Rep. Kathleen Willis

Filed: 5/6/2019





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2    AMENDMENT NO. ______. Amend Senate Bill 111 by replacing
3everything after the enacting clause with the following:
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;



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1        (2) the individual has a medical condition that
2    requires hospitalization or general anesthesia for dental
3    care; or
4        (3) the individual is a person with a disability.
5    (a-5) An individual or group policy of accident and health
6insurance amended, delivered, issued, or renewed after January
71, 2016 (the effective date of Public Act 99-141) shall cover
8charges incurred, and anesthetics provided by a dentist with a
9permit provided under Section 8.1 of the Illinois Dental
10Practice Act, in conjunction with dental care that is provided
11to a covered individual in a dental office, oral surgeon's
12office, hospital, or ambulatory surgical treatment center if
13the individual is under age 26 19 and has been diagnosed with
14an autism spectrum disorder as defined in Section 10 of the
15Autism Spectrum Disorders Reporting Act or a developmental
16disability. A covered individual shall be required to make 2
17visits to the dental care provider prior to accessing other
18coverage under this subsection.
19    For purposes of this subsection, "developmental
20disability" means a disability that is attributable to an
21intellectual disability or a related condition, if the related
22condition meets all of the following conditions:
23        (1) it is attributable to cerebral palsy, epilepsy, or
24    any other condition, other than mental illness, found to be
25    closely related to an intellectual disability because that
26    condition results in impairment of general intellectual



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1    functioning or adaptive behavior similar to that of
2    individuals with an intellectual disability and requires
3    treatment or services similar to those required for those
4    individuals; for purposes of this definition, autism is
5    considered a related condition;
6        (2) it is manifested before the individual reaches age
7    22;
8        (3) it is likely to continue indefinitely; and
9        (4) it results in substantial functional limitations
10    in 3 or more of the following areas of major life activity:
11    self-care, language, learning, mobility, self-direction,
12    and capacity for independent living.
13    (b) For purposes of this Section, "ambulatory surgical
14treatment center" has the meaning given to that term in Section
153 of the Ambulatory Surgical Treatment Center Act.
16    For purposes of this Section, "person with a disability"
17means a person, regardless of age, with a chronic disability if
18the chronic disability meets all of the following conditions:
19        (1) It is attributable to a mental or physical
20    impairment or combination of mental and physical
21    impairments.
22        (2) It is likely to continue.
23        (3) It results in substantial functional limitations
24    in one or more of the following areas of major life
25    activity:
26            (A) self-care;



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1            (B) receptive and expressive language;
2            (C) learning;
3            (D) mobility;
4            (E) capacity for independent living; or
5            (F) economic self-sufficiency.
6    (c) The coverage required under this Section may be subject
7to any limitations, exclusions, or cost-sharing provisions
8that apply generally under the insurance policy.
9    (d) This Section does not apply to a policy that covers
10only dental care.
11    (e) Nothing in this Section requires that the dental
12services be covered.
13    (f) The provisions of this Section do not apply to
14short-term travel, accident-only, limited, or specified
15disease policies, nor to policies or contracts designed for
16issuance to persons eligible for coverage under Title XVIII of
17the Social Security Act, known as Medicare, or any other
18similar coverage under State or federal governmental plans.
19(Source: P.A. 99-141, eff. 1-1-16; 99-143, eff. 7-27-15;
2099-642, eff. 7-28-16.)".