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92nd General Assembly

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Public Act 92-0106

HB1901 Enrolled                                LRB9200938JSpc

    AN ACT concerning health care benefit information cards.

    Be it enacted by the People of  the  State  of  Illinois,
represented in the General Assembly:

    Section  1.  Short  title.   This Act may be cited as the
Uniform Health Care Service Benefits Information Card Act.

    Section 5.  Legislative intent.  It is the intent of  the
legislature  to  lessen  patients'  waiting  times,  decrease
administrative  burdens  for  health  care  professionals and
health care institutions, and improve  care  to  patients  by
minimizing  confusion, eliminating unnecessary paperwork, and
streamlining the administrative aspects of care paid  for  by
third-party  payors.  This  Act  shall be broadly applied and
interpreted to effectuate this purpose.

    Section 10.  Definitions.   As  used  in  this  Act,  the
following terms have the meanings given in this Section.
    "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.

    Section  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.

    Section 20.  Coordination with Uniform Prescription  Drug
Information  Card. A health benefit plan may comply with this
Act by including the information required in  Section  15  on
one  card  if  a  card  is  also  required  under the Uniform
Prescription Drug Information Card Act.

    Section 25.  Applicability and enforcement.
    (a)  This Act applies to health care benefit  plans  that
are  amended,  delivered, issued, or renewed on and after the
effective date of this amendatory Act of the  92nd    General
Assembly.
    (b)  The  Director may adopt rules necessary to implement
the Department's responsibilities under this Act.  To enforce
the provisions of this Act, the Director may  issue  a  cease
and desist order or require a health benefit plan to submit a
plan  of  correction  for  violations  of  this Act, or both.
Subject to the  provisions  of  the  Illinois  Administrative
Procedure  Act, the Director may, pursuant to Section 403A of
the Illinois Insurance Code, impose  upon  a  health  benefit
plan  an  administrative  fine  not  to  exceed  $250,000 for
failure to submit a requested plan of correction, failure  to
comply with its plan or correction, or repeated violations of
this Act.
    Section  99.   Effective  date.  This Act takes effect on
January 1, 2002.
    Passed in the General Assembly May 01, 2001.
    Approved July 20, 2001.

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