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| Public Act 102-0768 | ||||
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AN ACT concerning regulation.
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Be it enacted by the People of the State of Illinois,
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represented in the General Assembly:
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Section 5. The State Employees Group Insurance Act of 1971 | ||||
is amended by changing Section 6.11 as follows:
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(5 ILCS 375/6.11)
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Sec. 6.11. Required health benefits; Illinois Insurance | ||||
Code
requirements. The program of health
benefits shall | ||||
provide the post-mastectomy care benefits required to be | ||||
covered
by a policy of accident and health insurance under | ||||
Section 356t of the Illinois
Insurance Code. The program of | ||||
health benefits shall provide the coverage
required under | ||||
Sections 356g, 356g.5, 356g.5-1, 356m, 356q,
356u, 356w, 356x, | ||||
356z.2, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, | ||||
356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.22, | ||||
356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33, | ||||
356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.51, | ||||
and 356z.53 and 356z.43 of the
Illinois Insurance Code.
The | ||||
program of health benefits must comply with Sections 155.22a, | ||||
155.37, 355b, 356z.19, 370c, and 370c.1 and Article XXXIIB of | ||||
the
Illinois Insurance Code. The Department of Insurance shall | ||||
enforce the requirements of this Section with respect to | ||||
Sections 370c and 370c.1 of the Illinois Insurance Code; all | ||||
other requirements of this Section shall be enforced by the | ||
Department of Central Management Services.
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Rulemaking authority to implement Public Act 95-1045, if | ||
any, is conditioned on the rules being adopted in accordance | ||
with all provisions of the Illinois Administrative Procedure | ||
Act and all rules and procedures of the Joint Committee on | ||
Administrative Rules; any purported rule not so adopted, for | ||
whatever reason, is unauthorized. | ||
(Source: P.A. 101-13, eff. 6-12-19; 101-281, eff. 1-1-20; | ||
101-393, eff. 1-1-20; 101-452, eff. 1-1-20; 101-461, eff. | ||
1-1-20; 101-625, eff. 1-1-21; 102-30, eff. 1-1-22; 102-103, | ||
eff. 1-1-22; 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; | ||
102-642, eff. 1-1-22; 102-665, eff. 10-8-21; revised | ||
10-26-21.) | ||
Section 10. The Illinois Insurance Code is amended by | ||
changing Section 356c and by adding Section 356z.53 as | ||
follows:
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(215 ILCS 5/356c) (from Ch. 73, par. 968c)
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Sec. 356c.
(1) No policy of accident and health insurance | ||
providing
coverage of hospital expenses or medical expenses or
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both on an expense incurred basis which in addition to | ||
covering the
insured, also covers members of the insured's | ||
immediate family, shall
contain any disclaimer, waiver or | ||
other limitation of coverage relative to
the hospital or | ||
medical
coverage or insurability of newborn infants from and | ||
after
the moment of birth.
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(2) Each such policy of accident and health insurance | ||
shall contain
a provision stating that the accident and health | ||
insurance benefits
applicable for children shall be granted | ||
immediately with respect to a
newly born child from the moment | ||
of birth. The coverage for newly born
children shall include | ||
coverage of illness, injury, congenital defects (including the | ||
treatment of cleft lip and cleft palate),
birth abnormalities | ||
and premature birth.
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(3) If payment of a specific premium is required to | ||
provide coverage
for a child, the policy may require that | ||
notification of birth of a
newly born child must be furnished | ||
to the insurer within 31 days after
the date of birth in order | ||
to have the coverage continue beyond such 31
day period and may | ||
require payment of the appropriate premium.
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(4) In the event that no other members of the insured's | ||
immediate
family are covered, immediate coverage for the first | ||
newborn infant shall
be provided if the insured applies for | ||
dependent's coverage
within 31 days of the newborn's birth.
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Such coverage shall be contingent upon payment of the | ||
additional premium.
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(5) The requirements of this Section shall apply, on or | ||
after the
sixtieth day following the effective date of this | ||
Section, (a) to all
such non-group policies delivered or | ||
issued for delivery, and (b) to all
such group policies | ||
delivered, issued for delivery, renewed or amended.
The | ||
insurers of such non-group policies in effect on the sixtieth | ||
day
following the effective date of this Section shall extend | ||
to owners of
said policies, on or before the first policy | ||
anniversary following such
date, the opportunity to apply for | ||
the addition to their policies of a
provision as set forth in | ||
paragraph (2) above, with, at the option of
the insurer, | ||
payment of a premium appropriate thereto.
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(Source: P.A. 85-220.)
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(215 ILCS 5/356z.53 new) | ||
Sec. 356z.53. Coverage for cleft lip and cleft palate. | ||
(a) As used in this Section, "medically necessary care and | ||
treatment" to address congenital anomalies associated with a | ||
cleft lip or palate, or both, includes: | ||
(1) oral and facial surgery, including reconstructive | ||
services and procedures necessary to improve and restore | ||
and maintain vital functions; | ||
(2) prosthetic treatment such as obdurators, speech | ||
appliances, and feeding appliances; | ||
(3) orthodontic treatment and management; | ||
(4) prosthodontic treatment and management; and | ||
(5) otolaryngology treatment and management. | ||
"Medically necessary care and treatment" does not include | ||
cosmetic surgery performed to reshape normal structures of the | ||
lip, jaw, palate, or other facial structures to improve | ||
appearance. | ||
(b) An individual or group policy of accident and health | ||
insurance amended, delivered, issued, or renewed on or after | ||
the effective date of this amendatory Act of the 102nd General | ||
Assembly shall provide coverage for the medically necessary | ||
care and treatment of cleft lip and palate for children under | ||
the age of 19. Coverage for cleft lip and palate care and | ||
treatment may impose the same deductible, coinsurance, or | ||
other cost-sharing limitation that is imposed on other related | ||
surgical benefits under the policy. | ||
(c) This Section does not apply to a policy that covers | ||
only dental care.
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Section 99. Effective date. This Act takes effect January | ||
1, 2024.
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