Illinois 2023-2024 Regular Session

Illinois House Bill HB3974 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB3974 Introduced , by Rep. Joyce Mason SYNOPSIS AS INTRODUCED: 215 ILCS 5/356z.61 new Amends the Illinois Insurance Code. 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, 2024. LRB103 29802 BMS 56209 b A BILL FOR 103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB3974 Introduced , by Rep. Joyce Mason SYNOPSIS AS INTRODUCED: 215 ILCS 5/356z.61 new 215 ILCS 5/356z.61 new Amends the Illinois Insurance Code. 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, 2024. LRB103 29802 BMS 56209 b LRB103 29802 BMS 56209 b A BILL FOR
2	2	103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB3974 Introduced , by Rep. Joyce Mason SYNOPSIS AS INTRODUCED:
3	3	215 ILCS 5/356z.61 new 215 ILCS 5/356z.61 new
4	4	215 ILCS 5/356z.61 new
5	5	Amends the Illinois Insurance Code. 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, 2024.
6	6	LRB103 29802 BMS 56209 b LRB103 29802 BMS 56209 b
7	7	LRB103 29802 BMS 56209 b
8	8	A BILL FOR
9	9	HB3974LRB103 29802 BMS 56209 b HB3974 LRB103 29802 BMS 56209 b
10	10	HB3974 LRB103 29802 BMS 56209 b
11	11	1 AN ACT concerning regulation.
12	12	2 Be it enacted by the People of the State of Illinois,
13	13	3 represented in the General Assembly:
14	14	4 Section 5. The Illinois Insurance Code is amended by
15	15	5 adding Section 356z.61 as follows:
16	16	6 (215 ILCS 5/356z.61 new)
17	17	7 Sec. 356z.61. Coverage for congenital anomaly or birth
18	18	8 defect.
19	19	9 (a) An individual or group policy of accident and health
20	20	10 insurance amended, delivered, issued, or renewed after the
21	21	11 effective date of this amendatory Act of the 103rd General
22	22	12 Assembly shall cover charges incurred and services provided
23	23	13 for outpatient and inpatient care in conjunction with services
24	24	14 that are provided to a covered individual related to the
25	25	15 diagnosis and treatment of a congenital anomaly or birth
26	26	16 defect, including, but not limited to, cleft lip and cleft
27	27	17 palate.
28	28	18 (b) Coverage required under this Section includes any
29	29	19 services to functionally improve, repair, or restore a body
30	30	20 part involving the cranial facial area, including cleft lip
31	31	21 and cleft palate, that is medically necessary to achieve
32	32	22 normal function or appearance. Any coverage provided may be
33	33	23 subject to coverage limits, such as pre-authorization or
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37	37	103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 HB3974 Introduced , by Rep. Joyce Mason SYNOPSIS AS INTRODUCED:
38	38	215 ILCS 5/356z.61 new 215 ILCS 5/356z.61 new
39	39	215 ILCS 5/356z.61 new
40	40	Amends the Illinois Insurance Code. 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, 2024.
41	41	LRB103 29802 BMS 56209 b LRB103 29802 BMS 56209 b
42	42	LRB103 29802 BMS 56209 b
43	43	A BILL FOR
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49	49	215 ILCS 5/356z.61 new
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67	67	HB3974 - 2 - LRB103 29802 BMS 56209 b
68	68	1 pre-certification, as required by the plan or issuer that are
69	69	2 no more restrictive than the predominant treatment limitations
70	70	3 applied to substantially all medical and surgical benefits
71	71	4 covered by the plan.
72	72	5 (c) As used in this Section, "treatment" includes
73	73	6 inpatient and outpatient care and services performed to
74	74	7 improve or restore body function, or performed to approximate
75	75	8 a normal appearance, due to a congenital anomaly, such as
76	76	9 cleft lip or cleft palate, involving the cranial facial area
77	77	10 and includes treatment of gross abnormalities of the lip and
78	78	11 palate and any condition or illness that is related to or
79	79	12 developed as a result of cleft lip or cleft palate.
80	80	13 "Treatment" does not include cosmetic surgery performed to
81	81	14 reshape normal facial structure or to improve appearance or
82	82	15 self-esteem.
83	83	16 (d) Coverage shall include, but not be limited to,
84	84	17 expenses for the following services up to the age of 19:
85	85	18 (1) oral surgery of the lip, palate, jaw, and related
86	86	19 structures, including bone grafts;
87	87	20 (2) facial surgery of the lip, palate, jaw, nose, and
88	88	21 related structures, including bone grafts;
89	89	22 (3) prosthetic treatment and appliances and
90	90	23 prosthodontia, including obturators, speech appliances,
91	91	24 and feeding appliances;
92	92	25 (4) orthodontic treatment and appliances and
93	93	26 orthodontia;
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99	99	HB3974 - 2 - LRB103 29802 BMS 56209 b
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102	102	HB3974- 3 -LRB103 29802 BMS 56209 b HB3974 - 3 - LRB103 29802 BMS 56209 b
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104	104	1 (5) preventative and restorative dentistry;
105	105	2 (6) otolaryngology treatment and management; and
106	106	3 (7) anesthetics provided by a dentist with a permit
107	107	4 provided under Section 8.1 of the Illinois Dental Practice
108	108	5 Act when performed in conjunction with the treatment
109	109	6 described in this Section.
110	110	7 Coverage shall not be denied solely on the grounds that
111	111	8 the treatment is for cosmetic purposes or is not for a
112	112	9 functional defect or impairment as provided in this Section.
113	113	10 (e) This Section does not apply to a policy that covers
114	114	11 only dental care.
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120	120	HB3974 - 3 - LRB103 29802 BMS 56209 b