Bill Text: IL HB4349 | 2021-2022 | 102nd General Assembly | Chaptered
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-Chaptered.html
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| Public Act 102-0768 | ||||
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AN ACT concerning regulation.
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Be it enacted by the People of the State of Illinois,
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represented in the General Assembly:
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Section 5. The State Employees Group Insurance Act of 1971 | ||||
is amended by changing Section 6.11 as follows:
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(5 ILCS 375/6.11)
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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 | ||||
other requirements of this Section shall be enforced by the | ||
Department of Central Management Services.
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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.)
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Section 10. The Illinois Insurance Code is amended by | ||
changing Section 356c and by adding Section 356z.53 as | ||
follows:
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(215 ILCS 5/356c) (from Ch. 73, par. 968c)
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Sec. 356c.
(1) No policy of accident and health insurance | ||
providing
coverage of hospital expenses or medical expenses or
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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 | ||
medical
coverage or insurability of newborn infants from and | ||
after
the moment of birth.
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(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.
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(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.
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(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.
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Such coverage shall be contingent upon payment of the | ||
additional premium.
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(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 | ||
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.
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(Source: P.A. 85-220.)
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(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 | ||
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.
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Section 99. Effective date. This Act takes effect January | ||
1, 2024.
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