| ||||
| Public Act 099-0141 | ||||
| ||||
| ||||
AN ACT concerning insurance.
| ||||
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 the | ||||
effective date of this
amendatory Act of the 92nd General | ||||
Assembly 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 disabled.
| ||||
(a-5) An individual or group policy of accident and health | ||||
insurance amended, delivered, issued, or renewed after the | ||||
effective date of this amendatory Act of the 99th General | ||||
Assembly 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 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, "disabled" 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. 95-331, eff. 8-21-07.)
| ||