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Public Act 102-0902 Public Act 0902 102ND GENERAL ASSEMBLY |
Public Act 102-0902 | SB3910 Enrolled | LRB102 24062 BMS 33282 b |
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| AN ACT concerning regulation.
| Be it enacted by the People of the State of Illinois,
| represented in the General Assembly:
| Section 5. The Uniform Prescription Drug Information Card | Act is amended by changing Section 15 as follows: | (215 ILCS 138/15) | Sec. 15. Uniform prescription drug information cards | required. | (a) A health benefit plan that issues a physical or | electronic card or other technology and
provides coverage for | prescription drugs or
devices
and an administrator of such a | plan including, but not limited to, third-party
administrators | for self-insured plans and state-administered plans shall | issue
to its
insureds a card or other technology containing | uniform prescription drug
information. The uniform | prescription drug information card or other
technology shall
| specifically identify and display the following
mandatory data | elements on the front of the card: | (1) BIN number; | (2) Processor control number if required for claims | adjudication; | (3) Group number; | (4) Card issuer identifier; |
| (5) Cardholder ID number; and | (6) The regulatory entity that holds authority over | the plan; for the purpose of this requirement, the | Department of Healthcare and Family Services is the | regulatory entity that holds authority over plans that the | Department of Healthcare and Family Services has | contracted with to provide services under the medical | assistance program; | (7) Any deductible applicable to the plan; if there is | a deductible specific to prescription drugs, that shall be | the applicable deductible for this card; | (8) Any out-of-pocket maximum limitation applicable to | the plan; if there is an out-of-pocket maximum limitation | specific to prescription drugs, that shall be the | applicable limitation for this card; | (9) A toll-free telephone number and Internet website | address through which the cardholder may seek consumer | assistance information, such as up-to-date lists of | preferred pharmacist and pharmacy providers and additional | information about the plan's prescription drug benefits; | and | (10) (6) Cardholder name. | The uniform prescription drug information card or other | technology shall
specifically identify and display the | following mandatory data elements on the
back of the card: | (1) Claims submission names and addresses; and |
| (2) Help desk telephone numbers and names. | (b) A new uniform prescription drug information card or | other technology
shall be
issued by a health benefit plan upon | enrollment and reissued upon any change in
the insured's | coverage that affects mandatory data elements contained on the
| card. | (c) Notwithstanding subsections (a) and (b) of this | Section, a discounted health care services plan administrator | providing discounts on prescription drugs or devices shall | issue to its beneficiaries a card containing the following | mandatory data elements: | (1) an Internet website for beneficiaries to access | up-to-date lists of preferred providers; | (2) a toll-free help desk number for beneficiaries and | providers to access up-to-date lists of preferred | providers and additional information about the discounted | health care services plan; | (3) the name or logo of the provider network; | (4) a group number; | (5) a cardholder ID number; | (6) the cardholder's name or a space to permit the | cardholder to print his or her name, if the cardholder | pays a periodic charge for use of the card; | (7) a processor control number, if required for claims | adjudication; and | (8) a statement that the plan is not insurance. |
| (d) As used in this Section, "discounted health care | services plan administrator" means any person, partnership, or | corporation, other than an insurer, health service | corporation, limited health service organization holding a | certificate of authority under the Limited Health Service | Organization Act, or health maintenance organization holding a | certificate of authority under the Health Maintenance | Organization Act that arranges, contracts with, or administers | contracts with a provider whereby insureds or beneficiaries | are provided an incentive to use health care services provided | by health care services providers under a discounted health | care services plan in which there are no other incentives, | such as copayment, coinsurance, or any other reimbursement | differential, for beneficiaries to utilize the provider. | "Discounted health care services plan administrator" also | includes any person, partnership, or corporation, other than | an insurer, health service corporation, limited health service | organization holding a certificate of authority under the | Limited Health Service Organization Act, or health maintenance | organization holding a certificate of authority under the | Health Maintenance Organization Act that enters into a | contract with another administrator to enroll beneficiaries or | insureds in a preferred provider program marketed as an | independently identifiable program based on marketing | materials or member benefit identification cards. | (Source: P.A. 96-1326, eff. 1-1-11.) |
