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1 | AN ACT concerning insurance.
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2 | Be it enacted by the People of the State of Illinois,
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3 | represented in the General Assembly:
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4 | Section 5. The Uniform Prescription Drug Information Card | ||||||
5 | Act is amended by changing Section 15 as follows: | ||||||
6 | (215 ILCS 138/15) | ||||||
7 | Sec. 15. Uniform prescription drug information cards | ||||||
8 | required. | ||||||
9 | (a) A health benefit plan that issues a card or other | ||||||
10 | technology and
provides coverage for prescription drugs or
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11 | devices
and an administrator of such a plan including, but not | ||||||
12 | limited to, third-party
administrators for self-insured plans | ||||||
13 | and state-administered plans shall issue
to its
insureds a card | ||||||
14 | or other technology containing uniform prescription drug
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15 | information. The uniform prescription drug information card or | ||||||
16 | other
technology shall
specifically identify and display the | ||||||
17 | following
mandatory data elements on the front of the card: | ||||||
18 | (1) BIN number; | ||||||
19 | (2) Processor control number if required for claims | ||||||
20 | adjudication; | ||||||
21 | (3) Group number; | ||||||
22 | (4) Card issuer identifier; | ||||||
23 | (5) Cardholder ID number; and |
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1 | (6) Cardholder name. | ||||||
2 | The uniform prescription drug information card or other | ||||||
3 | technology shall
specifically identify and display the | ||||||
4 | following mandatory data elements on the
back of the card: | ||||||
5 | (1) Claims submission names and addresses; and | ||||||
6 | (2) Help desk telephone numbers and names. | ||||||
7 | (b) A new uniform prescription drug information card or | ||||||
8 | other technology
shall be
issued by a health benefit plan upon | ||||||
9 | enrollment and reissued upon any change in
the insured's | ||||||
10 | coverage that affects mandatory data elements contained on the
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11 | card. | ||||||
12 | (c) Notwithstanding subsections (a) and (b) of this | ||||||
13 | Section, a discounted health care services plan administrator | ||||||
14 | providing discounts on prescription drugs or devices shall | ||||||
15 | issue to its beneficiaries a card containing the following | ||||||
16 | mandatory data elements: | ||||||
17 | (1) an Internet website for beneficiaries to access | ||||||
18 | up-to-date lists of preferred providers; | ||||||
19 | (2) a toll-free help desk number for beneficiaries and | ||||||
20 | providers to access up-to-date lists of preferred | ||||||
21 | providers and additional information about the discounted | ||||||
22 | health care services plan; | ||||||
23 | (3) the name or logo of the provider network; | ||||||
24 | (4) a BIN number; | ||||||
25 | (5) a group number; | ||||||
26 | (6) a cardholder ID number; |
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1 | (7) the cardholder's name or a space to permit the | ||||||
2 | cardholder to print his or her name, if the cardholder pays | ||||||
3 | a periodic charge for use of the card; | ||||||
4 | (8) a processor control number, if required for claims | ||||||
5 | adjudication; and | ||||||
6 | (9) a statement that the plan is not insurance. | ||||||
7 | (d) As used in this Section, "discounted health care | ||||||
8 | services plan administrator" means any person, partnership, or | ||||||
9 | corporation, other than an insurer, health service | ||||||
10 | corporation, limited health service organization holding a | ||||||
11 | certificate of authority under the Limited Health Service | ||||||
12 | Organization Act, or health maintenance organization holding a | ||||||
13 | certificate of authority under the Health Maintenance | ||||||
14 | Organization Act that arranges, contracts with, or administers | ||||||
15 | contracts with a provider whereby insureds or beneficiaries are | ||||||
16 | provided an incentive to use health care services provided by | ||||||
17 | health care services providers under a discounted health care | ||||||
18 | services plan in which there are no other incentives, such as | ||||||
19 | copayment, coinsurance, or any other reimbursement | ||||||
20 | differential, for beneficiaries to utilize the provider. | ||||||
21 | "Discounted health care services plan administrator" also | ||||||
22 | includes any person, partnership, or corporation, other than an | ||||||
23 | insurer, health service corporation, limited health service | ||||||
24 | organization holding a certificate of authority under the | ||||||
25 | Limited Health Service Organization Act, or health maintenance | ||||||
26 | organization holding a certificate of authority under the |
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1 | Health Maintenance Organization Act that enters into a contract | ||||||
2 | with another administrator to enroll beneficiaries or insureds | ||||||
3 | in a preferred provider program marketed as an independently | ||||||
