Coverage for anesthesia in dental careribbon

Illinois Insurance Code

    (Text of Section from P.A. 92-764) (215 ILCS 5/356z.2)

    Sec. 356z.2. Coverage for adjunctive services in dental care.

    (a) An individual or group policy of accident and health insurance amended, delivered, issued, or renewed after the effective date of this amendatory Act of the 92nd General Assembly shall cover charges incurred, and anesthetics provided, in conjunction with dental care that is provided to a covered individual in a hospital or an ambulatory surgical treatment center if any of the following applies:   (b) For purposes of this Section, "ambulatory surgical treatment center" has the meaning given to that term in Section 3 of the Ambulatory Surgical Treatment Center Act.
    For purposes of this Section, "disabled" means a person, regardless of age, with a chronic disability if the chronic disability meets all of the following conditions:
        (1) It is attributable to a mental or physical impairment or combination of mental and physical impairments.
        (2) It is likely to continue.
        (3) It results in substantial functional limitations in one or more of the following areas of major life activity:
            (A) self-care;
            (B) receptive and expressive language;
            (C) learning;
            (D) mobility;
            (E) capacity for independent living; or
            (F) economic self-sufficiency.

    (c) The coverage required under this Section may be subject to any limitations, exclusions, or cost-sharing provisions that apply generally under the insurance policy.

    (d) This Section does not apply to a policy that covers only dental care.

    (e) Nothing in this Section requires that the dental services be covered.

    (f) The provisions of this Section do not apply to short-term travel, accident-only, limited, or specified disease policies, nor to policies or contracts designed for issuance to persons eligible for coverage under Title XVIII of the Social Security Act, known as Medicare, or any other similar coverage under State or federal governmental plans.

(Source: P.A. 92-764, eff. 1/ 1 /2003.)

 (210 ILCS 5/3) (from former Ill. Rev. Stat. Ch. 111 1/2, par. 157-8.3)

    Sec. 3. As used in this Act, unless the context otherwise requires, the following words and phrases shall have the meanings ascribed to them:
    (A) "Ambulatory surgical treatment center" means any institution, place or building devoted primarily to the maintenance and operation of facilities for the performance of surgical procedures or any facility in which a medical or surgical procedure is utilized to terminate a pregnancy, irrespective of whether the facility is devoted primarily to this purpose. Such facility shall not provide beds or other accommodations for the overnight stay of patients; however, facilities devoted exclusively to the treatment of children may provide accommodations and beds for their patients for up to 23 hours following admission. Individual patients shall be discharged in an ambulatory condition without danger to the continued well being of the patients or shall be transferred to a hospital.

    The term "ambulatory surgical treatment center" does not include any of the following:
        (1) Any institution, place, building or agency required to be licensed pursuant to the "Hospital Licensing Act", approved July 1, 1953, as amended.
        (2) Any person or institution required to be licensed pursuant to the "Nursing Home Care Act", approved August 23, 1979, as amended.
         (3) Hospitals or ambulatory surgical treatment centers maintained by the State or any department or agency thereof, where such department or agency has authority under law to establish and enforce standards for the hospitals or ambulatory surgical treatment centers under its management and control.
         (4) Hospitals or ambulatory surgical treatment centers maintained by the Federal Government or agencies thereof.
         (5) Any place, agency, clinic, or practice, public or private, whether organized for profit or not, devoted exclusively to the performance of dental or oral surgical procedures.

  1. P.A. 92-764 also specified that the above dental mandate also applied to State  Employees Group Insurance, Voluntary Health Services Plans  and HMOs.
  2. (There are actually two sections in the Illinois Insurance Code with the name "section 356z2.")