Illinois General Assembly - Full Text of SB2851
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Full Text of SB2851  100th General Assembly




State of Illinois
2017 and 2018


Introduced 2/13/2018, by Sen. Pamela J. Althoff


215 ILCS 139/10
215 ILCS 139/15

    Amends the Uniform Health Care Services Benefits Information Card Act. Includes dental service plans under the definition of "health benefit plan". Requires a uniform health care benefit information card or other technology for a dental service plan to include a statement that the dental service plan is fully insured. Effective immediately.

LRB100 17182 SMS 32337 b





SB2851LRB100 17182 SMS 32337 b

1    AN ACT concerning regulation.
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
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    "Department" means the Department of Insurance.
11    "Director" means the Director of Insurance.
12    "Health benefit plan" means an accident and health
13insurance policy or certificate subject to the Illinois
14Insurance Code, a voluntary health services plan subject to the
15Voluntary Health Services Plans Act, a health maintenance
16organization subscriber contract subject to the Health
17Maintenance Organization Act, a plan provided by a multiple
18employer welfare arrangement, a dental service plan subject to
19the Dental Service Plan Act, or a plan provided by another
20benefit arrangement. Without limitation, "health benefit plan"
21does not mean any of the following types of insurance:
22        (1) accident;
23        (2) credit;



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1        (3) disability income;
2        (4) long-term or nursing home care;
3        (5) specified disease;
4        (6) dental or vision;
5        (7) coverage issued as a supplement to liability
6    insurance;
7        (8) medical payments under automobile or homeowners;
8        (9) insurance under which benefits are payable with or
9    without regard to fault as statutorily required to be
10    contained in any liability policy or equivalent
11    self-insurance;
12        (10) hospital income or indemnity; and
13        (11) self-insured health benefit plans under the
14    federal Employee Retirement Income Security Act of 1974.
15(Source: P.A. 92-106, eff. 1-1-02.)
16    (215 ILCS 139/15)
17    Sec. 15. Uniform health care benefit information cards
19    (a) A health benefit plan that issues a card or other
20technology and provides coverage for health care services
21including prescription drugs or devices also referred to as
22health care benefits and an administrator of such a plan
23including, but not limited to, third-party administrators for
24self-insured plans and state-administered plans shall issue to
25its insureds a card or other technology containing uniform



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1health care benefit information. The health care benefit
2information card or other technology shall specifically
3identify and display the following mandatory data elements on
4the card:
5        (1) processor control number, if required for claims
6    adjudication;
7        (2) group number;
8        (3) card issuer identifier;
9        (4) cardholder ID number; and
10        (5) cardholder name.
11    (b) The uniform health care benefit information card or
12other technology shall specifically identify and display the
13following mandatory data elements on the back of the card:
14        (1) claims submission names and addresses; and
15        (2) help desk telephone numbers and names.
16    (b-5) A uniform health care benefit information card or
17other technology for a dental service plan shall include a
18statement that the dental service plan is fully insured.
19    (c) A new uniform health care benefit information card or
20other technology shall be issued by a health benefit plan upon
21enrollment and reissued upon any change in the insured's
22coverage that affects mandatory data elements contained on the
24    (d) Notwithstanding subsections (a), (b), and (c) of this
25Section, a discounted health care services plan administrator
26shall issue to its beneficiaries a card containing the



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1following mandatory data elements:
2        (1) an Internet website for beneficiaries to access
3    up-to-date lists of preferred providers;
4        (2) a toll-free help desk number for beneficiaries and
5    providers to access up-to-date lists of preferred
6    providers and additional information about the discounted
7    health care services plan;
8        (3) the name or logo of the provider network;
9        (4) a group number, if necessary for the processing of
10    benefits;
11        (5) a cardholder ID number;
12        (6) the cardholder's name or a space to permit the
13    cardholder to print his or her name, if the cardholder pays
14    a periodic charge for use of the card;
15        (7) a processor control number, if required for claims
16    adjudication; and
17        (8) a statement that the plan is not insurance.
18    (e) As used in this Section, "discounted health care
19services plan administrator" means any person, partnership, or
20corporation, other than an insurer, health service
21corporation, limited health service organization holding a
22certificate of authority under the Limited Health Service
23Organization Act, or health maintenance organization holding a
24certificate of authority under the Health Maintenance
25Organization Act that arranges, contracts with, or administers
26contracts with a provider whereby insureds or beneficiaries are



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1provided an incentive to use health care services provided by
2health care services providers under a discounted health care
3services plan in which there are no other incentives, such as
4copayment, coinsurance, or any other reimbursement
5differential, for beneficiaries to utilize the provider.
6"Discounted health care services plan administrator" also
7includes any person, partnership, or corporation, other than an
8insurer, health service corporation, limited health service
9organization holding a certificate of authority under the
10Limited Health Service Organization Act, or health maintenance
11organization holding a certificate of authority under the
12Health Maintenance Organization Act that enters into a contract
13with another administrator to enroll beneficiaries or insureds
14in a preferred provider program marketed as an independently
15identifiable program based on marketing materials or member
16benefit identification cards.
17(Source: P.A. 96-1326, eff. 1-1-11.)
18    Section 99. Effective date. This Act takes effect upon
19becoming law.