurred, and anesthetics
provided by a dentist with a permit provided under Section 8.1
of the Illinois Dental Practice Act, in conjunction with dental
care that is provided to a covered individual in a dental
office, oral surgeon's office, hospital, or ambulatory
surgical treatment center if the individual is under age 19 and
has been diagnosed with an autism spectrum disorder as defined
in Section 10 of the Autism Spectrum Disorders Reporting Act or
a developmental disability. A covered individual shall be
required to make 2 visits to the dental care provider prior to
accessing other coverage under this subsection.
    For purposes of this subsection, "developmental
disability" means a disability that is attributable to an
intellectual disability or a related condition, if the related
condition meets all of the following conditions:
        (1) it is attributable to cerebral palsy, epilepsy, or
    any other condition, other than mental illness, found to be
    closely related to an intellectual disability because that
    condition results in impairment of general intellectual
    functioning or adaptive behavior similar to that of
    individuals with an intellectual disability and requires
    treatment or services similar to those required for those
    individuals; for purposes of this definition, autism is
    considered a related condition;
        (2) it is manifested before the individual reaches age
    22;
        (3) it is likely to continue indefinitely; and
        (4) it results in substantial functional limitations
    in 3 or more of the following areas of major life activity:
    self-care, language, learning, mobility, self-direction,
    and capacity for independent living.
    (b) For purposes of this Section, "ambulatory surgical
treatment center" has the meaning given to that term in Section
3 of the Ambulatory Surgical Treatment Center Act.
    For purposes of this Section, "disabled" means a person,
regardless of age, with a chronic disability if the chronic
disability meets all of the following conditions:
        (1) It is attributable to a mental or physical
    impairment or     combination of mental and physical
    impairments.
        (2) It is likely to continue.
        (3) It results in substantial functional limitations
    in one or more of the following areas of major life
    activity:
            (A) self-care;
            (B) receptive and expressive language;
            (C) learning;
            (D) mobility;
            (E) capacity for independent living; or
            (F) economic self-sufficiency.
    (c) The coverage required under this Section may be subject
to any limitations, exclusions, or cost-sharing provisions
that apply generally under the insurance policy.
    (d) This Section does not apply to a policy that covers
only dental care.
    (e) Nothing in this Section requires that the dental
services be covered.
    (f) The provisions of this Section do not apply to
short-term travel, accident-only, limited, or specified
disease policies, nor to policies or contracts designed for
issuance to persons eligible for coverage under Title XVIII of
the Social Security Act, known as Medicare, or any other
similar coverage under State or federal governmental plans.
(Source: P.A. 95-331, eff. 8-21-07.)

Effective Date: 1/1/2016