Full Text of SB2851 100th General Assembly
SB2851enr 100TH GENERAL ASSEMBLY |
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| 1 | | AN ACT concerning regulation.
| 2 | | Be it enacted by the People of the State of Illinois,
| 3 | | represented in the General Assembly:
| 4 | | Section 5. The Uniform Health Care Service Benefits | 5 | | Information Card Act is amended by changing Sections 10 and 15 | 6 | | as follows:
| 7 | | (215 ILCS 139/10)
| 8 | | Sec. 10. Definitions. As used in this Act, the following | 9 | | terms have the
meanings given in this Section.
| 10 | | "Dental plan" means an entity that provides coverage for | 11 | | dental care services, including an entity subject to the Dental | 12 | | Service 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 | 16 | | insurance policy or
certificate subject to the Illinois | 17 | | Insurance Code, a voluntary health services
plan subject to the | 18 | | Voluntary Health Services Plans Act, a health maintenance
| 19 | | organization subscriber contract subject to the Health | 20 | | Maintenance
Organization Act, a plan provided by a multiple | 21 | | employer welfare arrangement,
or a plan provided by another | 22 | | benefit arrangement. Without limitation, "health
benefit plan" | 23 | | does 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 | 20 | | required. | 21 | | (a) A health benefit plan or a dental plan that issues a | 22 | | card or other technology and
provides coverage for health care | 23 | | services including prescription drugs or
devices also referred | 24 | | to as health care benefits and an administrator of such a
plan | 25 | | including, but not limited to, third-party administrators for |
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| 1 | | self-insured
plans and state-administered plans shall issue to | 2 | | its insureds a card or other
technology containing uniform | 3 | | health care benefit information. The health care
benefit | 4 | | information card or other technology shall specifically | 5 | | identify and
display the following mandatory data elements on | 6 | | the 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 | 14 | | other technology
shall specifically identify and display the | 15 | | following 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 | 19 | | other technology for a health benefit plan offering dental | 20 | | coverage or dental plan shall include a statement indicating | 21 | | whether the health benefit plan offering dental coverage or | 22 | | dental plan is subject to regulation by the Department of | 23 | | Insurance. | 24 | | (c) A new uniform health care benefit information card or | 25 | | other technology
shall be issued by a health benefit plan or | 26 | | dental plan upon enrollment and reissued upon any
change in the |
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| 1 | | insured's coverage that affects mandatory data elements | 2 | | contained
on the card. | 3 | | (d) Notwithstanding subsections (a), (b), and (c) of this | 4 | | Section, a discounted health care services plan administrator | 5 | | shall issue to its beneficiaries a card containing the | 6 | | following 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 | 24 | | services plan administrator" means any person, partnership, or | 25 | | corporation, other than an insurer, health service | 26 | | corporation, limited health service organization holding a |
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| 1 | | certificate of authority under the Limited Health Service | 2 | | Organization Act, or health maintenance organization holding a | 3 | | certificate of authority under the Health Maintenance | 4 | | Organization Act that arranges, contracts with, or administers | 5 | | contracts with a provider whereby insureds or beneficiaries are | 6 | | provided an incentive to use health care services provided by | 7 | | health care services providers under a discounted health care | 8 | | services plan in which there are no other incentives, such as | 9 | | copayment, coinsurance, or any other reimbursement | 10 | | differential, for beneficiaries to utilize the provider. | 11 | | "Discounted health care services plan administrator" also | 12 | | includes any person, partnership, or corporation, other than an | 13 | | insurer, health service corporation, limited health service | 14 | | organization holding a certificate of authority under the | 15 | | Limited Health Service Organization Act, or health maintenance | 16 | | organization holding a certificate of authority under the | 17 | | Health Maintenance Organization Act that enters into a contract | 18 | | with another administrator to enroll beneficiaries or insureds | 19 | | in a preferred provider program marketed as an independently | 20 | | identifiable program based on marketing materials or member | 21 | | benefit identification cards. | 22 | | (Source: P.A. 96-1326, eff. 1-1-11.)
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