99TH GENERAL ASSEMBLY State of Illinois 2015 and 2016 HB0235

Introduced , by Rep. Laura Fine

SYNOPSIS AS INTRODUCED:

215 ILCS 5/356z.2

Amends the Illinois Insurance Code. Provides that individual or group policies of accident and health insurance amended, delivered, issued, or renewed after the effective date of the Act shall cover charges incurred, and anesthetics provided, 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 26 and has been diagnosed with an autism spectrum disorder as defined in Section 10 of the Autism Spectrum Disorders Reporting Act.

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A BILL FOR

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1 AN ACT concerning insurance.

2 Be it enacted by the People of the State of Illinois,

3 represented in the General Assembly:

4 Section 5. The Illinois Insurance Code is amended by

5 changing Section 356z.2 as follows:

6 (215 ILCS 5/356z.2)

7 Sec. 356z.2. Coverage for adjunctive services in dental

8 care.

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:

16 (1) the individual is a child age 6 or under;

17 (2) the individual has a medical condition that

18 requires hospitalization or general anesthesia for dental

19 care; or

20 (3) the individual is disabled.

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.

8 (b) For purposes of this Section, "ambulatory surgical

9 treatment center" has the meaning given to that term in Section

10 3 of the Ambulatory Surgical Treatment Center Act.

11 For purposes of this Section, "disabled" means a person,

12 regardless of age, with a chronic disability if the chronic

13 disability meets all of the following conditions:

14 (1) It is attributable to a mental or physical

15 impairment or combination of mental and physical

16 impairments.

17 (2) It is likely to continue.

18 (3) It results in substantial functional limitations

19 in one or more of the following areas of major life

20 activity:

21 (A) self-care;

22 (B) receptive and expressive language;

23 (C) learning;

24 (D) mobility;

25 (E) capacity for independent living; or

26 (F) economic self-sufficiency.

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1 (c) The coverage required under this Section may be subject

2 to any limitations, exclusions, or cost-sharing provisions

3 that apply generally under the insurance policy.

4 (d) This Section does not apply to a policy that covers

5 only dental care.

6 (e) Nothing in this Section requires that the dental

7 services be covered.

8 (f) The provisions of this Section do not apply to

9 short-term travel, accident-only, limited, or specified

10 disease policies, nor to policies or contracts designed for

11 issuance to persons eligible for coverage under Title XVIII of

12 the Social Security Act, known as Medicare, or any other

13 similar coverage under State or federal governmental plans.

14 (Source: P.A. 95-331, eff. 8-21-07.)