Rep. Steven Reick

Filed: 5/9/2018





10000SB2851ham001LRB100 17182 SMS 39820 a


2    AMENDMENT NO. ______. Amend Senate Bill 2851 by replacing
3everything after the enacting clause with the following:
4    "Section 5. The Uniform Health Care Service Benefits
5Information Card Act is amended by changing Sections 10 and 15
6as follows:
7    (215 ILCS 139/10)
8    Sec. 10. Definitions. As used in this Act, the following
9terms have the meanings given in this Section.
10    "Dental plan" means an entity that provides coverage for
11dental care services, including an entity subject to the Dental
12Service Plan Act.
13    "Department" means the Department of Insurance.
14    "Director" means the Director of Insurance.
15    "Health benefit plan" means an accident and health
16insurance policy or certificate subject to the Illinois



10000SB2851ham001- 2 -LRB100 17182 SMS 39820 a

1Insurance Code, a voluntary health services plan subject to the
2Voluntary Health Services Plans Act, a health maintenance
3organization subscriber contract subject to the Health
4Maintenance Organization Act, a plan provided by a multiple
5employer welfare arrangement, or a plan provided by another
6benefit arrangement. Without limitation, "health benefit plan"
7does not mean any of the following types of insurance:
8        (1) accident;
9        (2) credit;
10        (3) disability income;
11        (4) long-term or nursing home care;
12        (5) specified disease;
13        (6) dental or vision;
14        (7) coverage issued as a supplement to liability
15    insurance;
16        (8) medical payments under automobile or homeowners;
17        (9) insurance under which benefits are payable with or
18    without regard to fault as statutorily required to be
19    contained in any liability policy or equivalent
20    self-insurance;
21        (10) hospital income or indemnity; and
22        (11) self-insured health benefit plans under the
23    federal Employee Retirement Income Security Act of 1974.
24(Source: P.A. 92-106, eff. 1-1-02.)
25    (215 ILCS 139/15)



10000SB2851ham001- 3 -LRB100 17182 SMS 39820 a

1    Sec. 15. Uniform health care benefit information cards
3    (a) A health benefit plan or a dental plan that issues a
4card or other technology and provides coverage for health care
5services including prescription drugs or devices also referred
6to as health care benefits and an administrator of such a plan
7including, but not limited to, third-party administrators for
8self-insured plans and state-administered plans shall issue to
9its insureds a card or other technology containing uniform
10health care benefit information. The health care benefit
11information card or other technology shall specifically
12identify and display the following mandatory data elements on
13the card:
14        (1) processor control number, if required for claims
15    adjudication;
16        (2) group number;
17        (3) card issuer identifier;
18        (4) cardholder ID number; and
19        (5) cardholder name.
20    (b) The uniform health care benefit information card or
21other technology shall specifically identify and display the
22following mandatory data elements on the back of the card:
23        (1) claims submission names and addresses; and
24        (2) help desk telephone numbers and names.
25    (b-5) A uniform health care benefit information card or
26other technology for a health benefit plan offering dental



10000SB2851ham001- 4 -LRB100 17182 SMS 39820 a

1coverage or dental plan shall include a statement indicating
2whether the health benefit plan offering dental coverage or
3dental plan is subject to regulation by the Department of
5    (c) A new uniform health care benefit information card or
6other technology shall be issued by a health benefit plan or
7dental plan upon enrollment and reissued upon any change in the
8insured's coverage that affects mandatory data elements
9contained on the card.
10    (d) Notwithstanding subsections (a), (b), and (c) of this
11Section, a discounted health care services plan administrator
12shall issue to its beneficiaries a card containing the
13following mandatory data elements:
14        (1) an Internet website for beneficiaries to access
15    up-to-date lists of preferred providers;
16        (2) a toll-free help desk number for beneficiaries and
17    providers to access up-to-date lists of preferred
18    providers and additional information about the discounted
19    health care services plan;
20        (3) the name or logo of the provider network;
21        (4) a group number, if necessary for the processing of
22    benefits;
23        (5) a cardholder ID number;
24        (6) the cardholder's name or a space to permit the
25    cardholder to print his or her name, if the cardholder pays
26    a periodic charge for use of the card;



10000SB2851ham001- 5 -LRB100 17182 SMS 39820 a

1        (7) a processor control number, if required for claims
2    adjudication; and
3        (8) a statement that the plan is not insurance.
4    (e) As used in this Section, "discounted health care
5services plan administrator" means any person, partnership, or
6corporation, other than an insurer, health service
7corporation, limited health service organization holding a
8certificate of authority under the Limited Health Service
9Organization Act, or health maintenance organization holding a
10certificate of authority under the Health Maintenance
11Organization Act that arranges, contracts with, or administers
12contracts with a provider whereby insureds or beneficiaries are
13provided an incentive to use health care services provided by
14health care services providers under a discounted health care
15services plan in which there are no other incentives, such as
16copayment, coinsurance, or any other reimbursement
17differential, for beneficiaries to utilize the provider.
18"Discounted health care services plan administrator" also
19includes any person, partnership, or corporation, other than an
20insurer, health service corporation, limited health service
21organization holding a certificate of authority under the
22Limited Health Service Organization Act, or health maintenance
23organization holding a certificate of authority under the
24Health Maintenance Organization Act that enters into a contract
25with another administrator to enroll beneficiaries or insureds
26in a preferred provider program marketed as an independently



10000SB2851ham001- 6 -LRB100 17182 SMS 39820 a

1identifiable program based on marketing materials or member
2benefit identification cards.
3(Source: P.A. 96-1326, eff. 1-1-11.)".