Public Act 099-0141

HB0235 Enrolled LRB099 03691 MLM 23702 b

AN ACT concerning insurance.

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

changing Section 356z.2 as follows:

(215 ILCS 5/356z.2)

Sec. 356z.2. Coverage for adjunctive services in dental

care.

(a) 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 92nd General

Assembly shall cover charges incurred, and anesthetics

provided, in conjunction with dental care that is provided to a

covered individual in a hospital or an ambulatory surgical

treatment center if any of the following applies:

(1) the individual is a child age 6 or under;

(2) the individual has a medical condition that

requires hospitalization or general anesthesia for dental

care; or

(3) the individual is disabled.

(a-5) 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 99th General

Assembly shall cover charges incurred, and anesthetics

provided by a dentist with a permit provided under Section 8.1

of the Illinois Dental Practice Act, 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 19 and

has been diagnosed with an autism spectrum disorder as defined

in Section 10 of the Autism Spectrum Disorders Reporting Act or

a developmental disability. A covered individual shall be

required to make 2 visits to the dental care provider prior to

accessing other coverage under this subsection.

For purposes of this subsection, "developmental

disability" means a disability that is attributable to an

intellectual disability or a related condition, if the related

condition meets all of the following conditions:

(1) it is attributable to cerebral palsy, epilepsy, or

any other condition, other than mental illness, found to be

closely related to an intellectual disability because that

condition results in impairment of general intellectual

functioning or adaptive behavior similar to that of

individuals with an intellectual disability and requires

treatment or services similar to those required for those

individuals; for purposes of this definition, autism is

considered a related condition;

(2) it is manifested before the individual reaches age

22;

(3) it is likely to continue indefinitely; and

(4) it results in substantial functional limitations

in 3 or more of the following areas of major life activity:

self-care, language, learning, mobility, self-direction,

and capacity for independent living.

(b) For purposes of this Section, "ambulatory surgical

treatment center" has the meaning given to that term in Section

3 of the Ambulatory Surgical Treatment Center Act.

For purposes of this Section, "disabled" means a person,

regardless of age, with a chronic disability if the chronic

disability meets all of the following conditions:

(1) It is attributable to a mental or physical

impairment or combination of mental and physical

impairments.

(2) It is likely to continue.

(3) It results in substantial functional limitations

in one or more of the following areas of major life

activity:

(A) self-care;

(B) receptive and expressive language;

(C) learning;

(D) mobility;

(E) capacity for independent living; or

(F) economic self-sufficiency.

(c) The coverage required under this Section may be subject

to any limitations, exclusions, or cost-sharing provisions

that apply generally under the insurance policy.

(d) This Section does not apply to a policy that covers

only dental care.

(e) Nothing in this Section requires that the dental

services be covered.

(f) The provisions of this Section do not apply to

short-term travel, accident-only, limited, or specified

disease policies, nor to policies or contracts designed for

issuance to persons eligible for coverage under Title XVIII of

the Social Security Act, known as Medicare, or any other

similar coverage under State or federal governmental plans.

(Source: P.A. 95-331, eff. 8-21-07.)