State of Illinois
2019 and 2020


Introduced 1/23/2019, by Sen. Julie A. Morrison


215 ILCS 5/356z.2

    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).

LRB101 04609 SMS 49617 b





SB0111LRB101 04609 SMS 49617 b

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



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1        (3) it is likely to continue indefinitely; and
2        (4) it results in substantial functional limitations
3    in 3 or more of the following areas of major life activity:
4    self-care, language, learning, mobility, self-direction,
5    and capacity for independent living.
6    (b) For purposes of this Section, "ambulatory surgical
7treatment center" has the meaning given to that term in Section
83 of the Ambulatory Surgical Treatment Center Act.
9    For purposes of this Section, "person with a disability"
10means a person, regardless of age, with a chronic disability if
11the chronic disability meets all of the following conditions:
12        (1) It is attributable to a mental or physical
13    impairment or combination of mental and physical
14    impairments.
15        (2) It is likely to continue.
16        (3) It results in substantial functional limitations
17    in one or more of the following areas of major life
18    activity:
19            (A) self-care;
20            (B) receptive and expressive language;
21            (C) learning;
22            (D) mobility;
23            (E) capacity for independent living; or
24            (F) economic self-sufficiency.
25    (c) The coverage required under this Section may be subject
26to any limitations, exclusions, or cost-sharing provisions



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1that apply generally under the insurance policy.
2    (d) This Section does not apply to a policy that covers
3only dental care.
4    (e) Nothing in this Section requires that the dental
5services be covered.
6    (f) The provisions of this Section do not apply to
7short-term travel, accident-only, limited, or specified
8disease policies, nor to policies or contracts designed for
9issuance to persons eligible for coverage under Title XVIII of
10the Social Security Act, known as Medicare, or any other
11similar coverage under State or federal governmental plans.
12(Source: P.A. 99-141, eff. 1-1-16; 99-143, eff. 7-27-15;
1399-642, eff. 7-28-16.)