Full Text of HB5527 96th General Assembly
HB5527enr 96TH GENERAL ASSEMBLY
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HB5527 Enrolled |
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| AN ACT concerning insurance.
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| Be it enacted by the People of the State of Illinois,
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| represented in the General Assembly:
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| 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
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| 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
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| information. The uniform prescription drug information card or | 16 |
| other
technology shall
specifically identify and display the | 17 |
| following
mandatory data elements on the front of the card: | 18 |
| (1) BIN number; | 19 |
| (2) Processor control number if required for claims | 20 |
| adjudication; | 21 |
| (3) Group number; | 22 |
| (4) Card issuer identifier; | 23 |
| (5) Cardholder ID number; and |
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| (6) Cardholder name. | 2 |
| The uniform prescription drug information card or other | 3 |
| technology shall
specifically identify and display the | 4 |
| following mandatory data elements on the
back of the card: | 5 |
| (1) Claims submission names and addresses; and | 6 |
| (2) Help desk telephone numbers and names. | 7 |
| (b) A new uniform prescription drug information card or | 8 |
| other technology
shall be
issued by a health benefit plan upon | 9 |
| enrollment and reissued upon any change in
the insured's | 10 |
| coverage that affects mandatory data elements contained on the
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| card. | 12 |
| (c) Notwithstanding subsections (a) and (b) of this | 13 |
| Section, a discounted health care services plan administrator | 14 |
| providing discounts on prescription drugs or devices shall | 15 |
| issue to its beneficiaries a card containing the following | 16 |
| mandatory data elements: | 17 |
| (1) an Internet website for beneficiaries to access | 18 |
| up-to-date lists of preferred providers; | 19 |
| (2) a toll-free help desk number for beneficiaries and | 20 |
| providers to access up-to-date lists of preferred | 21 |
| providers and additional information about the discounted | 22 |
| health care services plan; | 23 |
| (3) the name or logo of the provider network; | 24 |
| (4) a group number; | 25 |
| (5) a cardholder ID number; | 26 |
| (6) the cardholder's name or a space to permit the |
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HB5527 Enrolled |
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| cardholder to print his or her name, if the cardholder pays | 2 |
| a periodic charge for use of the card; | 3 |
| (7) a processor control number, if required for claims | 4 |
| adjudication; and | 5 |
| (8) a statement that the plan is not insurance. | 6 |
| (d) As used in this Section, "discounted health care | 7 |
| services plan administrator" means any person, partnership, or | 8 |
| corporation, other than an insurer, health service | 9 |
| corporation, limited health service organization holding a | 10 |
| certificate of authority under the Limited Health Service | 11 |
| Organization Act, or health maintenance organization holding a | 12 |
| certificate of authority under the Health Maintenance | 13 |
| Organization Act that arranges, contracts with, or administers | 14 |
| contracts with a provider whereby insureds or beneficiaries are | 15 |
| provided an incentive to use health care services provided by | 16 |
| health care services providers under a discounted health care | 17 |
| services plan in which there are no other incentives, such as | 18 |
| copayment, coinsurance, or any other reimbursement | 19 |
| differential, for beneficiaries to utilize the provider. | 20 |
| "Discounted health care services plan administrator" also | 21 |
| includes any person, partnership, or corporation, other than an | 22 |
| insurer, health service corporation, limited health service | 23 |
| organization holding a certificate of authority under the | 24 |
| Limited Health Service Organization Act, or health maintenance | 25 |
| organization holding a certificate of authority under the | 26 |
| Health Maintenance Organization Act that enters into a contract |
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HB5527 Enrolled |
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LRB096 20211 RPM 35782 b |
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| with another administrator to enroll beneficiaries or insureds | 2 |
| in a preferred provider program marketed as an independently | 3 |
| identifiable program based on marketing materials or member | 4 |
| benefit identification cards. | 5 |
| (Source: P.A. 91-777, eff. 1-1-01.) | 6 |
| Section 10. The Uniform Health Care Service Benefits | 7 |
| Information Card Act is amended by changing Section 15 as | 8 |
