Public Act 100-1013
 
SB2851 EnrolledLRB100 17182 SMS 32337 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 Health Care Service Benefits
Information Card Act is amended by changing Sections 10 and 15
as follows:
 
    (215 ILCS 139/10)
    Sec. 10. Definitions. As used in this Act, the following
terms have the meanings given in this Section.
    "Dental plan" means an entity that provides coverage for
dental care services, including an entity subject to the Dental
Service Plan Act.
    "Department" means the Department of Insurance.
    "Director" means the Director of Insurance.
    "Health benefit plan" means an accident and health
insurance policy or certificate subject to the Illinois
Insurance Code, a voluntary health services plan subject to the
Voluntary Health Services Plans Act, a health maintenance
organization subscriber contract subject to the Health
Maintenance Organization Act, a plan provided by a multiple
employer welfare arrangement, or a plan provided by another
benefit arrangement. Without limitation, "health benefit plan"
does not mean any of the following types of insurance:
        (1) accident;
        (2) credit;
        (3) disability income;
        (4) long-term or nursing home care;
        (5) specified disease;
        (6) dental or vision;
        (7) coverage issued as a supplement to liability
    insurance;
        (8) medical payments under automobile or homeowners;
        (9) insurance under which benefits are payable with or
    without regard to fault as statutorily required to be
    contained in any liability policy or equivalent
    self-insurance;
        (10) hospital income or indemnity; and
        (11) self-insured health benefit plans under the
    federal Employee Retirement Income Security Act of 1974.
(Source: P.A. 92-106, eff. 1-1-02.)
 
    (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
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.
    (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. 96-1326, eff. 1-1-11.)