Bill Text: IL SB2255 | 2019-2020 | 101st General Assembly | Introduced

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Bill Title: Amends the Illinois Insurance Code. Provides that an individual or group policy of accident and health insurance amended, delivered, issued, or renewed after the effective date of the amendatory Act shall cover charges incurred and services provided for outpatient and inpatient care in conjunction with services that are provided to a covered individual related to the diagnosis and treatment of a congenital anomaly or birth defect. Provides that the required coverage includes any service to functionally improve, repair, or restore any body part that is medically necessary to achieve normal body function or appearance, as determined by the treating physician or dentist. Provides that any coverage provided may be subject to coverage limits, such as pre-authorization or pre-certification, as required by the plan or issuer that are no more restrictive than the predominant treatment limitations applied to substantially all medical and surgical benefits covered by the plan. Defines "treatment". Effective immediately.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Failed) 2021-01-13 - Session Sine Die [SB2255 Detail]

Download: Illinois-2019-SB2255-Introduced.html

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101ST GENERAL ASSEMBLY State of Illinois 2019 and 2020 SB2255 Introduced 5/9/2019, by Sen. Laura Fine SYNOPSIS AS INTRODUCED:
215 ILCS 5/356z.33 new
Amends the Illinois Insurance Code. Provides that an individual or group policy of accident and health insurance amended, delivered, issued, or renewed after the effective date of the amendatory Act shall cover charges incurred and services provided for outpatient and inpatient care in conjunction with services that are provided to a covered individual related to the diagnosis and treatment of a congenital anomaly or birth defect. Provides that the required coverage includes any service to functionally improve, repair, or restore any body part that is medically necessary to achieve normal body function or appearance, as determined by the treating physician or dentist. Provides that any coverage provided may be subject to coverage limits, such as pre-authorization or pre-certification, as required by the plan or issuer that are no more restrictive than the predominant treatment limitations applied to substantially all medical and surgical benefits covered by the plan. Defines "treatment". Effective immediately.
LRB101 12399 SMS 60462 b
A BILL FOR
SB2255 LRB101 12399 SMS 60462 b
AN ACT concerning regulation.
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 adding
Section 356z.33 as follows:
(215 ILCS 5/356z.33 new)
Sec. 356z.33. Coverage for congenital anomaly or birth
defect.
(a) As used in this Section, "treatment" includes inpatient
and outpatient care and services performed to improve or
restore body function, or performed to approximate a normal
appearance, due to congenital anomaly or birth defect and
includes treatment to any and all missing or abnormal body
parts, including teeth, the oral cavity, and their associated
structures, that would otherwise be provided under the plan or
coverage for any other injury and sickness, including:
(1) inpatient and outpatient care, reconstructive
services and procedures, and complications thereof,
including prosthetics and appliances;
(2) adjunctive dental, orthodontic, or prosthodontic
support from birth until the medical or surgical treatment
of the defect or anomaly has been completed, including
ongoing or subsequent treatment required to maintain

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function or approximate a normal appearance;
(3) procedures that do not materially restore or
improve the function of the body part being treated;
(4) procedures for secondary conditions and follow-up
treatment; and
(5) anesthetics provided by a dentist with a permit
provided under Section 8.1 of the Illinois Dental Practice
Act.
"Treatment" does not include cosmetic surgery performed to
reshape normal structures of the body to improve appearance or
self-esteem.
(b) 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 101st General
Assembly shall cover charges incurred and services provided for
outpatient and inpatient care in conjunction with services that
are provided to a covered individual related to the diagnosis
and treatment of a congenital anomaly or birth defect.
(c) Coverage required under this Section includes any
service to functionally improve, repair, or restore any body
part that is medically necessary to achieve normal body
function or appearance, as determined by the treating physician
or dentist. Any coverage provided may be subject to coverage
limits, such as pre-authorization or pre-certification, as
required by the plan or issuer that are no more restrictive
than the predominant treatment limitations applied to

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substantially all medical and surgical benefits covered by the
plan.
Section 99. Effective date. This Act takes effect upon
becoming law.