Full Text of SB2851 100th General Assembly
SB2851sam001 100TH GENERAL ASSEMBLY | Sen. Pamela J. Althoff Filed: 2/27/2018
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| 1 | | AMENDMENT TO SENATE BILL 2851
| 2 | | AMENDMENT NO. ______. Amend Senate Bill 2851 by replacing | 3 | | everything after the enacting clause with the following:
| 4 | | "Section 5. The Uniform Health Care Service Benefits | 5 | | Information Card Act is amended by changing Sections 10 and 15 | 6 | | as follows:
| 7 | | (215 ILCS 139/10)
| 8 | | Sec. 10. Definitions. As used in this Act, the following | 9 | | terms have the
meanings given in this Section.
| 10 | | "Department" means the Department of Insurance.
| 11 | | "Director" means the Director of Insurance.
| 12 | | "Health benefit plan" means an accident and health | 13 | | insurance policy or
certificate subject to the Illinois | 14 | | Insurance Code, a voluntary health services
plan subject to the | 15 | | Voluntary Health Services Plans Act, a health maintenance
| 16 | | organization subscriber contract subject to the Health |
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| 1 | | Maintenance
Organization Act, a plan provided by a multiple | 2 | | employer welfare arrangement, a dental service plan subject to | 3 | | the Dental Service Plan Act,
or a plan provided by another | 4 | | benefit arrangement. Without limitation, "health
benefit plan" | 5 | | does not mean any of the following types of insurance:
| 6 | | (1) accident;
| 7 | | (2) credit;
| 8 | | (3) disability income;
| 9 | | (4) long-term or nursing home care;
| 10 | | (5) specified disease;
| 11 | | (6) dental or vision;
| 12 | | (7) coverage issued as a supplement to liability | 13 | | insurance;
| 14 | | (8) medical payments under automobile or homeowners;
| 15 | | (9) insurance under which benefits are payable with or | 16 | | without regard to
fault as statutorily required to be | 17 | | contained in any liability policy or
equivalent | 18 | | self-insurance;
| 19 | | (10) hospital income or indemnity; and
| 20 | | (11) self-insured health benefit plans under the | 21 | | federal Employee
Retirement Income Security Act of 1974.
| 22 | | (Source: P.A. 92-106, eff. 1-1-02.)
| 23 | | (215 ILCS 139/15) | 24 | | Sec. 15. Uniform health care benefit information cards | 25 | | required. |
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| 1 | | (a) A health benefit plan that issues a card or other | 2 | | technology and
provides coverage for health care services | 3 | | including prescription drugs or
devices also referred to as | 4 | | health care benefits and an administrator of such a
plan | 5 | | including, but not limited to, third-party administrators for | 6 | | self-insured
plans and state-administered plans shall issue to | 7 | | its insureds a card or other
technology containing uniform | 8 | | health care benefit information. The health care
benefit | 9 | | information card or other technology shall specifically | 10 | | identify and
display the following mandatory data elements on | 11 | | the card: | 12 | | (1) processor control number, if required for claims | 13 | | adjudication; | 14 | | (2) group number; | 15 | | (3) card issuer identifier; | 16 | | (4) cardholder ID number; and | 17 | | (5) cardholder name. | 18 | | (b) The uniform health care benefit information card or | 19 | | other technology
shall specifically identify and display the | 20 | | following 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 | 24 | | other technology for a health benefit plan offering dental | 25 | | coverage shall include a statement that the health benefit plan | 26 | | offering dental coverage is not subject to the federal Employee |
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| 1 | | Retirement Income Security Act of 1974. | 2 | | (c) A new uniform health care benefit information card or | 3 | | other technology
shall be issued by a health benefit plan upon | 4 | | enrollment and reissued upon any
change in the insured's | 5 | | coverage that affects mandatory data elements contained
on the | 6 | | card. | 7 | | (d) Notwithstanding subsections (a), (b), and (c) of this | 8 | | Section, a discounted health care services plan administrator | 9 | | shall issue to its beneficiaries a card containing the | 10 | | following mandatory data elements: | 11 | | (1) an Internet website for beneficiaries to access | 12 | | up-to-date lists of preferred providers; | 13 | | (2) a toll-free help desk number for beneficiaries and | 14 | | providers to access up-to-date lists of preferred | 15 | | providers and additional information about the discounted | 16 | | health care services plan; | 17 | | (3) the name or logo of the provider network; | 18 | | (4) a group number, if necessary for the processing of | 19 | | benefits; | 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 pays | 23 | | 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. |
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| 1 | | (e) As used in this Section, "discounted health care | 2 | | services plan administrator" means any person, partnership, or | 3 | | corporation, other than an insurer, health service | 4 | | corporation, limited health service organization holding a | 5 | | certificate of authority under the Limited Health Service | 6 | | Organization Act, or health maintenance organization holding a | 7 | | certificate of authority under the Health Maintenance | 8 | | Organization Act that arranges, contracts with, or administers | 9 | | contracts with a provider whereby insureds or beneficiaries are | 10 | | provided an incentive to use health care services provided by | 11 | | health care services providers under a discounted health care | 12 | | services plan in which there are no other incentives, such as | 13 | | copayment, coinsurance, or any other reimbursement | 14 | | differential, for beneficiaries to utilize the provider. | 15 | | "Discounted health care services plan administrator" also | 16 | | includes any person, partnership, or corporation, other than an | 17 | | insurer, health service corporation, limited health service | 18 | | organization holding a certificate of authority under the | 19 | | Limited Health Service Organization Act, or health maintenance | 20 | | organization holding a certificate of authority under the | 21 | | Health Maintenance Organization Act that enters into a contract | 22 | | with another administrator to enroll beneficiaries or insureds | 23 | | in a preferred provider program marketed as an independently | 24 | | identifiable program based on marketing materials or member | 25 | | benefit identification cards. | 26 | | (Source: P.A. 96-1326, eff. 1-1-11.)".
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