102ND GENERAL ASSEMBLY
State of Illinois
2021 and 2022
SB3910

 

Introduced 1/21/2022, by Sen. Laura Fine

 

SYNOPSIS AS INTRODUCED:
 
215 ILCS 138/15
215 ILCS 139/15

    Amends the Uniform Prescription Drug Information Card Act. Provides that a uniform prescription drug information card issued by a health benefit plan shall display on the card the regulatory entity that holds authority over the plan, whether the plan is fully insured or self-insured, the issuer's National Association of Insurance Commissioners company code, any deductible applicable to the plan, any out-of-pocket maximum limitation applicable to the plan, and a toll-free telephone number and Internet website address through which the cardholder may seek consumer assistance information. Provides that a discounted health care services plan administrator shall issue to its beneficiaries a card that contains information about the regulatory entity that holds authority over the plan and whether the plan is fully insured or self-insured. Amends the Uniform Health Care Service Benefits Information Card Act. Provides that a health care benefit information card or other technology containing uniform health care benefit information issued by a health benefit plan or a dental plan shall specifically identify and display on the card the regulatory entity that holds authority over the plan, whether the plan is fully insured or self-insured, the issuer's National Association of Insurance Commissioners company code, any deductible applicable to the plan, any out-of-pocket maximum limitation applicable to the plan, and a toll-free telephone number and Internet website address through which the cardholder may seek consumer assistance information. Makes other changes. Effective January 1, 2023.


LRB102 24062 BMS 33282 b

 

 

A BILL FOR

 

SB3910LRB102 24062 BMS 33282 b

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

 

 

SB3910- 2 -LRB102 24062 BMS 33282 b

1        (5) Cardholder ID number; and
2        (6) The regulatory entity that holds authority over
3    the plan;
4        (7) Whether the plan is fully insured or self-insured;
5        (8) The issuer's 5-digit National Association of
6    Insurance Commissioners Company Code;
7        (9) Any deductible applicable to the plan; if there is
8    a deductible specific to prescription drugs, that shall be
9    the applicable deductible for this card;
10        (10) Any out-of-pocket maximum limitation applicable
11    to the plan; if there is an out-of-pocket maximum
12    limitation specific to prescription drugs, that shall be
13    the applicable limitation for this card;
14        (11) A toll-free telephone number and Internet website
15    address through which the cardholder may seek consumer
16    assistance information, such as up-to-date lists of
17    preferred pharmacist and pharmacy providers and additional
18    information about the plan's prescription drug benefits;
19    and
20        (12) (6) Cardholder name.
21    The uniform prescription drug information card or other
22technology shall specifically identify and display the
23following mandatory data elements on the back of the card:
24        (1) Claims submission names and addresses; and
25        (2) Help desk telephone numbers and names.
26    (b) A new uniform prescription drug information card or

 

 

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1other technology shall be issued by a health benefit plan upon
2enrollment and reissued upon any change in the insured's
3coverage that affects mandatory data elements contained on the
4card.
5    (c) Notwithstanding subsections (a) and (b) of this
6Section, a discounted health care services plan administrator
7providing discounts on prescription drugs or devices shall
8issue to its beneficiaries a card containing the following
9mandatory data elements:
10        (1) an Internet website for beneficiaries to access
11    up-to-date lists of preferred providers;
12        (2) a toll-free help desk number for beneficiaries and
13    providers to access up-to-date lists of preferred
14    providers and additional information about the discounted
15    health care services plan;
16        (3) the name or logo of the provider network;
17        (4) a group number;
18        (5) a cardholder ID number;
19        (6) the regulatory entity that holds authority over
20    the plan;
21        (7) whether the plan is fully insured or self-insured;
22        (8) (6) the cardholder's name or a space to permit the
23    cardholder to print his or her name, if the cardholder
24    pays a periodic charge for use of the card;
25        (9) (7) a processor control number, if required for
26    claims adjudication; and

 

 

SB3910- 4 -LRB102 24062 BMS 33282 b

1        (10) (8) a statement that the plan is not insurance.
2    (d) As used in this Section, "discounted health care
3services plan administrator" means any person, partnership, or
4corporation, other than an insurer, health service
5corporation, limited health service organization holding a
6certificate of authority under the Limited Health Service
7Organization Act, or health maintenance organization holding a
8certificate of authority under the Health Maintenance
9Organization Act that arranges, contracts with, or administers
10contracts with a provider whereby insureds or beneficiaries
11are provided an incentive to use health care services provided
12by health care services providers under a discounted health
13care services plan in which there are no other incentives,
14such as copayment, coinsurance, or any other reimbursement
15differential, for beneficiaries to utilize the provider.
16"Discounted health care services plan administrator" also
17includes any person, partnership, or corporation, other than
18an insurer, health service corporation, limited health service
19organization holding a certificate of authority under the
20Limited Health Service Organization Act, or health maintenance
21organization holding a certificate of authority under the
22Health Maintenance Organization Act that enters into a
23contract with another administrator to enroll beneficiaries or
24insureds in a preferred provider program marketed as an
25independently identifiable program based on marketing
26materials or member benefit identification cards.

