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Public Act 102-0902


 

Public Act 0902 102ND GENERAL ASSEMBLY

  
  
  

 


 
Public Act 102-0902
 
SB3910 EnrolledLRB102 24062 BMS 33282 b

    AN ACT concerning regulation.
 
    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 physical or
electronic 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) 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;
        (7) Any deductible applicable to the plan; if there is
    a deductible specific to prescription drugs, that shall be
    the applicable deductible for this card;
        (8) Any out-of-pocket maximum limitation applicable to
    the plan; if there is an out-of-pocket maximum limitation
    specific to prescription drugs, that shall be the
    applicable limitation for this card;
        (9) 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 pharmacist and pharmacy providers and additional
    information about the plan's prescription drug benefits;
    and
        (10) (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. 96-1326, eff. 1-1-11.)
 
    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 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; and
        (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) (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.
    (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. 100-1013, eff. 1-1-19.)
 
    Section 99. Effective date. This Act takes effect January
1, 2024.

Effective Date: 1/1/2024