Sec. 40. Coverage; prior authorization.
142 words·~1 min read·
/il/chapter-215/act-109/40A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
Sec. 40. Coverage; prior authorization. A managed care dental plan shall:
(1)cover palliative treatment for emergency dental services, as included in its
certificate of coverage, without regard to whether the provider furnishing the services has a contractual or other arrangement with the entity to provide items or services to covered individuals, provided that the enrollee has made a reasonable attempt to first obtain service through the appropriate primary care dentist; and
(2)if an enrollee suffers trauma to the mouth, teeth or oral cavity that results in a
need for emergency dental services, as included in the certificate of coverage, provide that the prior authorization requirement for emergency dental is waived.
Nothing in this Section shall be deemed as requiring managed care dental plans to provide coverage for emergency dental services in excess of that required in the Illinois Insurance Code.