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FAQ: Illinois Health Insurance Coverage of Anesthesia for Dental Care

February 01, 2016

Illinois Health Insurance Coverage of Anesthesia for Dental Care for Individuals with Autism or Developmental Disabilities

Illinois Public Act 99-0141 amends existing State law related to coverage for adjunctive services in dental care to include coverage for charges incurred, and anesthetics provided to individuals with an autism spectrum disorder or a developmental disability.  

To which type of health insurance plans does PA 99-0141 apply?

The law applies to State Employee Health Benefit Plans administered by the Illinois Department of Central Management Services, individual plans and fully insured group plans.  Terms of coverage do not apply to self funded health benefit plans, Medicaid, Tricare or Federal Employee Health Benefit plans.  

How can I tell what type of health insurance plan I have?

If you purchased a health plan directly from an insurance company or broker, it is likely an “individual plan.”  If you obtain health insurance through your (or your spouse’s) employer you may need to do a little investigating to determine whether it is “fully insured” and subject to State law, or “self funded.”  Self funded plans are federally regulated and therefore not subject to PA 99-0141.

If this information is not printed on your insurance card, please review your Summary Plan Description or contact your Human Resources Department.

Are there any restrictions on coverage? 

Individuals with autism or developmental disabilities are entitled to benefits under this law until age 19.  Two (2) visits to a dental care provider are required prior to accessing coverage for anesthesia.

Who can provide the services?

Services must be provided by a dentist with a permit for the administration of anesthesia and sedation provided under Section 8.1 of the Illinois Dental Practice Act.

Where can services be provided?

Coverage applies to services provided in a dental office, oral surgeon’s office, hospital or ambulatory surgical treatment center.

When does the law take effect?

PA 99-0141 takes effect January 1, 2016.

Where can I find more details about the law?

For more details, the entire text of PA-99-0141 can be found here.  If you have additional question, please contact your health insurance company or your child’s dentist.