Bill Amendment: IL SB0111 | 2019-2020 | 101st General Assembly
NOTE: For additional amemendments please see the Bill Drafting List
Bill Title: INS CODE-DENTAL ANESTHETICS
Status: 2019-08-23 - Public Act . . . . . . . . . 101-0525 [SB0111 Detail]
Download: Illinois-2019-SB0111-Senate_Amendment_001.html
Bill Title: INS CODE-DENTAL ANESTHETICS
Status: 2019-08-23 - Public Act . . . . . . . . . 101-0525 [SB0111 Detail]
Download: Illinois-2019-SB0111-Senate_Amendment_001.html
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1 | AMENDMENT TO SENATE BILL 111
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2 | AMENDMENT NO. ______. Amend Senate Bill 111 by replacing | ||||||
3 | everything after the enacting clause with the following:
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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 January | ||||||
11 | 1, 2003 (the effective date of Public Act 92-764) shall cover
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12 | charges incurred, and anesthetics provided, in
conjunction | ||||||
13 | with dental care that is provided to a covered individual in a
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14 | hospital or
an ambulatory surgical treatment center
if any of | ||||||
15 | the
following
applies:
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16 | (1) the individual is a child age 6 or under;
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1 | (2) the individual has a medical condition that | ||||||
2 | requires
hospitalization or general anesthesia for dental | ||||||
3 | care; or
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4 | (3) the individual is a person with a disability.
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5 | (a-5) An individual or group policy of accident and health | ||||||
6 | insurance amended, delivered, issued, or renewed after January | ||||||
7 | 1, 2016 (the effective date of Public Act 99-141) shall cover | ||||||
8 | charges incurred, and anesthetics provided by a dentist with a | ||||||
9 | permit provided under Section 8.1 of the Illinois Dental | ||||||
10 | Practice Act or a physician licensed to practice medicine in | ||||||
11 | all of its branches under the Medical Practice Act of 1987 , in | ||||||
12 | conjunction with dental care that is provided to a covered | ||||||
13 | individual in a dental office, oral surgeon's office, hospital, | ||||||
14 | or ambulatory surgical treatment center if the individual is | ||||||
15 | under age 26 19 and has been diagnosed with an autism spectrum | ||||||
16 | disorder as defined in Section 10 of the Autism Spectrum | ||||||
17 | Disorders Reporting Act or a developmental disability. A | ||||||
18 | covered individual shall be required to make 2 visits to the | ||||||
19 | dental care provider prior to accessing other coverage under | ||||||
20 | this subsection. | ||||||
21 | For purposes of this subsection, "developmental | ||||||
22 | disability" means a disability that is attributable to an | ||||||
23 | intellectual disability or a related condition, if the related | ||||||
24 | condition meets all of the following conditions: | ||||||
25 | (1) it is attributable to cerebral palsy, epilepsy, or | ||||||
26 | any other condition, other than mental illness, found to be |
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1 | closely related to an intellectual disability because that | ||||||
2 | condition results in impairment of general intellectual | ||||||
3 | functioning or adaptive behavior similar to that of | ||||||
4 | individuals with an intellectual disability and requires | ||||||
5 | treatment or services similar to those required for those | ||||||
6 | individuals; for purposes of this definition, autism is | ||||||
7 | considered a related condition; | ||||||
8 | (2) it is manifested before the individual reaches age | ||||||
9 | 22; | ||||||
10 | (3) it is likely to continue indefinitely; and | ||||||
11 | (4) it results in substantial functional limitations | ||||||
12 | in 3 or more of the following areas of major life activity: | ||||||
13 | self-care, language, learning, mobility, self-direction, | ||||||
14 | and capacity for independent living. | ||||||
15 | (b) For purposes of this Section, "ambulatory surgical | ||||||
16 | treatment center"
has the meaning given to that term in Section | ||||||
17 | 3 of the Ambulatory
Surgical Treatment Center Act.
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18 | For purposes of this Section, "person with a disability" | ||||||
19 | means a person, regardless of age,
with a chronic
disability if | ||||||
20 | the chronic disability meets all of the following conditions:
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21 | (1) It is attributable to a mental or physical | ||||||
22 | impairment or
combination of mental and physical | ||||||
23 | impairments.
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24 | (2) It is likely to continue.
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25 | (3) It results in substantial functional limitations | ||||||
26 | in one or more of
the following areas of major life |
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1 | activity:
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2 | (A) self-care;
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3 | (B) receptive and expressive language;
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4 | (C) learning;
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5 | (D) mobility;
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6 | (E) capacity for independent living; or
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7 | (F) economic self-sufficiency.
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8 | (c) The coverage required under this Section may be subject | ||||||
9 | to any
limitations, exclusions, or cost-sharing provisions | ||||||
10 | that apply generally under
the insurance policy.
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11 | (d) This Section does not apply to a policy that covers | ||||||
12 | only dental care.
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13 | (e) Nothing in this Section requires that the dental | ||||||
14 | services be
covered.
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15 | (f) The provisions of this Section do not apply to | ||||||
16 | short-term travel,
accident-only, limited, or specified | ||||||
17 | disease policies, nor to policies or
contracts designed for | ||||||
18 | issuance to persons eligible for coverage under Title
XVIII of | ||||||
19 | the Social Security Act, known as Medicare, or any other | ||||||
20 | similar
coverage under State or federal governmental plans.
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21 | (Source: P.A. 99-141, eff. 1-1-16; 99-143, eff. 7-27-15; | ||||||
22 | 99-642, eff. 7-28-16.)".
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