HB5527 Enrolled LRB096 20211 RPM 35782 b

1     AN ACT concerning insurance.
 
2     Be it enacted by the People of the State of Illinois,
3 represented in the General Assembly:
 
4     Section 5. The Uniform Prescription Drug Information Card
5 Act is amended by changing Section 15 as follows:
 
6     (215 ILCS 138/15)
7     Sec. 15. Uniform prescription drug information cards
8 required.
9     (a) A health benefit plan that issues a card or other
10 technology and provides coverage for prescription drugs or
11 devices and an administrator of such a plan including, but not
12 limited to, third-party administrators for self-insured plans
13 and state-administered plans shall issue to its insureds a card
14 or other technology containing uniform prescription drug
15 information. The uniform prescription drug information card or
16 other technology shall specifically identify and display the
17 following mandatory data elements on the front of the card:
18         (1) BIN number;
19         (2) Processor control number if required for claims
20     adjudication;
21         (3) Group number;
22         (4) Card issuer identifier;
23         (5) Cardholder ID number; and

 

 

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1         (6) Cardholder name.
2     The uniform prescription drug information card or other
3 technology shall specifically identify and display the
4 following mandatory data elements on the back of the card:
5         (1) Claims submission names and addresses; and
6         (2) Help desk telephone numbers and names.
7     (b) A new uniform prescription drug information card or
8 other technology shall be issued by a health benefit plan upon
9 enrollment and reissued upon any change in the insured's
10 coverage that affects mandatory data elements contained on the
11 card.
12     (c) Notwithstanding subsections (a) and (b) of this
13 Section, a discounted health care services plan administrator
14 providing discounts on prescription drugs or devices shall
15 issue to its beneficiaries a card containing the following
16 mandatory data elements:
17         (1) an Internet website for beneficiaries to access
18     up-to-date lists of preferred providers;
19         (2) a toll-free help desk number for beneficiaries and
20     providers to access up-to-date lists of preferred
21     providers and additional information about the discounted
22     health care services plan;
23         (3) the name or logo of the provider network;
24         (4) a group number;
25         (5) a cardholder ID number;
26         (6) the cardholder's name or a space to permit the

 

 

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1     cardholder to print his or her name, if the cardholder pays
2     a periodic charge for use of the card;
3         (7) a processor control number, if required for claims
4     adjudication; and
5         (8) a statement that the plan is not insurance.
6     (d) As used in this Section, "discounted health care
7 services plan administrator" means any person, partnership, or
8 corporation, other than an insurer, health service
9 corporation, limited health service organization holding a
10 certificate of authority under the Limited Health Service
11 Organization Act, or health maintenance organization holding a
12 certificate of authority under the Health Maintenance
13 Organization Act that arranges, contracts with, or administers
14 contracts with a provider whereby insureds or beneficiaries are
15 provided an incentive to use health care services provided by
16 health care services providers under a discounted health care
17 services plan in which there are no other incentives, such as
18 copayment, coinsurance, or any other reimbursement
19 differential, for beneficiaries to utilize the provider.
20 "Discounted health care services plan administrator" also
21 includes any person, partnership, or corporation, other than an
22 insurer, health service corporation, limited health service
23 organization holding a certificate of authority under the
24 Limited Health Service Organization Act, or health maintenance
25 organization holding a certificate of authority under the
26 Health Maintenance Organization Act that enters into a contract

 

 

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1 with another administrator to enroll beneficiaries or insureds
2 in a preferred provider program marketed as an independently
3 identifiable program based on marketing materials or member
4 benefit identification cards.
5 (Source: P.A. 91-777, eff. 1-1-01.)
 
6     Section 10. The Uniform Health Care Service Benefits
7 Information Card Act is amended by changing Section 15 as
8 follows:
 
9     (215 ILCS 139/15)
10     Sec. 15. Uniform health care benefit information cards
11 required.
12     (a) A health benefit plan that issues a card or other
13 technology and provides coverage for health care services
14 including prescription drugs or devices also referred to as
15 health care benefits and an administrator of such a plan
16 including, but not limited to, third-party administrators for
17 self-insured plans and state-administered plans shall issue to
18 its insureds a card or other technology containing uniform
19 health care benefit information. The health care benefit
20 information card or other technology shall specifically
21 identify and display the following mandatory data elements on
22 the card:
23         (1) processor control number, if required for claims
24     adjudication;

 

 

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1         (2) group number;
2         (3) card issuer identifier;
3         (4) cardholder ID number; and
4         (5) cardholder name.
5     (b) The uniform health care benefit information card or
6 other technology shall specifically identify and display the
7 following mandatory data elements on the back of the card:
8         (1) claims submission names and addresses; and
9         (2) help desk telephone numbers and names.
10     (c) A new uniform health care benefit information card or
11 other technology shall be issued by a health benefit plan upon
12 enrollment and reissued upon any change in the insured's
13 coverage that affects mandatory data elements contained on the
14 card.
15     (d) Notwithstanding subsections (a), (b), and (c) of this
16 Section, a discounted health care services plan administrator
17 shall issue to its beneficiaries a card containing the
18 following mandatory data elements:
19         (1) an Internet website for beneficiaries to access
20     up-to-date lists of preferred providers;
21         (2) a toll-free help desk number for beneficiaries and
22     providers to access up-to-date lists of preferred
23     providers and additional information about the discounted
24     health care services plan;
25         (3) the name or logo of the provider network;
26         (4) a group number, if necessary for the processing of

 

 

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1     benefits;
2         (5) a cardholder ID number;
3         (6) the cardholder's name or a space to permit the
4     cardholder to print his or her name, if the cardholder pays
5     a periodic charge for use of the card;
6         (7) a processor control number, if required for claims
7     adjudication; and
8         (8) a statement that the plan is not insurance.
9     (e) As used in this Section, "discounted health care
10 services plan administrator" means any person, partnership, or
11 corporation, other than an insurer, health service
12 corporation, limited health service organization holding a
13 certificate of authority under the Limited Health Service
14 Organization Act, or health maintenance organization holding a
15 certificate of authority under the Health Maintenance
16 Organization Act that arranges, contracts with, or administers
17 contracts with a provider whereby insureds or beneficiaries are
18 provided an incentive to use health care services provided by
19 health care services providers under a discounted health care
20 services plan in which there are no other incentives, such as
21 copayment, coinsurance, or any other reimbursement
22 differential, for beneficiaries to utilize the provider.
23 "Discounted health care services plan administrator" also
24 includes any person, partnership, or corporation, other than an
25 insurer, health service corporation, limited health service
26 organization holding a certificate of authority under the

 

 

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1 Limited Health Service Organization Act, or health maintenance
2 organization holding a certificate of authority under the
3 Health Maintenance Organization Act that enters into a contract
4 with another administrator to enroll beneficiaries or insureds
5 in a preferred provider program marketed as an independently
6 identifiable program based on marketing materials or member
7 benefit identification cards.
8 (Source: P.A. 92-106, eff. 1-1-02.)