Sen. James A. DeLeo
Filed: 4/15/2010
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1 | AMENDMENT TO HOUSE BILL 5527
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2 | AMENDMENT NO. ______. Amend House Bill 5527 by replacing | ||||||
3 | everything after the enacting clause with the following:
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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 |
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1 | following
mandatory data elements on the front of the card: | ||||||
2 | (1) BIN number; | ||||||
3 | (2) Processor control number if required for claims | ||||||
4 | adjudication; | ||||||
5 | (3) Group number; | ||||||
6 | (4) Card issuer identifier; | ||||||
7 | (5) Cardholder ID number; and | ||||||
8 | (6) Cardholder name. | ||||||
9 | The uniform prescription drug information card or other | ||||||
10 | technology shall
specifically identify and display the | ||||||
11 | following mandatory data elements on the
back of the card: | ||||||
12 | (1) Claims submission names and addresses; and | ||||||
13 | (2) Help desk telephone numbers and names. | ||||||
14 | (b) A new uniform prescription drug information card or | ||||||
15 | other technology
shall be
issued by a health benefit plan upon | ||||||
16 | enrollment and reissued upon any change in
the insured's | ||||||
17 | coverage that affects mandatory data elements contained on the
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18 | card. | ||||||
19 | (c) Notwithstanding subsections (a) and (b) of this | ||||||
20 | Section, a discounted health care services plan administrator | ||||||
21 | providing discounts on prescription drugs or devices shall | ||||||
22 | issue to its beneficiaries a card containing the following | ||||||
23 | mandatory data elements: | ||||||
24 | (1) an Internet website for beneficiaries to access | ||||||
25 | up-to-date lists of preferred providers; | ||||||
26 | (2) a toll-free help desk number for beneficiaries and |
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1 | providers to access up-to-date lists of preferred | ||||||
2 | providers and additional information about the discounted | ||||||
3 | health care services plan; | ||||||
4 | (3) the name or logo of the provider network; | ||||||
5 | (4) a group number; | ||||||
6 | (5) a cardholder ID number; | ||||||
7 | (6) the cardholder's name or a space to permit the | ||||||
8 | cardholder to print his or her name, if the cardholder pays | ||||||
9 | a periodic charge for use of the card; | ||||||
10 | (7) a processor control number, if required for claims | ||||||
11 | adjudication; and | ||||||
12 | (8) a statement that the plan is not insurance. | ||||||
13 | (d) As used in this Section, "discounted health care | ||||||
14 | services plan administrator" means any person, partnership, or | ||||||
15 | corporation, other than an insurer, health service | ||||||
16 | corporation, limited health service organization holding a | ||||||
17 | certificate of authority under the Limited Health Service | ||||||
18 | Organization Act, or health maintenance organization holding a | ||||||
19 | certificate of authority under the Health Maintenance | ||||||
20 | Organization Act that arranges, contracts with, or administers | ||||||
21 | contracts with a provider whereby insureds or beneficiaries are | ||||||
22 | provided an incentive to use health care services provided by | ||||||
23 | health care services providers under a discounted health care | ||||||
24 | services plan in which there are no other incentives, such as | ||||||
25 | copayment, coinsurance, or any other reimbursement | ||||||
26 | differential, for beneficiaries to utilize the provider. |
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1 | "Discounted health care services plan administrator" also | ||||||
2 | includes any person, partnership, or corporation, other than an | ||||||
3 | insurer, health service corporation, limited health service | ||||||
4 | organization holding a certificate of authority under the | ||||||
5 | Limited Health Service Organization Act, or health maintenance | ||||||
6 | organization holding a certificate of authority under the | ||||||
7 | Health Maintenance Organization Act that enters into a contract | ||||||
8 | with another administrator to enroll beneficiaries or insureds | ||||||
9 | in a preferred provider program marketed as an independently | ||||||
10 | identifiable program based on marketing materials or member | ||||||
11 | benefit identification cards. | ||||||
12 | (Source: P.A. 91-777, eff. 1-1-01.) | ||||||
13 | Section 10. The Uniform Health Care Service Benefits | ||||||
14 | Information Card Act is amended by changing Section 15 as | ||||||
15 | follows: | ||||||
16 | (215 ILCS 139/15) | ||||||
17 | Sec. 15. Uniform health care benefit information cards | ||||||
