Full Text of HB4479 101st General Assembly
HB4479 101ST GENERAL ASSEMBLY |
| | 101ST GENERAL ASSEMBLY
State of Illinois
2019 and 2020 HB4479 Introduced 2/4/2020, by Rep. Kathleen Willis SYNOPSIS AS INTRODUCED: |
| 215 ILCS 5/356c | from Ch. 73, par. 968c | 215 ILCS 5/356z.41 new | |
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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, 2021.
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| | A BILL FOR |
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| | | HB4479 | | LRB101 15491 BMS 64834 b |
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| 1 | | AN ACT concerning regulation.
| 2 | | Be it enacted by the People of the State of Illinois,
| 3 | | represented in the General Assembly:
| 4 | | Section 5. The Illinois Insurance Code is amended by | 5 | | changing Section 356c and by adding Section 356z.41 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 | 17 | | insurance benefits
applicable for children shall be granted | 18 | | immediately with respect to a
newly born child from the moment | 19 | | of birth. The coverage for newly born
children shall include | 20 | | coverage of illness, injury, congenital defects (including the | 21 | | treatment of cranial facial anomalies) ,
birth abnormalities | 22 | | and premature birth.
| 23 | | (3) If payment of a specific premium is required to provide |
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| 1 | | coverage
for a child, the policy may require that notification | 2 | | of birth of a
newly born child must be furnished to the insurer | 3 | | within 31 days after
the date of birth in order to have the | 4 | | coverage continue beyond such 31
day period and may require | 5 | | payment of the appropriate premium.
| 6 | | (4) In the event that no other members of the insured's | 7 | | immediate
family are covered, immediate coverage for the first | 8 | | newborn infant shall
be provided if the insured applies for | 9 | | dependent's coverage
within 31 days of the newborn's birth.
| 10 | | Such coverage shall be contingent upon payment of the | 11 | | additional premium.
| 12 | | (5) The requirements of this Section shall apply, on or | 13 | | after the
sixtieth day following the effective date of this | 14 | | Section, (a) to all
such non-group policies delivered or issued | 15 | | for delivery, and (b) to all
such group policies delivered, | 16 | | issued for delivery, renewed or amended.
The insurers of such | 17 | | non-group policies in effect on the sixtieth day
following the | 18 | | effective date of this Section shall extend to owners of
said | 19 | | policies, on or before the first policy anniversary following | 20 | | such
date, the opportunity to apply for the addition to their | 21 | | policies of a
provision as set forth in paragraph (2) above, | 22 | | with, at the option of
the insurer, payment of a premium | 23 | | appropriate thereto.
| 24 | | (Source: P.A. 85-220.)
| 25 | | (215 ILCS 5/356z.41 new) |
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| 1 | | Sec. 356z.41. Coverage for congenital anomaly or birth | 2 | | defect. | 3 | | (a) An individual or group policy of accident and health | 4 | | insurance amended, delivered, issued, or renewed after the | 5 | | effective date of this amendatory Act of the 101st General | 6 | | Assembly shall cover charges incurred and services provided for | 7 | | outpatient and inpatient care in conjunction with services that | 8 | | are provided to a covered individual related to the diagnosis | 9 | | and treatment of a congenital anomaly or birth defect. | 10 | | (b) Coverage required under this Section includes any | 11 | | services to functionally improve, repair, or restore a body | 12 | | part involving the cranial facial area that is medically | 13 | | necessary to achieve normal function or appearance. Any | 14 | | coverage provided may be subject to coverage limits, such as | 15 | | pre-authorization or pre-certification, as required by the | 16 | | plan or issuer that are no more restrictive than the | 17 | | predominant treatment limitations applied to substantially all | 18 | | medical and surgical benefits covered by the plan. | 19 | | (c) As used in this Section, "treatment" includes inpatient | 20 | | and outpatient care and services performed to improve or | 21 | | restore body function, or performed to approximate a normal | 22 | | appearance, due to congenital anomaly or birth defect involving | 23 | | the cranial facial area and includes treatment to any and all | 24 | | missing or abnormal body parts, including teeth, oral cavity, | 25 | | and their associated structures, that would otherwise be | 26 | | provided under the plan or coverage for any other injury and |
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| 1 | | sickness, up to the age of 26, including: | 2 | | (1) inpatient and outpatient care; | 3 | | (2) reconstructive services and procedures and | 4 | | complications thereof, including prosthetics and | 5 | | appliances; | 6 | | (3) adjunctive dental, orthodontic, or prosthodontic | 7 | | support, including ongoing or subsequent treatment | 8 | | required to maintain function or approximate a normal | 9 | | appearance; | 10 | | (4) procedures for secondary conditions and follow-up | 11 | | treatment; and | 12 | | (5) anesthetics provided by a dentist with a permit | 13 | | provided under Section 8.1 of the Illinois Dental Practice | 14 | | Act when performed in conjunction with the treatment | 15 | | described in this subsection (c). | 16 | | "Treatment" does not include cosmetic surgery performed to | 17 | | reshape normal facial structure or to improve appearance or | 18 | | self-esteem. | 19 | | (d) This Section does not apply to a policy that covers | 20 | | only dental care.
| 21 | | Section 99. Effective date. This Act takes effect January | 22 | | 1, 2021.
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