HB 4349

Abstract

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 services to functionally improve, repair, or restore a 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 coverage for a congenital anomaly or birth defect shall include expenses for specified services and items up to the age of 19. Provides that coverage shall not be denied solely on the grounds that the treatment is for cosmetic purposes or is not for a functional defect or impairment. Provides that the coverage does not apply to a policy that covers only dental care. Defines "treatment". Makes conforming changes in the State Employees Group Insurance Act of 1971. Effective January 1, 2024. House Committee Amendment No. 1 Replaces everything after the enacting clause. Amends the Illinois Insurance Code. In provisions requiring coverage for newborn infants, provides that coverage for congenital defects shall include the treatment of cleft lip and cleft palate. Provides that an individual or group policy of accident and health insurance amended, delivered, issued, or renewed on or after the effective date of the amendatory Act shall provide coverage for the medically necessary care and treatment of cleft lip and palate for children under the age of 19. Provides that coverage for cleft lip and palate care and treatment may impose the same deductible, coinsurance, or other cost-sharing limitation that is imposed on other related surgical benefits under the policy. Provides that the coverage does not apply to a policy that covers only dental care. Defines "medically necessary care and treatment". Makes conforming changes in the State Employees Group Insurance Act of 1971. Effective January 1, 2024.