18 | required. | ||||||
19 | (a) A health benefit plan that issues a card or other | ||||||
20 | technology and
provides coverage for health care services | ||||||
21 | including prescription drugs or
devices also referred to as | ||||||
22 | health care benefits and an administrator of such a
plan | ||||||
23 | including, but not limited to, third-party administrators for | ||||||
24 | self-insured
plans and state-administered plans shall issue to |
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1 | its insureds a card or other
technology containing uniform | ||||||
2 | health care benefit information. The health care
benefit | ||||||
3 | information card or other technology shall specifically | ||||||
4 | identify and
display the following mandatory data elements on | ||||||
5 | the card: | ||||||
6 | (1) processor control number, if required for claims | ||||||
7 | adjudication; | ||||||
8 | (2) group number; | ||||||
9 | (3) card issuer identifier; | ||||||
10 | (4) cardholder ID number; and | ||||||
11 | (5) cardholder name. | ||||||
12 | (b) The uniform health care benefit information card or | ||||||
13 | other technology
shall specifically identify and display the | ||||||
14 | following mandatory data elements
on the back of the card: | ||||||
15 | (1) claims submission names and addresses; and | ||||||
16 | (2) help desk telephone numbers and names. | ||||||
17 | (c) A new uniform health care benefit information card or | ||||||
18 | other technology
shall be issued by a health benefit plan upon | ||||||
19 | enrollment and reissued upon any
change in the insured's | ||||||
20 | coverage that affects mandatory data elements contained
on the | ||||||
21 | card. | ||||||
22 | (d) Notwithstanding subsections (a), (b), and (c) of this | ||||||
23 | Section, a discounted health care services plan administrator | ||||||
24 | shall issue to its beneficiaries a card containing the | ||||||
25 | following mandatory data elements: | ||||||
26 | (1) an Internet website for beneficiaries to access |
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1 | up-to-date lists of preferred providers; | ||||||
2 | (2) a toll-free help desk number for beneficiaries and | ||||||
3 | providers to access up-to-date lists of preferred | ||||||
4 | providers and additional information about the discounted | ||||||
5 | health care services plan; | ||||||
6 | (3) the name or logo of the provider network; | ||||||
7 | (4) a group number, if necessary for the processing of | ||||||
8 | benefits; | ||||||
9 | (5) a cardholder ID number; | ||||||
10 | (6) the cardholder's name or a space to permit the | ||||||
11 | cardholder to print his or her name, if the cardholder pays | ||||||
12 | a periodic charge for use of the card; | ||||||
13 | (7) a processor control number, if required for claims | ||||||
14 | adjudication; and | ||||||
15 | (8) a statement that the plan is not insurance. | ||||||
16 | (e) As used in this Section, "discounted health care | ||||||
17 | services plan administrator" means any person, partnership, or | ||||||
18 | corporation, other than an insurer, health service | ||||||
19 | corporation, limited health service organization holding a | ||||||
20 | certificate of authority under the Limited Health Service | ||||||
21 | Organization Act, or health maintenance organization holding a | ||||||
22 | certificate of authority under the Health Maintenance | ||||||
23 | Organization Act that arranges, contracts with, or administers | ||||||
24 | contracts with a provider whereby insureds or beneficiaries are | ||||||
25 | provided an incentive to use health care services provided by | ||||||
26 | health care services providers under a discounted health care |
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1 | services plan in which there are no other incentives, such as | ||||||
2 | copayment, coinsurance, or any other reimbursement | ||||||
3 | differential, for beneficiaries to utilize the provider. | ||||||
4 | "Discounted health care services plan administrator" also | ||||||
5 | includes any person, partnership, or corporation, other than an | ||||||
6 | insurer, health service corporation, limited health service | ||||||
7 | organization holding a certificate of authority under the | ||||||
8 | Limited Health Service Organization Act, or health maintenance | ||||||
9 | organization holding a certificate of authority under the | ||||||
10 | Health Maintenance Organization Act that enters into a contract | ||||||
11 | with another administrator to enroll beneficiaries or insureds | ||||||
12 | in a preferred provider program marketed as an independently | ||||||
13 | identifiable program based on marketing materials or member | ||||||
14 | benefit identification cards. | ||||||
15 | (Source: P.A. 92-106, eff. 1-1-02.)".
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