Full Text of HB5527 96th General Assembly
HB5527sam001 96TH GENERAL ASSEMBLY
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Sen. James A. DeLeo
Filed: 4/15/2010
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09600HB5527sam001 |
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LRB096 20211 RPM 40024 a |
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| AMENDMENT TO HOUSE BILL 5527
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| AMENDMENT NO. ______. Amend House Bill 5527 by replacing | 3 |
| everything after the enacting clause with the following:
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| "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
| 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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| information. The uniform prescription drug information card or | 16 |
| other
technology shall
specifically identify and display the |
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09600HB5527sam001 |
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LRB096 20211 RPM 40024 a |
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| 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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| 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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09600HB5527sam001 |
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LRB096 20211 RPM 40024 a |
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| 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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09600HB5527sam001 |
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LRB096 20211 RPM 40024 a |
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| "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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09600HB5527sam001 |
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LRB096 20211 RPM 40024 a |
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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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|
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09600HB5527sam001 |
- 6 - |
LRB096 20211 RPM 40024 a |
|
| 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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|
|
09600HB5527sam001 |
- 7 - |
LRB096 20211 RPM 40024 a |
|
| 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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