Public Act 096-1326
 
HB5527 EnrolledLRB096 20211 RPM 35782 b


  
    AN ACT concerning insurance.
  
 
    Be it enacted by the People of the State of Illinois,
 
represented in the General Assembly:
  




 
    Section 5. The Uniform Prescription Drug Information Card 
Act is amended  by changing Section 15 as follows:
 
    (215 ILCS 138/15)
    Sec. 15. Uniform prescription drug information cards 
required. 
    (a) A health benefit plan that issues a card or other 
technology and
provides coverage for prescription drugs or

devices
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 prescription drug

information.  The uniform prescription drug information card or 
other
technology shall
specifically identify and display the 
following
mandatory data elements on the front of the card:
        (1) BIN number;
        (2) Processor control number if required for claims 
    adjudication;
        (3) Group number;
        (4) Card issuer identifier;
        (5) Cardholder ID number; and
        (6) Cardholder name.
    The uniform prescription drug 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) A new uniform prescription drug information card or 
other technology
shall be
issued by a health benefit plan upon 
enrollment and reissued upon any change in
the insured's 
coverage that affects mandatory data elements contained on the

card.
    (c) Notwithstanding subsections (a) and (b) of this 
Section, a discounted health care services plan administrator 
providing discounts on prescription drugs or devices 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;
        (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.
    (d) 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. 91-777, eff. 1-1-01.)
 
    Section 10. The Uniform Health Care Service Benefits 
Information Card Act is amended  by changing Section 15 as 
follows:
 
    (215 ILCS 139/15)
    Sec. 15. Uniform health care benefit information cards 
required. 
    (a) A health benefit plan that issues a 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; and
        (5) 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.
    (c) A new uniform health care benefit information card or 
other technology
shall be issued by a health benefit 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. 92-106, eff. 1-1-02.)



Effective Date:  1/1/2011