SB3910 EngrossedLRB102 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;

 

 

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

 

 

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1card.
2    (c) Notwithstanding subsections (a) and (b) of this
3Section, a discounted health care services plan administrator
4providing discounts on prescription drugs or devices shall
5issue to its beneficiaries a card containing the following
6mandatory data elements:
7        (1) an Internet website for beneficiaries to access
8    up-to-date lists of preferred providers;
9        (2) a toll-free help desk number for beneficiaries and
10    providers to access up-to-date lists of preferred
11    providers and additional information about the discounted
12    health care services plan;
13        (3) the name or logo of the provider network;
14        (4) a group number;
15        (5) a cardholder ID number;
16        (6) the regulatory entity that holds authority over
17    the plan;
18        (7) (6) the cardholder's name or a space to permit the
19    cardholder to print his or her name, if the cardholder
20    pays a periodic charge for use of the card;
21        (8) (7) a processor control number, if required for
22    claims adjudication; and
23        (9) (8) a statement that the plan is not insurance.
24    (d) As used in this Section, "discounted health care
25services plan administrator" means any person, partnership, or
26corporation, other than an insurer, health service

 

 

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1corporation, limited health service organization holding a
2certificate of authority under the Limited Health Service
3Organization Act, or health maintenance organization holding a
4certificate of authority under the Health Maintenance
5Organization Act that arranges, contracts with, or administers
6contracts with a provider whereby insureds or beneficiaries
7are provided an incentive to use health care services provided
8by health care services providers under a discounted health
9care services plan in which there are no other incentives,
10such as copayment, coinsurance, or any other reimbursement
11differential, for beneficiaries to utilize the provider.
12"Discounted health care services plan administrator" also
13includes any person, partnership, or corporation, other than
14an insurer, health service corporation, limited health service
15organization holding a certificate of authority under the
16Limited Health Service Organization Act, or health maintenance
17organization holding a certificate of authority under the
18Health Maintenance Organization Act that enters into a
19contract with another administrator to enroll beneficiaries or
20insureds in a preferred provider program marketed as an
21independently identifiable program based on marketing
22materials or member benefit identification cards.
23(Source: P.A. 96-1326, eff. 1-1-11.)
 
24    Section 10. The Uniform Health Care Service Benefits
25Information Card Act is amended by changing Section 15 as

 

 

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

 

 

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

 

 

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1Section, a discounted health care services plan administrator
2shall issue to its beneficiaries a card containing the
3following mandatory data elements:
4        (1) an Internet website for beneficiaries to access
5    up-to-date lists of preferred providers;
6        (2) a toll-free help desk number for beneficiaries and
7    providers to access up-to-date lists of preferred
8    providers and additional information about the discounted
9    health care services plan;
10        (3) the name or logo of the provider network;
11        (4) a group number, if necessary for the processing of
12    benefits;
13        (5) a cardholder ID number;
14        (6) the regulatory entity that holds authority over
15    the plan;
16        (7) (6) the cardholder's name or a space to permit the
17    cardholder to print his or her name, if the cardholder
18    pays a periodic charge for use of the card;
19        (8) (7) a processor control number, if required for
20    claims adjudication; and
21        (9) (8) a statement that the plan is not insurance.
22    (e) As used in this Section, "discounted health care
23services plan administrator" means any person, partnership, or
24corporation, other than an insurer, health service
25corporation, limited health service organization holding a
26certificate of authority under the Limited Health Service

 

 

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1Organization Act, or health maintenance organization holding a
2certificate of authority under the Health Maintenance
3Organization Act that arranges, contracts with, or administers
4contracts with a provider whereby insureds or beneficiaries
5are provided an incentive to use health care services provided
6by health care services providers under a discounted health
7care services plan in which there are no other incentives,
8such as copayment, coinsurance, or any other reimbursement
9differential, for beneficiaries to utilize the provider.
10"Discounted health care services plan administrator" also
11includes any person, partnership, or corporation, other than
12an insurer, health service corporation, limited health service
13organization holding a certificate of authority under the
14Limited Health Service Organization Act, or health maintenance
15organization holding a certificate of authority under the
16Health Maintenance Organization Act that enters into a
17contract with another administrator to enroll beneficiaries or
18insureds in a preferred provider program marketed as an
19independently identifiable program based on marketing
20materials or member benefit identification cards.
21(Source: P.A. 100-1013, eff. 1-1-19.)
 
22    Section 99. Effective date. This Act takes effect January
231, 2024.