Full Text of HB4479 101st General Assembly
HB4479ham001 101ST GENERAL ASSEMBLY | Rep. Kathleen Willis Filed: 3/3/2020
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| 1 | | AMENDMENT TO HOUSE BILL 4479
| 2 | | AMENDMENT NO. ______. Amend House Bill 4479 by replacing | 3 | | everything after the enacting clause with the following:
| 4 | | "Section 5. The Illinois Insurance Code is amended by | 5 | | changing Section 356c and by adding Section 356z.43 as follows:
| 6 | | (215 ILCS 5/356c) (from Ch. 73, par. 968c)
| 7 | | Sec. 356c.
(1) No policy of accident and health insurance | 8 | | providing
coverage of hospital expenses or medical expenses or
| 9 | | both on an expense incurred basis which in addition to covering | 10 | | the
insured, also covers members of the insured's immediate | 11 | | family, shall
contain any disclaimer, waiver or other | 12 | | limitation of coverage relative to
the hospital or medical
| 13 | | coverage or insurability of newborn infants from and after
the | 14 | | moment of birth.
| 15 | | (2) Each such policy of accident and health insurance shall | 16 | | contain
a provision stating that the accident and health |
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| 1 | | insurance benefits
applicable for children shall be granted | 2 | | immediately with respect to a
newly born child from the moment | 3 | | of birth. The coverage for newly born
children shall include | 4 | | coverage of illness, injury, congenital defects (including the | 5 | | treatment of cranial facial anomalities, including, but not | 6 | | limited to, cleft lip or cleft palate) ,
birth abnormalities and | 7 | | premature birth.
| 8 | | (3) If payment of a specific premium is required to provide | 9 | | coverage
for a child, the policy may require that notification | 10 | | of birth of a
newly born child must be furnished to the insurer | 11 | | within 31 days after
the date of birth in order to have the | 12 | | coverage continue beyond such 31
day period and may require | 13 | | payment of the appropriate premium.
| 14 | | (4) In the event that no other members of the insured's | 15 | | immediate
family are covered, immediate coverage for the first | 16 | | newborn infant shall
be provided if the insured applies for | 17 | | dependent's coverage
within 31 days of the newborn's birth.
| 18 | | Such coverage shall be contingent upon payment of the | 19 | | additional premium.
| 20 | | (5) The requirements of this Section shall apply, on or | 21 | | after the
sixtieth day following the effective date of this | 22 | | Section, (a) to all
such non-group policies delivered or issued | 23 | | for delivery, and (b) to all
such group policies delivered, | 24 | | issued for delivery, renewed or amended.
The insurers of such | 25 | | non-group policies in effect on the sixtieth day
following the | 26 | | effective date of this Section shall extend to owners of
said |
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| 1 | | policies, on or before the first policy anniversary following | 2 | | such
date, the opportunity to apply for the addition to their | 3 | | policies of a
provision as set forth in paragraph (2) above, | 4 | | with, at the option of
the insurer, payment of a premium | 5 | | appropriate thereto.
| 6 | | (Source: P.A. 85-220.)
| 7 | | (215 ILCS 5/356z.43 new) | 8 | | Sec. 356z.43. Coverage for congenital anomaly or birth | 9 | | defect. | 10 | | (a) An individual or group policy of accident and health | 11 | | insurance amended, delivered, issued, or renewed after the | 12 | | effective date of this amendatory Act of the 101st General | 13 | | Assembly shall cover charges incurred and services provided for | 14 | | outpatient and inpatient care in conjunction with services that | 15 | | are provided to a covered individual related to the diagnosis | 16 | | and treatment of a congenital anomaly or birth defect, | 17 | | including, but not limited to, cleft lip and cleft palate. | 18 | | (b) Coverage required under this Section includes any | 19 | | services to functionally improve, repair, or restore a body | 20 | | part involving the cranial facial area, including cleft lip and | 21 | | cleft palate, that is medically necessary to achieve normal | 22 | | function or appearance. Any coverage provided may be subject to | 23 | | coverage limits, such as pre-authorization or | 24 | | pre-certification, as required by the plan or issuer that are | 25 | | no more restrictive than the predominant treatment limitations |
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| 1 | | applied to substantially all medical and surgical benefits | 2 | | covered by the plan. | 3 | | (c) As used in this Section, "treatment" includes inpatient | 4 | | and outpatient care and services performed to improve or | 5 | | restore body function, or performed to approximate a normal | 6 | | appearance, due to a congenital anomaly, such as cleft lip or | 7 | | cleft palate, involving the cranial facial area and includes | 8 | | treatment of gross abnormalities of the lip and palate and any | 9 | | condition or illness that is related to or developed as a | 10 | | result of cleft lip or cleft palate. "Treatment" does not | 11 | | include cosmetic surgery performed to reshape normal facial | 12 | | structure or to improve appearance or self-esteem. | 13 | | (d) Coverage shall include, but not be limited to, expenses | 14 | | for the following services up to the age of 19: | 15 | | (1) oral surgery of the lip, palate, jaw, and related | 16 | | structures, including bone grafts; | 17 | | (2) facial surgery of the lip, palate, jaw, nose, and | 18 | | related structures, including bone grafts; | 19 | | (3) prosthetic treatment and appliances and | 20 | | prosthodontia, including obturators, speech appliances, | 21 | | and feeding appliances; | 22 | | (4) orthodontic treatment and appliances and | 23 | | orthodontia; | 24 | | (5) preventative and restorative dentistry; | 25 | | (6) otolaryngology treatment and management; and | 26 | | (7) anesthetics provided by a dentist with a permit |
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| 1 | | provided under Section 8.1 of the Illinois Dental Practice | 2 | | Act when performed in conjunction with the treatment | 3 | | described in this Section. | 4 | | Coverage shall not be denied solely on the grounds that the | 5 | | treatment is for cosmetic purposes or is not for a functional | 6 | | defect or impairment as provided in this Section. | 7 | | (e) This Section does not apply to a policy that covers | 8 | | only dental care.
| 9 | | Section 99. Effective date. This Act takes effect January | 10 | | 1, 2021.".
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