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

SB3910sam001 102ND GENERAL ASSEMBLY

Sen. Laura Fine

Filed: 2/14/2022

 

 


 

 


 
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1
AMENDMENT TO SENATE BILL 3910

2    AMENDMENT NO. ______. Amend Senate Bill 3910 by replacing
3everything after the enacting clause with the following:
 
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

 

 

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1specifically identify and display the following mandatory data
2elements on the front of the card:
3        (1) BIN number;
4        (2) Processor control number if required for claims
5    adjudication;
6        (3) Group number;
7        (4) Card issuer identifier;
8        (5) Cardholder ID number; and
9        (6) The regulatory entity that holds authority over
10    the plan;
11        (7) Any deductible applicable to the plan; if there is
12    a deductible specific to prescription drugs, that shall be
13    the applicable deductible for this card;
14        (8) Any out-of-pocket maximum limitation applicable to
15    the plan; if there is an out-of-pocket maximum limitation
16    specific to prescription drugs, that shall be the
17    applicable limitation for this card;
18        (9) A toll-free telephone number and Internet website
19    address through which the cardholder may seek consumer
20    assistance information, such as up-to-date lists of
21    preferred pharmacist and pharmacy providers and additional
22    information about the plan's prescription drug benefits;
23    and
24        (10) (6) Cardholder name.
25    The uniform prescription drug information card or other
26technology shall specifically identify and display the

 

 

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

 

 

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

 

 

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

 

 

10200SB3910sam001- 6 -LRB102 24062 BMS 36232 a

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

 

 

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1Insurance.
2    (c) A new uniform health care benefit information card or
3other technology shall be issued by a health benefit plan or
4dental plan upon enrollment and reissued upon any change in
5the insured's coverage that affects mandatory data elements
6contained on the card.
7    (d) Notwithstanding subsections (a), (b), and (c) of this
8Section, a discounted health care services plan administrator
9shall issue to its beneficiaries a card containing the
10following 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 regulatory entity that holds authority over
22    the plan;
23        (7) (6) the cardholder's name or a space to permit the
24    cardholder to print his or her name, if the cardholder
25    pays a periodic charge for use of the card;
26        (8) (7) a processor control number, if required for

 

 

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

 

 

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1materials or member benefit identification cards.
2(Source: P.A. 100-1013, eff. 1-1-19.)
 
3    Section 99. Effective date. This Act takes effect January
41, 2024.".