215 ILCS 139/ Uniform Health Care Service Benefits Information Card Act.

(215 ILCS 139/1)

Sec. 1. Short title. This Act may be cited as the Uniform Health Care Service Benefits Information Card Act.

(Source: P.A. 92-106, eff. 1-1-02.)

(215 ILCS 139/5)

Sec. 5. Legislative intent. It is the intent of the legislature to lessen patients' waiting times, decrease administrative burdens for health care professionals and health care institutions, and improve care to patients by minimizing confusion, eliminating unnecessary paperwork, and streamlining the administrative aspects of care paid for by third-party payors. This Act shall be broadly applied and interpreted to effectuate this purpose.

(Source: P.A. 92-106, eff. 1-1-02.)

(215 ILCS 139/10)

Sec. 10. Definitions. As used in this Act, the following terms have the meanings given in this Section.

"Dental plan" means an entity that provides coverage for dental care services, including an entity subject to the Dental Service Plan Act.

"Department" means the Department of Insurance.

"Director" means the Director of Insurance.

"Health benefit plan" means an accident and health insurance policy or certificate subject to the Illinois Insurance Code, a voluntary health services plan subject to the Voluntary Health Services Plans Act, a health maintenance organization subscriber contract subject to the Health Maintenance Organization Act, a plan provided by a multiple employer welfare arrangement, or a plan provided by another benefit arrangement. Without limitation, "health benefit plan" does not mean any of the following types of insurance:

(1) accident;

(2) credit;

(3) disability income;

(4) long-term or nursing home care;

(5) specified disease;

(6) dental or vision;

(7) coverage issued as a supplement to liability insurance;

(8) medical payments under automobile or homeowners;

(9) insurance under which benefits are payable with or without regard to fault as statutorily required to be contained in any liability policy or equivalent self-insurance;

(10) hospital income or indemnity; and

(11) self-insured health benefit plans under the federal Employee Retirement Income Security Act of 1974.

(Source: P.A. 100-1013, eff. 1-1-19.)

(215 ILCS 139/15)

Sec. 15. Uniform health care benefit information cards required.

(a) A health benefit plan or a dental plan that issues a physical or electronic card or other technology and provides coverage for health care services including prescription drugs or devices also referred to as health care benefits and an administrator of such a plan including, but not limited to, third-party administrators for self-insured plans and state-administered plans shall issue to its insureds a card or other technology containing uniform health care benefit information. The health care benefit information card or other technology shall specifically identify and display the following mandatory data elements on the card:

(1) processor control number, if required for claims adjudication;

(2) group number;

(3) card issuer identifier;

(4) cardholder ID number;

(5) except for dental plans, the regulatory entity that holds authority over the plan; for the purpose of this requirement, the Department of Healthcare and Family Services is the regulatory entity that holds authority over plans that the Department of Healthcare and Family Services has contracted with to provide services under the medical assistance program;

(6) except for dental plans, any deductible applicable to the plan;

(7) except for dental plans, any out-of-pocket maximum limitation applicable to the plan;

(8) a toll-free telephone number and Internet website address through which the cardholder may seek consumer assistance information, such as up-to-date lists of preferred providers, including health care professionals, hospitals, and other facilities, offices, or sites that are contracted to furnish items or services under the plan, and additional information about the plan; and

(9) cardholder name.

(b) The uniform health care benefit information card or other technology shall specifically identify and display the following mandatory data elements on the back of the card:

(1) claims submission names and addresses; and

(2) help desk telephone numbers and names.

(b-5) A uniform health care benefit information card or other technology for a health benefit plan offering dental coverage or dental plan shall include a statement indicating whether the health benefit plan offering dental coverage or dental plan is subject to regulation by the Department of Insurance.

(c) A new uniform health care benefit information card or other technology shall be issued by a health benefit plan or dental plan upon enrollment and reissued upon any change in the insured's coverage that affects mandatory data elements contained on the card.

(d) Notwithstanding subsections (a), (b), and (c) of this Section, a discounted health care services plan administrator shall issue to its beneficiaries a card containing the following mandatory data elements:

(1) an Internet website for beneficiaries to access up-to-date lists of preferred providers;

(2) a toll-free help desk number for beneficiaries and providers to access up-to-date lists of preferred providers and additional information about the discounted health care services plan;

(3) the name or logo of the provider network;

(4) a group number, if necessary for the processing of benefits;

(5) a cardholder ID number;

(6) the cardholder's name or a space to permit the cardholder to print his or her name, if the cardholder pays a periodic charge for use of the card;

(7) a processor control number, if required for claims adjudication; and

(8) a statement that the plan is not insurance.

(e) As used in this Section, "discounted health care services plan administrator" means any person, partnership, or corporation, other than an insurer, health service corporation, limited health service organization holding a certificate of authority under the Limited Health Service Organization Act, or health maintenance organization holding a certificate of authority under the Health Maintenance Organization Act that arranges, contracts with, or administers contracts with a provider whereby insureds or beneficiaries are provided an incentive to use health care services provided by health care services providers under a discounted health care services plan in which there are no other incentives, such as copayment, coinsurance, or any other reimbursement differential, for beneficiaries to utilize the provider. "Discounted health care services plan administrator" also includes any person, partnership, or corporation, other than an insurer, health service corporation, limited health service organization holding a certificate of authority under the Limited Health Service Organization Act, or health maintenance organization holding a certificate of authority under the Health Maintenance Organization Act that enters into a contract with another administrator to enroll beneficiaries or insureds in a preferred provider program marketed as an independently identifiable program based on marketing materials or member benefit identification cards.

(Source: P.A. 102-902, eff. 1-1-24.)

(215 ILCS 139/20)

Sec. 20. Coordination with Uniform Prescription Drug Information Card. A health benefit plan may comply with this Act by including the information required in Section 15 on one card if a card is also required under the Uniform Prescription Drug Information Card Act.

(Source: P.A. 92-106, eff. 1-1-02.)

(215 ILCS 139/25)

Sec. 25. Applicability and enforcement.

(a) This Act applies to health care benefit plans that are amended, delivered, issued, or renewed on and after the effective date of this amendatory Act of the 92nd General Assembly.

(b) The Director may adopt rules necessary to implement the Department's responsibilities under this Act. To enforce the provisions of this Act, the Director may issue a cease and desist order or require a health benefit plan to submit a plan of correction for violations of this Act, or both. Subject to the provisions of the Illinois Administrative Procedure Act, the Director may, pursuant to Section 403A of the Illinois Insurance Code, impose upon a health benefit plan an administrative fine not to exceed $250,000 for failure to submit a requested plan of correction, failure to comply with its plan or correction, or repeated violations of this Act.

(Source: P.A. 92-106, eff. 1-1-02.)

(215 ILCS 139/99)

Sec. 99. Effective date. This Act takes effect on January 1, 2002.

(Source: P.A. 92-106, eff. 1-1-02.)