Sen. Julie A. Morrison

Filed: 2/5/2019





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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 or a physician licensed to practice medicine in
11all of its branches under the Medical Practice Act of 1987, in
12conjunction with dental care that is provided to a covered
13individual in a dental office, oral surgeon's office, hospital,
14or ambulatory surgical treatment center if the individual is
15under age 26 19 and has been diagnosed with an autism spectrum
16disorder as defined in Section 10 of the Autism Spectrum
17Disorders Reporting Act or a developmental disability. A
18covered individual shall be required to make 2 visits to the
19dental care provider prior to accessing other coverage under
20this subsection.
21    For purposes of this subsection, "developmental
22disability" means a disability that is attributable to an
23intellectual disability or a related condition, if the related
24condition meets all of the following conditions:
25        (1) it is attributable to cerebral palsy, epilepsy, or
26    any other condition, other than mental illness, found to be



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



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1    activity:
2            (A) self-care;
3            (B) receptive and expressive language;
4            (C) learning;
5            (D) mobility;
6            (E) capacity for independent living; or
7            (F) economic self-sufficiency.
8    (c) The coverage required under this Section may be subject
9to any limitations, exclusions, or cost-sharing provisions
10that apply generally under the insurance policy.
11    (d) This Section does not apply to a policy that covers
12only dental care.
13    (e) Nothing in this Section requires that the dental
14services be covered.
15    (f) The provisions of this Section do not apply to
16short-term travel, accident-only, limited, or specified
17disease policies, nor to policies or contracts designed for
18issuance to persons eligible for coverage under Title XVIII of
19the Social Security Act, known as Medicare, or any other
20similar coverage under State or federal governmental plans.
21(Source: P.A. 99-141, eff. 1-1-16; 99-143, eff. 7-27-15;
2299-642, eff. 7-28-16.)".