Bill Text: IL SB0111 | 2019-2020 | 101st General Assembly | Engrossed


Bill Title: Amends the Illinois Insurance Code. In provisions concerning coverage for anesthetics provided in conjunction with dental care to an individual diagnosed with autism spectrum disorder, removes the requirement that anesthetics be provided by a dentist licensed under the Illinois Dental Practice Act and changes the age of the individual that treatment shall be covered to under age 26 (rather than under age 19).

Spectrum: Strong Partisan Bill (Democrat 22-2)

Status: (Engrossed) 2019-05-20 - Added Alternate Co-Sponsor Rep. Terra Costa Howard [SB0111 Detail]

Download: Illinois-2019-SB0111-Engrossed.html



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1 AN ACT concerning regulation.
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 January
111, 2003 (the effective date of Public Act 92-764) shall cover
12charges incurred, and anesthetics provided, in conjunction
13with dental care that is provided to a covered individual in a
14hospital or an ambulatory surgical treatment center if any of
15the 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 a person with a disability.
21 (a-5) An individual or group policy of accident and health
22insurance amended, delivered, issued, or renewed after January
231, 2016 (the effective date of Public Act 99-141) shall cover

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1charges incurred, and anesthetics provided by a dentist with a
2permit provided under Section 8.1 of the Illinois Dental
3Practice Act or a physician licensed to practice medicine in
4all of its branches under the Medical Practice Act of 1987, in
5conjunction with dental care that is provided to a covered
6individual in a dental office, oral surgeon's office, hospital,
7or ambulatory surgical treatment center if the individual is
8under age 26 19 and has been diagnosed with an autism spectrum
9disorder as defined in Section 10 of the Autism Spectrum
10Disorders Reporting Act or a developmental disability. A
11covered individual shall be required to make 2 visits to the
12dental care provider prior to accessing other coverage under
13this subsection.
14 For purposes of this subsection, "developmental
15disability" means a disability that is attributable to an
16intellectual disability or a related condition, if the related
17condition meets all of the following conditions:
18 (1) it is attributable to cerebral palsy, epilepsy, or
19 any other condition, other than mental illness, found to be
20 closely related to an intellectual disability because that
21 condition results in impairment of general intellectual
22 functioning or adaptive behavior similar to that of
23 individuals with an intellectual disability and requires
24 treatment or services similar to those required for those
25 individuals; for purposes of this definition, autism is
26 considered a related condition;

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

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1 (c) The coverage required under this Section may be subject
2to any limitations, exclusions, or cost-sharing provisions
3that apply generally under the insurance policy.
4 (d) This Section does not apply to a policy that covers
5only dental care.
6 (e) Nothing in this Section requires that the dental
7services be covered.
8 (f) The provisions of this Section do not apply to
9short-term travel, accident-only, limited, or specified
10disease policies, nor to policies or contracts designed for
11issuance to persons eligible for coverage under Title XVIII of
12the Social Security Act, known as Medicare, or any other
13similar coverage under State or federal governmental plans.
14(Source: P.A. 99-141, eff. 1-1-16; 99-143, eff. 7-27-15;
1599-642, eff. 7-28-16.)
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