 

 

SB3910- 5 -LRB102 24062 BMS 33282 b

1(Source: P.A. 96-1326, eff. 1-1-11.)
 
2    Section 10. The Uniform Health Care Service Benefits
3Information Card Act is amended by changing Section 15 as
4follows:
 
5    (215 ILCS 139/15)
6    Sec. 15. Uniform health care benefit information cards
7required.
8    (a) A health benefit plan or a dental plan that issues a
9physical or electronic card or other technology and provides
10coverage for health care services including prescription drugs
11or devices also referred to as health care benefits and an
12administrator of such a plan including, but not limited to,
13third-party administrators for self-insured plans and
14state-administered plans shall issue to its insureds a card or
15other technology containing uniform health care benefit
16information. The health care benefit information card or other
17technology shall specifically identify and display the
18following mandatory data elements on the card:
19        (1) processor control number, if required for claims
20    adjudication;
21        (2) group number;
22        (3) card issuer identifier;
23        (4) cardholder ID number; and
24        (5) the regulatory entity that holds authority over

 

 

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1    the plan;
2        (6) whether the plan is fully insured or self-insured;
3        (7) the issuer's 5-digit National Association of
4    Insurance Commissioners Company Code;
5        (8) any deductible applicable to the plan;
6        (9) any out-of-pocket maximum limitation applicable to
7    the plan;
8        (10) a toll-free telephone number and Internet website
9    address through which the cardholder may seek consumer
10    assistance information, such as up-to-date lists of
11    preferred providers, including health care professionals,
12    hospitals, and other facilities, offices, or sites that
13    are contracted to furnish items or services under the
14    plan, and additional information about the plan; and
15        (11) (5) cardholder name.
16    (b) The uniform health care benefit information card or
17other technology shall specifically identify and display the
18following mandatory data elements on the back of the card:
19        (1) claims submission names and addresses; and
20        (2) help desk telephone numbers and names.
21    (b-5) A uniform health care benefit information card or
22other technology for a health benefit plan offering dental
23coverage or dental plan shall include a statement indicating
24whether the health benefit plan offering dental coverage or
25dental plan is subject to regulation by the Department of
26Insurance.

 

 

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1    (c) A new uniform health care benefit information card or
2other technology shall be issued by a health benefit plan or
3dental plan upon enrollment and reissued upon any change in
4the insured's coverage that affects mandatory data elements
5contained on the card.
6    (d) Notwithstanding subsections (a), (b), and (c) of this
7Section, a discounted health care services plan administrator
8shall issue to its beneficiaries a card containing the
9following mandatory data elements:
10        (1) an Internet website for beneficiaries to access
11    up-to-date lists of preferred providers;
12        (2) a toll-free help desk number for beneficiaries and
13    providers to access up-to-date lists of preferred
14    providers and additional information about the discounted
15    health care services plan;
16        (3) the name or logo of the provider network;
17        (4) a group number, if necessary for the processing of
18    benefits;
19        (5) a cardholder ID number;
20        (6) the cardholder's name or a space to permit the
21    cardholder to print his or her name, if the cardholder
22    pays a periodic charge for use of the card;
23        (7) a processor control number, if required for claims
24    adjudication; and
25        (8) a statement that the plan is not insurance.
26    (e) As used in this Section, "discounted health care

 

 

SB3910- 8 -LRB102 24062 BMS 33282 b

1services plan administrator" means any person, partnership, or
2corporation, other than an insurer, health service
3corporation, limited health service organization holding a
4certificate of authority under the Limited Health Service
5Organization Act, or health maintenance organization holding a
6certificate of authority under the Health Maintenance
7Organization Act that arranges, contracts with, or administers
8contracts with a provider whereby insureds or beneficiaries
9are provided an incentive to use health care services provided
10by health care services providers under a discounted health
11care services plan in which there are no other incentives,
12such as copayment, coinsurance, or any other reimbursement
13differential, for beneficiaries to utilize the provider.
14"Discounted health care services plan administrator" also
15includes any person, partnership, or corporation, other than
16an insurer, health service corporation, limited health service
17organization holding a certificate of authority under the
18Limited Health Service Organization Act, or health maintenance
19organization holding a certificate of authority under the
20Health Maintenance Organization Act that enters into a
21contract with another administrator to enroll beneficiaries or
22insureds in a preferred provider program marketed as an
23independently identifiable program based on marketing
24materials or member benefit identification cards.
25(Source: P.A. 100-1013, eff. 1-1-19.)
 
26    Section 99. Effective date. This Act takes effect January

 

 

SB3910- 9 -LRB102 24062 BMS 33282 b

11, 2023.