State of Illinois
92nd General Assembly
Legislation

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92_HB1901

 
                                               LRB9200938JSpc

 1        AN ACT concerning health care benefit information cards.

 2        Be  it  enacted  by  the People of the State of Illinois,
 3    represented in the General Assembly:

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

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

14        Section  10.  Definitions.   As  used  in  this  Act, the
15    following terms have the meanings given in this Section.
16        "Department" means the Department of Insurance.
17        "Director" means the Director of Insurance.
18        "Health  benefit  plan"  means  an  accident  and  health
19    insurance policy  or  certificate  subject  to  the  Illinois
20    Insurance  Code,  a voluntary health services plan subject to
21    the Voluntary Health Services Plans Act, a health maintenance
22    organization  subscriber  contract  subject  to  the   Health
23    Maintenance  Organization  Act, a plan provided by a multiple
24    employer welfare arrangement, or a plan provided  by  another
25    benefit  arrangement.   Without  limitation,  "health benefit
26    plan" does not mean any of the following types of insurance:
27             (1)  accident;
28             (2)  credit;
29             (3)  disability income;
30             (4)  long-term or nursing home care;
 
                            -2-                LRB9200938JSpc
 1             (5)  specified disease;
 2             (6)  dental or vision;
 3             (7)  coverage issued as a  supplement  to  liability
 4        insurance;
 5             (8)  medical    payments    under    automobile   or
 6        homeowners;
 7             (9)  insurance under which benefits are payable with
 8        or without regard to fault as statutorily required to  be
 9        contained   in   any   liability   policy  or  equivalent
10        self-insurance;
11             (10)  hospital income or indemnity; and
12             (11)  self-insured health benefit  plans  under  the
13        federal Employee Retirement Income Security Act of 1974.

14        Section  15.  Uniform  health  care  benefit  information
15    cards required.
16        (a)  A  health  benefit  plan that issues a card or other
17    technology and provides coverage  for  health  care  services
18    including  prescription  drugs or devices also referred to as
19    health care benefits and an  administrator  of  such  a  plan
20    including, but not limited to, third-party administrators for
21    self-insured  plans  and state-administered plans shall issue
22    to its insureds a card or other technology containing uniform
23    health care benefit information.   The  health  care  benefit
24    information  card  or  other  technology  shall  specifically
25    identify and display the following mandatory data elements on
26    the card:
27             (1)  processor   control  number,  if  required  for
28        claims adjudication;
29             (2)  group number;
30             (3)  card issuer identifier;
31             (4)  cardholder ID number; and
32             (5)  cardholder name.
33        (b)  The uniform health care benefit information card  or
 
                            -3-                LRB9200938JSpc
 1    other  technology shall specifically identify and display the
 2    following mandatory data elements on the back of the card:
 3             (1)  claims submission names and addresses; and
 4             (2)  help  desk  telephone  numbers  and  names  and
 5        website addresses, if available.
 6        (c)  A new uniform health care benefit  information  card
 7    or  other technology shall be issued by a health benefit plan
 8    upon enrollment and reissued upon any change in the insured's
 9    coverage that affects mandatory data  elements  contained  on
10    the card.

11        Section 20.  Applicability and enforcement.
12        (a)  This  Act  applies to health care benefit plans that
13    are amended, delivered, issued, or renewed on and  after  the
14    effective  date  of  this amendatory Act of the 92nd  General
15    Assembly.
16        (b)  The Director may adopt rules necessary to  implement
17    the Department's responsibilities under this Act.  To enforce
18    the  provisions  of  this Act, the Director may issue a cease
19    and desist order or require a health benefit plan to submit a
20    plan of correction for  violations  of  this  Act,  or  both.
21    Subject  to  the  provisions  of  the Illinois Administrative
22    Procedure Act, the Director may, pursuant to Section 403A  of
23    the  Illinois  Insurance  Code,  impose upon a health benefit
24    plan an  administrative  fine  not  to  exceed  $250,000  for
25    failure  to submit a requested plan of correction, failure to
26    comply with its plan or correction, or repeated violations of
27    this Act.

28        Section 99.  Effective date.  This Act  takes  effect  on
29    January 1, 2002.

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