Bill Text: IL SB0111 | 2019-2020 | 101st General Assembly | Chaptered


Bill Title: Amends the Illinois Insurance Code. In provisions concerning coverage for anesthetics provided in conjunction with dental care to an individual diagnosed with autism spectrum disorder, removes the requirement that anesthetics be provided by a dentist licensed under the Illinois Dental Practice Act and changes the age of the individual that treatment shall be covered to under age 26 (rather than under age 19).

Spectrum: Strong Partisan Bill (Democrat 23-2)

Status: (Passed) 2019-08-23 - Public Act . . . . . . . . . 101-0525 [SB0111 Detail]

Download: Illinois-2019-SB0111-Chaptered.html



Public Act 101-0525
SB0111 EnrolledLRB101 04609 SMS 49617 b
AN ACT concerning regulation.
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 January
1, 2003 (the effective date of Public Act 92-764) 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 a person with a disability.
(a-5) An individual or group policy of accident and health
insurance amended, delivered, issued, or renewed after January
1, 2016 (the effective date of Public Act 99-141) 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 26 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, "person with a disability"
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. 99-141, eff. 1-1-16; 99-143, eff. 7-27-15;
99-642, eff. 7-28-16.)
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