| follows: | 9 |
| (215 ILCS 139/15) | 10 |
| Sec. 15. Uniform health care benefit information cards | 11 |
| required. | 12 |
| (a) A health benefit plan that issues a card or other | 13 |
| technology and
provides coverage for health care services | 14 |
| including prescription drugs or
devices also referred to as | 15 |
| health care benefits and an administrator of such a
plan | 16 |
| including, but not limited to, third-party administrators for | 17 |
| self-insured
plans and state-administered plans shall issue to | 18 |
| its insureds a card or other
technology containing uniform | 19 |
| health care benefit information. The health care
benefit | 20 |
| information card or other technology shall specifically | 21 |
| identify and
display the following mandatory data elements on | 22 |
| the card: | 23 |
| (1) processor control number, if required for claims | 24 |
| adjudication; |
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HB5527 Enrolled |
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LRB096 20211 RPM 35782 b |
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| (2) group number; | 2 |
| (3) card issuer identifier; | 3 |
| (4) cardholder ID number; and | 4 |
| (5) cardholder name. | 5 |
| (b) The uniform health care benefit information card or | 6 |
| other technology
shall specifically identify and display the | 7 |
| following mandatory data elements
on the back of the card: | 8 |
| (1) claims submission names and addresses; and | 9 |
| (2) help desk telephone numbers and names. | 10 |
| (c) A new uniform health care benefit information card or | 11 |
| other technology
shall be issued by a health benefit plan upon | 12 |
| enrollment and reissued upon any
change in the insured's | 13 |
| coverage that affects mandatory data elements contained
on the | 14 |
| card. | 15 |
| (d) Notwithstanding subsections (a), (b), and (c) of this | 16 |
| Section, a discounted health care services plan administrator | 17 |
| shall issue to its beneficiaries a card containing the | 18 |
| following mandatory data elements: | 19 |
| (1) an Internet website for beneficiaries to access | 20 |
| up-to-date lists of preferred providers; | 21 |
| (2) a toll-free help desk number for beneficiaries and | 22 |
| providers to access up-to-date lists of preferred | 23 |
| providers and additional information about the discounted | 24 |
| health care services plan; | 25 |
| (3) the name or logo of the provider network; | 26 |
| (4) a group number, if necessary for the processing of |
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HB5527 Enrolled |
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LRB096 20211 RPM 35782 b |
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| benefits; | 2 |
| (5) a cardholder ID number; | 3 |
| (6) the cardholder's name or a space to permit the | 4 |
| cardholder to print his or her name, if the cardholder pays | 5 |
| a periodic charge for use of the card; | 6 |
| (7) a processor control number, if required for claims | 7 |
| adjudication; and | 8 |
| (8) a statement that the plan is not insurance. | 9 |
| (e) As used in this Section, "discounted health care | 10 |
| services plan administrator" means any person, partnership, or | 11 |
| corporation, other than an insurer, health service | 12 |
| corporation, limited health service organization holding a | 13 |
| certificate of authority under the Limited Health Service | 14 |
| Organization Act, or health maintenance organization holding a | 15 |
| certificate of authority under the Health Maintenance | 16 |
| Organization Act that arranges, contracts with, or administers | 17 |
| contracts with a provider whereby insureds or beneficiaries are | 18 |
| provided an incentive to use health care services provided by | 19 |
| health care services providers under a discounted health care | 20 |
| services plan in which there are no other incentives, such as | 21 |
| copayment, coinsurance, or any other reimbursement | 22 |
| differential, for beneficiaries to utilize the provider. | 23 |
| "Discounted health care services plan administrator" also | 24 |
| includes any person, partnership, or corporation, other than an | 25 |
| insurer, health service corporation, limited health service | 26 |
| organization holding a certificate of authority under the |
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HB5527 Enrolled |
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LRB096 20211 RPM 35782 b |
|
| 1 |
| Limited Health Service Organization Act, or health maintenance | 2 |
| organization holding a certificate of authority under the | 3 |
| Health Maintenance Organization Act that enters into a contract | 4 |
| with another administrator to enroll beneficiaries or insureds | 5 |
| in a preferred provider program marketed as an independently | 6 |
| identifiable program based on marketing materials or member | 7 |
| benefit identification cards. | 8 |
| (Source: P.A. 92-106, eff. 1-1-02.)
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