§ 356z.55 — Coverage for cleft lip and cleft palate

Illinois § 356z.55

• Jurisdiction: Illinois
• Topic: REGULATION
• Ch. 215: INSURANCE
• Act 215 ILCS 5/: Illinois Insurance Code.
• Art.: Article XX - Accident And Health Insurance

Text

(a) As used in this Section, "medically necessary care and treatment" to address congenital anomalies associated with a cleft lip or palate, or both, includes: (1) oral and facial surgery, including reconstructive services and procedures necessary to improve and restore and maintain vital functions; (2) prosthetic treatment such as obturators, speech appliances, and feeding appliances; (3) orthodontic treatment and management; (4) prosthodontic treatment and management; and (5) otolaryngology treatment and management. "Medically necessary care and treatment" does not include cosmetic surgery performed to reshape normal structures of the lip, jaw, palate, or other facial structures to improve appearance. (b) An individual or group policy of accident and health insurance amended, delivered, issued, or renewed on or after January 1, 2024 (the effective date of Public Act 102-768) shall provide coverage for the medically necessary care and treatment of cleft lip and palate for children under the age of 19. 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. (c) This Section does not apply to a policy that covers only dental care.

Legislative History

(Source: P.A. 102-768, eff. 1-1-24; 103-154, eff. 6-30-23 .)