4 | identifiable program based on marketing materials or member | ||||||
5 | benefit identification cards. | ||||||
6 | (Source: P.A. 91-777, eff. 1-1-01.) | ||||||
7 | Section 10. The Uniform Health Care Service Benefits | ||||||
8 | Information Card Act is amended by changing Section 15 as | ||||||
9 | follows: | ||||||
10 | (215 ILCS 139/15) | ||||||
11 | Sec. 15. Uniform health care benefit information cards | ||||||
12 | required. | ||||||
13 | (a) A health benefit plan that issues a card or other | ||||||
14 | technology and
provides coverage for health care services | ||||||
15 | including prescription drugs or
devices also referred to as | ||||||
16 | health care benefits and an administrator of such a
plan | ||||||
17 | including, but not limited to, third-party administrators for | ||||||
18 | self-insured
plans and state-administered plans shall issue to | ||||||
19 | its insureds a card or other
technology containing uniform | ||||||
20 | health care benefit information. The health care
benefit | ||||||
21 | information card or other technology shall specifically | ||||||
22 | identify and
display the following mandatory data elements on | ||||||
23 | the card: | ||||||
24 | (1) processor control number, if required for claims |
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1 | adjudication; | ||||||
2 | (2) group number; | ||||||
3 | (3) card issuer identifier; | ||||||
4 | (4) cardholder ID number; and | ||||||
5 | (5) cardholder name. | ||||||
6 | (b) The uniform health care benefit information card or | ||||||
7 | other technology
shall specifically identify and display the | ||||||
8 | following mandatory data elements
on the back of the card: | ||||||
9 | (1) claims submission names and addresses; and | ||||||
10 | (2) help desk telephone numbers and names. | ||||||
11 | (c) A new uniform health care benefit information card or | ||||||
12 | other technology
shall be issued by a health benefit plan upon | ||||||
13 | enrollment and reissued upon any
change in the insured's | ||||||
14 | coverage that affects mandatory data elements contained
on the | ||||||
15 | card. | ||||||
16 | (d) Notwithstanding subsections (a), (b), and (c) of this | ||||||
17 | Section, a discounted health care services plan administrator | ||||||
18 | shall issue to its beneficiaries a card containing the | ||||||
19 | following mandatory data elements: | ||||||
20 | (1) an Internet website for beneficiaries to access | ||||||
21 | up-to-date lists of preferred providers; | ||||||
22 | (2) a toll-free help desk number for beneficiaries and | ||||||
23 | providers to access up-to-date lists of preferred | ||||||
24 | providers and additional information about the discounted | ||||||
25 | health care services plan; | ||||||
26 | (3) the name or logo of the provider network; |
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1 | (4) a group number, if necessary for the processing of | ||||||
2 | benefits; | ||||||
3 | (5) a cardholder ID number; | ||||||
4 | (6) the cardholder's name or a space to permit the | ||||||
5 | cardholder to print his or her name, if the cardholder pays | ||||||
6 | a periodic charge for use of the card; | ||||||
7 | (7) a processor control number, if required for claims | ||||||
8 | adjudication; and | ||||||
9 | (8) a statement that the plan is not insurance. | ||||||
10 | (e) As used in this Section, "discounted health care | ||||||
11 | services plan administrator" means any person, partnership, or | ||||||
12 | corporation, other than an insurer, health service | ||||||
13 | corporation, limited health service organization holding a | ||||||
14 | certificate of authority under the Limited Health Service | ||||||
15 | Organization Act, or health maintenance organization holding a | ||||||
16 | certificate of authority under the Health Maintenance | ||||||
17 | Organization Act that arranges, contracts with, or administers | ||||||
18 | contracts with a provider whereby insureds or beneficiaries are | ||||||
19 | provided an incentive to use health care services provided by | ||||||
20 | health care services providers under a discounted health care | ||||||
21 | services plan in which there are no other incentives, such as | ||||||
22 | copayment, coinsurance, or any other reimbursement | ||||||
23 | differential, for beneficiaries to utilize the provider. | ||||||
24 | "Discounted health care services plan administrator" also | ||||||
25 | includes any person, partnership, or corporation, other than an | ||||||
26 | insurer, health service corporation, limited health service |
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| |||||||
1 | organization holding a certificate of authority under the | ||||||
2 | Limited Health Service Organization Act, or health maintenance | ||||||
3 | organization holding a certificate of authority under the | ||||||
4 | Health Maintenance Organization Act that enters into a contract | ||||||
5 | with another administrator to enroll beneficiaries or insureds | ||||||
6 | in a preferred provider program marketed as an independently | ||||||
7 | identifiable program based on marketing materials or member | ||||||
8 | benefit identification cards. | ||||||
9 | (Source: P.A. 92-106, eff. 1-1-02.)
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