| Section 10. The Uniform Health Care Service Benefits | Information Card Act is amended by changing Section 15 as | follows: | (215 ILCS 139/15) | Sec. 15. Uniform health care benefit information cards | required. | (a) A health benefit plan or a dental plan that issues a | physical or electronic card or other technology and
provides | coverage for health care services including prescription drugs | or
devices also referred to as health care benefits and an | administrator of such a
plan including, but not limited to, | third-party administrators for self-insured
plans and | state-administered plans shall issue to its insureds a card or | other
technology containing uniform health care benefit | information. The health care
benefit information card or other | technology shall specifically identify and
display the | following mandatory data elements on the card: | (1) processor control number, if required for claims | adjudication; | (2) group number; | (3) card issuer identifier; | (4) cardholder ID number; and | (5) except for dental plans, the regulatory entity | that holds authority over the plan; for the purpose of |
| this requirement, the Department of Healthcare and Family | Services is the regulatory entity that holds authority | over plans that the Department of Healthcare and Family | Services has contracted with to provide services under the | medical assistance program; | (6) except for dental plans, any deductible applicable | to the plan; | (7) except for dental plans, any out-of-pocket maximum | limitation applicable to the plan; | (8) a toll-free telephone number and Internet website | address through which the cardholder may seek consumer | assistance information, such as up-to-date lists of | preferred providers, including health care professionals, | hospitals, and other facilities, offices, or sites that | are contracted to furnish items or services under the | plan, and additional information about the plan; and | (9) (5) cardholder name. | (b) The uniform health care benefit information card or | other technology
shall specifically identify and display the | following mandatory data elements
on the back of the card: | (1) claims submission names and addresses; and | (2) help desk telephone numbers and names. | (b-5) A uniform health care benefit information card or | other technology for a health benefit plan offering dental | coverage or dental plan shall include a statement indicating | whether the health benefit plan offering dental coverage or |
| dental plan is subject to regulation by the Department of | Insurance. | (c) A new uniform health care benefit information card or | other technology
shall be issued by a health benefit plan or | dental plan upon enrollment and reissued upon any
change in | the insured's coverage that affects mandatory data elements | contained
on the card. | (d) Notwithstanding subsections (a), (b), and (c) of this | Section, a discounted health care services plan administrator | shall issue to its beneficiaries a card containing the | following mandatory data elements: | (1) an Internet website for beneficiaries to access | up-to-date lists of preferred providers; | (2) a toll-free help desk number for beneficiaries and | providers to access up-to-date lists of preferred | providers and additional information about the discounted | health care services plan; | (3) the name or logo of the provider network; | (4) a group number, if necessary for the processing of | benefits; | (5) a cardholder ID number; | (6) the cardholder's name or a space to permit the | cardholder to print his or her name, if the cardholder | pays a periodic charge for use of the card; | (7) a processor control number, if required for claims | adjudication; and |
| (8) a statement that the plan is not insurance. | (e) As used in this Section, "discounted health care | services plan administrator" means any person, partnership, or | corporation, other than an insurer, health service | corporation, limited health service organization holding a | certificate of authority under the Limited Health Service | Organization Act, or health maintenance organization holding a | certificate of authority under the Health Maintenance | Organization Act that arranges, contracts with, or administers | contracts with a provider whereby insureds or beneficiaries | are provided an incentive to use health care services provided | by health care services providers under a discounted health | care services plan in which there are no other incentives, | such as copayment, coinsurance, or any other reimbursement | differential, for beneficiaries to utilize the provider. | "Discounted health care services plan administrator" also | includes any person, partnership, or corporation, other than | an insurer, health service corporation, limited health service | organization holding a certificate of authority under the | Limited Health Service Organization Act, or health maintenance | organization holding a certificate of authority under the | Health Maintenance Organization Act that enters into a | contract with another administrator to enroll beneficiaries or | insureds in a preferred provider program marketed as an | independently identifiable program based on marketing | materials or member benefit identification cards. |
| (Source: P.A. 100-1013, eff. 1-1-19 .)
| Section 99. Effective date. This Act takes effect January | 1, 2024. |
Effective Date: 1/1/2024
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