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ILHB00235
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.
Status: 7/27/2015 : House Public Act . . . . . . . . . 99-0141
All Versions: Introduced | Engrossed | Enrolled | Enacted

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HB0235enr 99TH GENERAL ASSEMBLY

  
  
  

 


 
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1    AN ACT concerning insurance.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Illinois Insurance Code is amended by
5changing Section 356z.2 as follows:
 
6    (215 ILCS 5/356z.2)
7    Sec. 356z.2. Coverage for adjunctive services in dental
8care.
9    (a) An individual or group policy of accident and health
10insurance amended, delivered, issued, or renewed after the
11effective date of this amendatory Act of the 92nd General
12Assembly shall cover charges incurred, and anesthetics
13provided, in conjunction with dental care that is provided to a
14covered individual in a hospital or an ambulatory surgical
15treatment 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
22insurance amended, delivered, issued, or renewed after the
23effective date of this amendatory Act of the 99th General

 

 

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1Assembly shall cover charges incurred, and anesthetics
2provided by a dentist with a permit provided under Section 8.1
3of the Illinois Dental Practice Act, in conjunction with dental
4care that is provided to a covered individual in a dental
5office, oral surgeon's office, hospital, or ambulatory
6surgical treatment center if the individual is under age 19 and
7has been diagnosed with an autism spectrum disorder as defined
8in Section 10 of the Autism Spectrum Disorders Reporting Act or
9a developmental disability. A covered individual shall be
10required to make 2 visits to the dental care provider prior to
11accessing other coverage under this subsection.
12    For purposes of this subsection, "developmental
13disability" means a disability that is attributable to an
14intellectual disability or a related condition, if the related
15condition meets all of the following conditions:
16        (1) it is attributable to cerebral palsy, epilepsy, or
17    any other condition, other than mental illness, found to be
18    closely related to an intellectual disability because that
19    condition results in impairment of general intellectual
20    functioning or adaptive behavior similar to that of
21    individuals with an intellectual disability and requires
22    treatment or services similar to those required for those
23    individuals; for purposes of this definition, autism is
24    considered a related condition;
25        (2) it is manifested before the individual reaches age
26    22;

 

 

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1        (3) it is likely to continue indefinitely; and
2        (4) it results in substantial functional limitations
3    in 3 or more of the following areas of major life activity:
4    self-care, language, learning, mobility, self-direction,
5    and capacity for independent living.
6    (b) For purposes of this Section, "ambulatory surgical
7treatment center" has the meaning given to that term in Section
83 of the Ambulatory Surgical Treatment Center Act.
9    For purposes of this Section, "disabled" means a person,
10regardless of age, with a chronic disability if the chronic
11disability meets all of the following conditions:
12        (1) It is attributable to a mental or physical
13    impairment or     combination of mental and physical
14    impairments.
15        (2) It is likely to continue.
16        (3) It results in substantial functional limitations
17    in one or more of the following areas of major life
18    activity:
19            (A) self-care;
20            (B) receptive and expressive language;
21            (C) learning;
22            (D) mobility;
23            (E) capacity for independent living; or
24            (F) economic self-sufficiency.
25    (c) The coverage required under this Section may be subject
26to any limitations, exclusions, or cost-sharing provisions

 

 

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1that apply generally under the insurance policy.
2    (d) This Section does not apply to a policy that covers
3only dental care.
4    (e) Nothing in this Section requires that the dental
5services be covered.
6    (f) The provisions of this Section do not apply to
7short-term travel, accident-only, limited, or specified
8disease policies, nor to policies or contracts designed for
9issuance to persons eligible for coverage under Title XVIII of
10the Social Security Act, known as Medicare, or any other
11similar coverage under State or federal governmental plans.
12(Source: P.A. 95-331, eff. 8-21-07.)