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


Sen. Pamela J. Althoff

Filed: 2/27/2018





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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    "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



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



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



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1Retirement Income Security Act of 1974.
2    (c) A new uniform health care benefit information card or
3other technology shall be issued by a health benefit plan upon
4enrollment and reissued upon any change in the insured's
5coverage that affects mandatory data elements contained on the
7    (d) Notwithstanding subsections (a), (b), and (c) of this
8Section, a discounted health care services plan administrator
9shall issue to its beneficiaries a card containing the
10following mandatory data elements:
11        (1) an Internet website for beneficiaries to access
12    up-to-date lists of preferred providers;
13        (2) a toll-free help desk number for beneficiaries and
14    providers to access up-to-date lists of preferred
15    providers and additional information about the discounted
16    health care services plan;
17        (3) the name or logo of the provider network;
18        (4) a group number, if necessary for the processing of
19    benefits;
20        (5) a cardholder ID number;
21        (6) the cardholder's name or a space to permit the
22    cardholder to print his or her name, if the cardholder pays
23    a periodic charge for use of the card;
24        (7) a processor control number, if required for claims
25    adjudication; and
26        (8) a statement that the plan is not insurance.



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1    (e) As used in this Section, "discounted health care
2services plan administrator" means any person, partnership, or
3corporation, other than an insurer, health service
4corporation, limited health service organization holding a
5certificate of authority under the Limited Health Service
6Organization Act, or health maintenance organization holding a
7certificate of authority under the Health Maintenance
8Organization Act that arranges, contracts with, or administers
9contracts with a provider whereby insureds or beneficiaries are
10provided an incentive to use health care services provided by
11health care services providers under a discounted health care
12services plan in which there are no other incentives, such as
13copayment, coinsurance, or any other reimbursement
14differential, for beneficiaries to utilize the provider.
15"Discounted health care services plan administrator" also
16includes any person, partnership, or corporation, other than an
17insurer, health service corporation, limited health service
18organization holding a certificate of authority under the
19Limited Health Service Organization Act, or health maintenance
20organization holding a certificate of authority under the
21Health Maintenance Organization Act that enters into a contract
22with another administrator to enroll beneficiaries or insureds
23in a preferred provider program marketed as an independently
24identifiable program based on marketing materials or member
25benefit identification cards.
26(Source: P.A. 96-1326, eff. 1-1-11.)".