Illinois General Assembly - Full Text of SB3910
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Full Text of SB3910  102nd General Assembly

SB3910enr 102ND GENERAL ASSEMBLY

  
  
  

 


 
SB3910 EnrolledLRB102 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 Enrolled- 2 -LRB102 24062 BMS 33282 b

1        (5) Cardholder ID number; and
2        (6) The regulatory entity that holds authority over
3    the plan; for the purpose of this requirement, the
4    Department of Healthcare and Family Services is the
5    regulatory entity that holds authority over plans that the
6    Department of Healthcare and Family Services has
7    contracted with to provide services under the medical
8    assistance program;
9        (7) Any deductible applicable to the plan; if there is
10    a deductible specific to prescription drugs, that shall be
11    the applicable deductible for this card;
12        (8) Any out-of-pocket maximum limitation applicable to
13    the plan; if there is an out-of-pocket maximum limitation
14    specific to prescription drugs, that shall be the
15    applicable limitation for this card;
16        (9) A toll-free telephone number and Internet website
17    address through which the cardholder may seek consumer
18    assistance information, such as up-to-date lists of
19    preferred pharmacist and pharmacy providers and additional
20    information about the plan's prescription drug benefits;
21    and
22        (10) (6) Cardholder name.
23    The uniform prescription drug information card or other
24technology shall specifically identify and display the
25following mandatory data elements on the back of the card:
26        (1) Claims submission names and addresses; and

 

 

SB3910 Enrolled- 3 -LRB102 24062 BMS 33282 b

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

 

 

SB3910 Enrolled- 4 -LRB102 24062 BMS 33282 b

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

 

 

SB3910 Enrolled- 5 -LRB102 24062 BMS 33282 b

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

 

 

SB3910 Enrolled- 6 -LRB102 24062 BMS 33282 b

1    this requirement, the Department of Healthcare and Family
2    Services is the regulatory entity that holds authority
3    over plans that the Department of Healthcare and Family
4    Services has contracted with to provide services under the
5    medical assistance program;
6        (6) except for dental plans, any deductible applicable
7    to the plan;
8        (7) except for dental plans, any out-of-pocket maximum
9    limitation applicable to the plan;
10        (8) a toll-free telephone number and Internet website
11    address through which the cardholder may seek consumer
12    assistance information, such as up-to-date lists of
13    preferred providers, including health care professionals,
14    hospitals, and other facilities, offices, or sites that
15    are contracted to furnish items or services under the
16    plan, and additional information about the plan; and
17        (9) (5) cardholder name.
18    (b) The uniform health care benefit information card or
19other technology 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-5) A uniform health care benefit information card or
24other technology for a health benefit plan offering dental
25coverage or dental plan shall include a statement indicating
26whether the health benefit plan offering dental coverage or

 

 

SB3910 Enrolled- 7 -LRB102 24062 BMS 33282 b

1dental plan is subject to regulation by the Department of
2Insurance.
3    (c) A new uniform health care benefit information card or
4other technology shall be issued by a health benefit plan or
5dental plan upon enrollment and reissued upon any change in
6the insured's coverage that affects mandatory data elements
7contained on the card.
8    (d) Notwithstanding subsections (a), (b), and (c) of this
9Section, a discounted health care services plan administrator
10shall issue to its beneficiaries a card containing the
11following mandatory data elements:
12        (1) an Internet website for beneficiaries to access
13    up-to-date lists of preferred providers;
14        (2) a toll-free help desk number for beneficiaries and
15    providers to access up-to-date lists of preferred
16    providers and additional information about the discounted
17    health care services plan;
18        (3) the name or logo of the provider network;
19        (4) a group number, if necessary for the processing of
20    benefits;
21        (5) a cardholder ID number;
22        (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        (7) a processor control number, if required for claims
26    adjudication; and

 

 

SB3910 Enrolled- 8 -LRB102 24062 BMS 33282 b

1        (8) a statement that the plan is not insurance.
2    (e) 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 Enrolled- 9 -LRB102 24062 BMS 33282 b

1(Source: P.A. 100-1013, eff. 1-1-19.)
 
2    Section 99. Effective date. This Act takes effect January
31, 2024.