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




SB2851 EnrolledLRB100 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    "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
17Insurance Code, a voluntary health services plan subject to the
18Voluntary Health Services Plans Act, a health maintenance
19organization subscriber contract subject to the Health
20Maintenance Organization Act, a plan provided by a multiple
21employer welfare arrangement, or a plan provided by another
22benefit arrangement. Without limitation, "health benefit plan"
23does not mean any of the following types of insurance:



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1        (1) accident;
2        (2) credit;
3        (3) disability income;
4        (4) long-term or nursing home care;
5        (5) specified disease;
6        (6) dental or vision;
7        (7) coverage issued as a supplement to liability
8    insurance;
9        (8) medical payments under automobile or homeowners;
10        (9) insurance under which benefits are payable with or
11    without regard to fault as statutorily required to be
12    contained in any liability policy or equivalent
13    self-insurance;
14        (10) hospital income or indemnity; and
15        (11) self-insured health benefit plans under the
16    federal Employee Retirement Income Security Act of 1974.
17(Source: P.A. 92-106, eff. 1-1-02.)
18    (215 ILCS 139/15)
19    Sec. 15. Uniform health care benefit information cards
21    (a) A health benefit plan or a dental plan that issues a
22card or other technology and provides coverage for health care
23services including prescription drugs or devices also referred
24to as health care benefits and an administrator of such a plan
25including, but not limited to, third-party administrators for



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1self-insured plans and state-administered plans shall issue to
2its insureds a card or other technology containing uniform
3health care benefit information. The health care benefit
4information card or other technology shall specifically
5identify and display the following mandatory data elements on
6the card:
7        (1) processor control number, if required for claims
8    adjudication;
9        (2) group number;
10        (3) card issuer identifier;
11        (4) cardholder ID number; and
12        (5) cardholder name.
13    (b) The uniform health care benefit information card or
14other technology shall specifically identify and display the
15following mandatory data elements on the back of the card:
16        (1) claims submission names and addresses; and
17        (2) help desk telephone numbers and names.
18    (b-5) A uniform health care benefit information card or
19other technology for a health benefit plan offering dental
20coverage or dental plan shall include a statement indicating
21whether the health benefit plan offering dental coverage or
22dental plan is subject to regulation by the Department of
24    (c) A new uniform health care benefit information card or
25other technology shall be issued by a health benefit plan or
26dental plan upon enrollment and reissued upon any change in the



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1insured's coverage that affects mandatory data elements
2contained on the card.
3    (d) Notwithstanding subsections (a), (b), and (c) of this
4Section, a discounted health care services plan administrator
5shall issue to its beneficiaries a card containing the
6following mandatory data elements:
7        (1) an Internet website for beneficiaries to access
8    up-to-date lists of preferred providers;
9        (2) a toll-free help desk number for beneficiaries and
10    providers to access up-to-date lists of preferred
11    providers and additional information about the discounted
12    health care services plan;
13        (3) the name or logo of the provider network;
14        (4) a group number, if necessary for the processing of
15    benefits;
16        (5) a cardholder ID number;
17        (6) the cardholder's name or a space to permit the
18    cardholder to print his or her name, if the cardholder pays
19    a periodic charge for use of the card;
20        (7) a processor control number, if required for claims
21    adjudication; and
22        (8) a statement that the plan is not insurance.
23    (e) As used in this Section, "discounted health care
24services plan administrator" means any person, partnership, or
25corporation, other than an insurer, health service
26corporation, limited health service organization holding a



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1certificate of authority under the Limited Health Service
2Organization Act, or health maintenance organization holding a
3certificate of authority under the Health Maintenance
4Organization Act that arranges, contracts with, or administers
5contracts with a provider whereby insureds or beneficiaries are
6provided an incentive to use health care services provided by
7health care services providers under a discounted health care
8services plan in which there are no other incentives, such as
9copayment, coinsurance, or any other reimbursement
10differential, for beneficiaries to utilize the provider.
11"Discounted health care services plan administrator" also
12includes any person, partnership, or corporation, other than an
13insurer, health service corporation, limited health service
14organization holding a certificate of authority under the
15Limited Health Service Organization Act, or health maintenance
16organization holding a certificate of authority under the
17Health Maintenance Organization Act that enters into a contract
18with another administrator to enroll beneficiaries or insureds
19in a preferred provider program marketed as an independently
20identifiable program based on marketing materials or member
21benefit identification cards.
22(Source: P.A. 96-1326, eff. 1-1-11.)