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| | HB0235 Engrossed | | LRB099 03691 MLM 23702 b |
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| 1 | | AN ACT concerning insurance.
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| 2 | | Be it enacted by the People of the State of Illinois,
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| 3 | | represented in the General Assembly:
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| 4 | | Section 5. The Illinois Insurance Code is amended by |
| 5 | | changing Section 356z.2 as follows:
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| 6 | | (215 ILCS 5/356z.2)
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| 7 | | Sec. 356z.2. Coverage for adjunctive services in dental |
| 8 | | care.
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| 9 | | (a) An individual or group policy of accident and health |
| 10 | | insurance
amended, delivered, issued, or renewed after the |
| 11 | | effective date of this
amendatory Act of the 92nd General |
| 12 | | Assembly shall cover
charges incurred, and anesthetics |
| 13 | | provided, in
conjunction with dental care that is provided to a |
| 14 | | covered individual in a
hospital or
an ambulatory surgical |
| 15 | | treatment center
if any of the
following
applies:
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| 16 | | (1) the individual is a child age 6 or under;
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| 17 | | (2) the individual has a medical condition that |
| 18 | | requires
hospitalization or general anesthesia for dental |
| 19 | | care; or
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| 20 | | (3) the individual is disabled.
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| 21 | | (a-5) An individual or group policy of accident and health |
| 22 | | insurance amended, delivered, issued, or renewed after the |
| 23 | | effective date of this amendatory Act of the 99th General |
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| 1 | | Assembly shall cover charges incurred, and anesthetics |
| 2 | | provided, in conjunction with dental care that is provided to a |
| 3 | | covered individual in a dental office, oral surgeon's office, |
| 4 | | hospital, or ambulatory surgical treatment center if the |
| 5 | | individual is under age 26 and has been diagnosed with an |
| 6 | | autism spectrum disorder as defined in Section 10 of the Autism |
| 7 | | Spectrum Disorders Reporting Act or a developmental |
| 8 | | disability. |
| 9 | | For purposes of this subsection, "developmental |
| 10 | | disability" means a disability that is attributable to an |
| 11 | | intellectual disability or a related condition, if the related |
| 12 | | condition meets all of the following conditions: |
| 13 | | (1) it is attributable to cerebral palsy, epilepsy, or |
| 14 | | any other condition, other than mental illness, found to be |
| 15 | | closely related to an intellectual disability because that |
| 16 | | condition results in impairment of general intellectual |
| 17 | | functioning or adaptive behavior similar to that of |
| 18 | | individuals with an intellectual disability and requires |
| 19 | | treatment or services similar to those required for those |
| 20 | | individuals; for purposes of this definition, autism is |
| 21 | | considered a related condition; |
| 22 | | (2) it is manifested before the individual reaches age |
| 23 | | 22; |
| 24 | | (3) it is likely to continue indefinitely; and |
| 25 | | (4) it results in substantial functional limitations |
| 26 | | in 3 or more of the following areas of major life activity: |
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| 1 | | self-care, language, learning, mobility, self-direction, |
| 2 | | and capacity for independent living. |
| 3 | | (b) For purposes of this Section, "ambulatory surgical |
| 4 | | treatment center"
has the meaning given to that term in Section |
| 5 | | 3 of the Ambulatory
Surgical Treatment Center Act.
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| 6 | | For purposes of this Section, "disabled" means a person, |
| 7 | | regardless of age,
with a chronic
disability if the chronic |
| 8 | | disability meets all of the following conditions:
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| 9 | | (1) It is attributable to a mental or physical |
| 10 | | impairment or
combination of mental and physical |
| 11 | | impairments.
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| 12 | | (2) It is likely to continue.
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| 13 | | (3) It results in substantial functional limitations |
| 14 | | in one or more of
the following areas of major life |
| 15 | | activity:
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| 16 | | (A) self-care;
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| 17 | | (B) receptive and expressive language;
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| 18 | | (C) learning;
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| 19 | | (D) mobility;
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| 20 | | (E) capacity for independent living; or
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| 21 | | (F) economic self-sufficiency.
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| 22 | | (c) The coverage required under this Section may be subject |
| 23 | | to any
limitations, exclusions, or cost-sharing provisions |
| 24 | | that apply generally under
the insurance policy.
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| 25 | | (d) This Section does not apply to a policy that covers |
| 26 | | only dental care.
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| 1 | | (e) Nothing in this Section requires that the dental |
| 2 | | services be
covered.
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| 3 | | (f) The provisions of this Section do not apply to |
| 4 | | short-term travel,
accident-only, limited, or specified |
| 5 | | disease policies, nor to policies or
contracts designed for |
| 6 | | issuance to persons eligible for coverage under Title
XVIII of |
| 7 | | the Social Security Act, known as Medicare, or any other |
| 8 | | similar
coverage under State or federal governmental plans.
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| 9 | | (Source: P.A. 95-331, eff. 8-21-07.)
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