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.