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.)