102ND GENERAL ASSEMBLY
State of Illinois
2021 and 2022
SB1587

 

Introduced 2/26/2021, by Sen. Laura Fine

 

SYNOPSIS AS INTRODUCED:
 
215 ILCS 5/356c  from Ch. 73, par. 968c
215 ILCS 5/356z.43 new

    Amends the Illinois Insurance Code. In provisions requiring coverage for newborn infants, provides that coverage for congenital defects shall include treatment of cranial facial anomalies. 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 involving the cranial facial area that is medically necessary to achieve normal function or appearance. 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. Provides that the coverage does not apply to a policy that covers only dental care. Defines "treatment". Effective January 1, 2022.


LRB102 13173 BMS 18516 b

 

 

A BILL FOR

 

SB1587LRB102 13173 BMS 18516 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 356c and by adding Section 356z.43 as
6follows:
 
7    (215 ILCS 5/356c)  (from Ch. 73, par. 968c)
8    Sec. 356c. (1) No policy of accident and health insurance
9providing coverage of hospital expenses or medical expenses or
10both on an expense incurred basis which in addition to
11covering the insured, also covers members of the insured's
12immediate family, shall contain any disclaimer, waiver or
13other limitation of coverage relative to the hospital or
14medical coverage or insurability of newborn infants from and
15after the moment of birth.
16    (2) Each such policy of accident and health insurance
17shall contain a provision stating that the accident and health
18insurance benefits applicable for children shall be granted
19immediately with respect to a newly born child from the moment
20of birth. The coverage for newly born children shall include
21coverage of illness, injury, congenital defects (including the
22treatment of cranial facial anomalies), birth abnormalities
23and premature birth.

 

 

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1    (3) If payment of a specific premium is required to
2provide coverage for a child, the policy may require that
3notification of birth of a newly born child must be furnished
4to the insurer within 31 days after the date of birth in order
5to have the coverage continue beyond such 31 day period and may
6require payment of the appropriate premium.
7    (4) In the event that no other members of the insured's
8immediate family are covered, immediate coverage for the first
9newborn infant shall be provided if the insured applies for
10dependent's coverage within 31 days of the newborn's birth.
11Such coverage shall be contingent upon payment of the
12additional premium.
13    (5) The requirements of this Section shall apply, on or
14after the sixtieth day following the effective date of this
15Section, (a) to all such non-group policies delivered or
16issued for delivery, and (b) to all such group policies
17delivered, issued for delivery, renewed or amended. The
18insurers of such non-group policies in effect on the sixtieth
19day following the effective date of this Section shall extend
20to owners of said policies, on or before the first policy
21anniversary following such date, the opportunity to apply for
22the addition to their policies of a provision as set forth in
23paragraph (2) above, with, at the option of the insurer,
24payment of a premium appropriate thereto.
25(Source: P.A. 85-220.)
 

 

 

SB1587- 3 -LRB102 13173 BMS 18516 b

1    (215 ILCS 5/356z.43 new)
2    Sec. 356z.43. Coverage for congenital anomaly or birth
3defect.
4    (a) An individual or group policy of accident and health
5insurance amended, delivered, issued, or renewed after the
6effective date of this amendatory Act of the 102nd General
7Assembly shall cover charges incurred and services provided
8for outpatient and inpatient care in conjunction with services
9that are provided to a covered individual related to the
10diagnosis and treatment of a congenital anomaly or birth
11defect.
12    (b) Coverage required under this Section includes any
13services to functionally improve, repair, or restore a body
14part involving the cranial facial area that is medically
15necessary to achieve normal function or appearance. Any
16coverage provided may be subject to coverage limits, such as
17pre-authorization or pre-certification, as required by the
18plan or issuer that are no more restrictive than the
19predominant treatment limitations applied to substantially all
20medical and surgical benefits covered by the plan.
21    (c) As used in this Section, "treatment" includes
22inpatient and outpatient care and services performed to
23improve or restore body function, or performed to approximate
24a normal appearance, due to congenital anomaly or birth defect
25involving the cranial facial area and includes treatment to
26any and all missing or abnormal body parts, including teeth,

 

 

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1oral cavity, and their associated structures, that would
2otherwise be provided under the plan or coverage for any other
3injury and sickness, up to the age of 26, including:
4        (1) inpatient and outpatient care;
5        (2) reconstructive services and procedures and
6    complications thereof, including prosthetics and
7    appliances;
8        (3) adjunctive dental, orthodontic, or prosthodontic
9    support, including ongoing or subsequent treatment
10    required to maintain function or approximate a normal
11    appearance;
12        (4) procedures for secondary conditions and follow-up
13    treatment; and
14        (5) anesthetics provided by a dentist with a permit
15    provided under Section 8.1 of the Illinois Dental Practice
16    Act when performed in conjunction with the treatment
17    described in this subsection (c).
18    "Treatment" does not include cosmetic surgery performed to
19reshape normal facial structure or to improve appearance or
20self-esteem.
21    (d) This Section does not apply to a policy that covers
22only dental care.
 
23    Section 99. Effective date. This Act takes effect January
241, 2022.