Bill Text: IL HB4349 | 2021-2022 | 102nd General Assembly | Enrolled

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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Bill Title: Amends the Illinois Insurance Code. In provisions requiring coverage for newborn infants, provides that coverage for congenital defects shall include the treatment of cleft lip and cleft palate. Provides that an individual or group policy of accident and health insurance amended, delivered, issued, or renewed on or after the effective date of the amendatory Act shall provide coverage for the medically necessary care and treatment of cleft lip and palate for children under the age of 19. Provides that coverage for cleft lip and palate care and treatment may impose the same deductible, coinsurance, or other cost-sharing limitation that is imposed on other related surgical benefits under the policy. Provides that the coverage does not apply to a policy that covers only dental care. Defines "medically necessary care and treatment". Makes conforming changes in the State Employees Group Insurance Act of 1971. Effective January 1, 2024.

Spectrum: Strong Partisan Bill (Democrat 32-3)

Status: (Passed) 2022-05-13 - Public Act . . . . . . . . . 102-0768 [HB4349 Detail]

Download: Illinois-2021-HB4349-Enrolled.html

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AN ACT concerning regulation.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
Section 5. The State Employees Group Insurance Act of 1971
is amended by changing Section 6.11 as follows:
(5 ILCS 375/6.11)
Sec. 6.11. Required health benefits; Illinois Insurance
Code requirements. The program of health benefits shall
provide the post-mastectomy care benefits required to be
covered by a policy of accident and health insurance under
Section 356t of the Illinois Insurance Code. The program of
health benefits shall provide the coverage required under
Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u, 356w, 356x,
356z.2, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10,
356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, 356z.22,
356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33,
356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.51,
and 356z.53 and 356z.43 of the Illinois Insurance Code. The
program of health benefits must comply with Sections 155.22a,
155.37, 355b, 356z.19, 370c, and 370c.1 and Article XXXIIB of
the Illinois Insurance Code. The Department of Insurance shall
enforce the requirements of this Section with respect to
Sections 370c and 370c.1 of the Illinois Insurance Code; all

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other requirements of this Section shall be enforced by the
Department of Central Management Services.
Rulemaking authority to implement Public Act 95-1045, if
any, is conditioned on the rules being adopted in accordance
with all provisions of the Illinois Administrative Procedure
Act and all rules and procedures of the Joint Committee on
Administrative Rules; any purported rule not so adopted, for
whatever reason, is unauthorized.
(Source: P.A. 101-13, eff. 6-12-19; 101-281, eff. 1-1-20;
101-393, eff. 1-1-20; 101-452, eff. 1-1-20; 101-461, eff.
1-1-20; 101-625, eff. 1-1-21; 102-30, eff. 1-1-22; 102-103,
eff. 1-1-22; 102-203, eff. 1-1-22; 102-306, eff. 1-1-22;
102-642, eff. 1-1-22; 102-665, eff. 10-8-21; revised
10-26-21.)
Section 10. The Illinois Insurance Code is amended by
changing Section 356c and by adding Section 356z.53 as
follows:
(215 ILCS 5/356c) (from Ch. 73, par. 968c)
Sec. 356c. (1) No policy of accident and health insurance
providing coverage of hospital expenses or medical expenses or
both on an expense incurred basis which in addition to
covering the insured, also covers members of the insured's
immediate family, shall contain any disclaimer, waiver or
other limitation of coverage relative to the hospital or

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medical coverage or insurability of newborn infants from and
after the moment of birth.
(2) Each such policy of accident and health insurance
shall contain a provision stating that the accident and health
insurance benefits applicable for children shall be granted
immediately with respect to a newly born child from the moment
of birth. The coverage for newly born children shall include
coverage of illness, injury, congenital defects (including the
treatment of cleft lip and cleft palate), birth abnormalities
and premature birth.
(3) If payment of a specific premium is required to
provide coverage for a child, the policy may require that
notification of birth of a newly born child must be furnished
to the insurer within 31 days after the date of birth in order
to have the coverage continue beyond such 31 day period and may
require payment of the appropriate premium.
(4) In the event that no other members of the insured's
immediate family are covered, immediate coverage for the first
newborn infant shall be provided if the insured applies for
dependent's coverage within 31 days of the newborn's birth.
Such coverage shall be contingent upon payment of the
additional premium.
(5) The requirements of this Section shall apply, on or
after the sixtieth day following the effective date of this
Section, (a) to all such non-group policies delivered or
issued for delivery, and (b) to all such group policies

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delivered, issued for delivery, renewed or amended. The
insurers of such non-group policies in effect on the sixtieth
day following the effective date of this Section shall extend
to owners of said policies, on or before the first policy
anniversary following such date, the opportunity to apply for
the addition to their policies of a provision as set forth in
paragraph (2) above, with, at the option of the insurer,
payment of a premium appropriate thereto.
(Source: P.A. 85-220.)
(215 ILCS 5/356z.53 new)
Sec. 356z.53. Coverage for cleft lip and cleft palate.
(a) As used in this Section, "medically necessary care and
treatment" to address congenital anomalies associated with a
cleft lip or palate, or both, includes:
(1) oral and facial surgery, including reconstructive
services and procedures necessary to improve and restore
and maintain vital functions;
(2) prosthetic treatment such as obdurators, speech
appliances, and feeding appliances;
(3) orthodontic treatment and management;
(4) prosthodontic treatment and management; and
(5) otolaryngology treatment and management.
"Medically necessary care and treatment" does not include
cosmetic surgery performed to reshape normal structures of the
lip, jaw, palate, or other facial structures to improve

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appearance.
(b) An individual or group policy of accident and health
insurance amended, delivered, issued, or renewed on or after
the effective date of this amendatory Act of the 102nd General
Assembly shall provide coverage for the medically necessary
care and treatment of cleft lip and palate for children under
the age of 19. Coverage for cleft lip and palate care and
treatment may impose the same deductible, coinsurance, or
other cost-sharing limitation that is imposed on other related
surgical benefits under the policy.
(c) This Section does not apply to a policy that covers
only dental care.
Section 99. Effective date. This Act takes effect January
1, 2024.