96TH GENERAL ASSEMBLY
State of Illinois
2009 and 2010
HB5352

 

Introduced 2/5/2010, by Rep. Angelo Saviano - Michael J. Zalewski

 

SYNOPSIS AS INTRODUCED:
 
215 ILCS 138/15

    Amends the Uniform Prescription Drug Information Card Act. Provides that a discounted health care services plan administrator shall issue to its beneficiaries and insureds a card or other technology containing uniform prescription drug information. Provides that the card or other technology issued by a discounted health care services plan administrator shall display the same mandatory data elements as is required on cards and other technologies issued by health benefit plans. Sets forth a definition for "discounted health care services plan administrator".


LRB096 16811 RPM 32118 b

 

 

A BILL FOR

 

HB5352 LRB096 16811 RPM 32118 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. A discounted health care services plan
16 administrator shall issue to its beneficiaries and insureds a
17 card or other technology containing uniform prescription drug
18 information. The uniform prescription drug information card or
19 other technology issued by a health benefit plan or discounted
20 health care services plan administrator shall specifically
21 identify and display the following mandatory data elements on
22 the front of the card:
23         (1) BIN number;

 

 

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1         (2) Processor control number if required for claims
2     adjudication;
3         (3) Group number;
4         (4) Card issuer identifier;
5         (5) Cardholder ID number; and
6         (6) Cardholder name.
7     The uniform prescription drug information card or other
8 technology shall specifically identify and display the
9 following mandatory data elements on the back of the card:
10         (1) Claims submission names and addresses; and
11         (2) Help desk telephone numbers and names.
12     (b) A new uniform prescription drug information card or
13 other technology shall be issued by a health benefit plan upon
14 enrollment and reissued upon any change in the insured's
15 coverage that affects mandatory data elements contained on the
16 card.
17     (c) As used in this Section, "discounted health care
18 services plan administrator" means any person, partnership, or
19 corporation, other than an insurer, health service
20 corporation, limited health service organization holding a
21 certificate of authority under the Limited Health Service
22 Organization Act, or health maintenance organization holding a
23 certificate of authority under the Health Maintenance
24 Organization Act, that arranges, contracts with, or
25 administers contracts with a provider whereby insureds or
26 beneficiaries are provided an incentive to use health care

 

 

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1 services provided by health care service providers under a
2 discounted health care service plan in which there are no other
3 incentives, such as copayment, coinsurance, or any other
4 reimbursement differential, for beneficiaries to utilize the
5 provider. "Discounted health care services plan administrator"
6 also includes any person, partnership, or corporation, other
7 than an insurer, health service corporation, limited health
8 service organization holding a certificate of authority under
9 the Limited Health Service Organization Act, or health
10 maintenance organization holding a certificate of authority
11 under the Health Maintenance Organization Act, that enters into
12 a contract with another administrator to enroll beneficiaries
13 or insureds in a preferred provider program marketed as an
14 independently identifiable program based on marketing
15 materials or member benefit identification cards.
16 (Source: P.A. 91-777, eff. 1-1-01.)