96TH GENERAL ASSEMBLY
State of Illinois
2009 and 2010
HB5352


 
Introduced 2/5/2010, by Rep. Angelo Saviano - Michael J. Zalewski
 
SYNOPSIS AS INTRODUCED:
 		





 








215 ILCS 138/15










     Amends the Uniform Prescription Drug Information Card Act. Provides that a discounted health care services plan administrator shall issue
to its beneficiaries and insureds a card or other technology containing uniform prescription drug
information. Provides that the card or other technology issued by a discounted health care services plan administrator shall display the same mandatory data elements as is required on cards and other technologies issued by health benefit plans. Sets forth a definition for "discounted health care services plan administrator".
  















LRB096 16811 RPM 32118 b

















 


 


A BILL FOR









 




  






HB5352

LRB096 16811 RPM 32118 b





  
1
    AN ACT concerning insurance.
  
 
2
    Be it enacted by the People of the State of Illinois,
 
3
represented in the General Assembly:
  
 
 
4
    Section 5. The Uniform Prescription Drug Information Card 
5
Act is amended  by changing Section 15 as follows:
 



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    (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

11
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

15
information. A discounted health care services plan 
16
administrator shall issue
to its beneficiaries and insureds a 
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card or other technology containing uniform prescription drug

18
information.  The uniform prescription drug information card or 
19
other
technology issued by a health benefit plan or discounted 
20
health care services plan administrator shall
specifically 
21
identify and display the following
mandatory data elements on 
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the front of the card:


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        (1) BIN number;


 


 






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LRB096 16811 RPM 32118 b




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        (2) Processor control number if required for claims 
2
    adjudication;


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        (3) Group number;


4
        (4) Card issuer identifier;


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        (5) Cardholder ID number; and


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        (6) Cardholder name.

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    The uniform prescription drug information card or other 
8
technology shall
specifically identify and display the 
9
following mandatory data elements on the
back of the card:


10
        (1) Claims submission names and addresses; and


11
        (2) Help desk telephone numbers and names.

12
    (b) A new uniform prescription drug information card or 
13
other technology
shall be
issued by a health benefit plan upon 
14
enrollment and reissued upon any change in
the insured's 
15
coverage that affects mandatory data elements contained on the

16
card.
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    (c) As used in this Section, "discounted health care 
18
services plan administrator" means any person, partnership, or 
19
corporation, other than an insurer, health service 
20
corporation, limited health service organization holding a 
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certificate of authority under the Limited Health Service 
22
Organization Act, or health maintenance organization holding a 
23
certificate of authority under the Health Maintenance 
24
Organization Act, that arranges, contracts with, or 
25
administers contracts with a provider whereby insureds or 
26
beneficiaries are provided an incentive to use health care 
 


 






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services provided by health care service providers under a 
2
discounted health care service plan in which there are no other 
3
incentives, such as copayment, coinsurance, or any other 
4
reimbursement differential, for beneficiaries to utilize the 
5
provider. "Discounted health care services plan administrator" 
6
also includes any person, partnership, or corporation, other 
7
than an insurer, health service corporation, limited health 
8
service organization holding a certificate of authority under 
9
the Limited Health Service Organization Act, or health 
10
maintenance organization holding a certificate of authority 
11
under the Health Maintenance Organization Act, that enters into 
12
a contract with another administrator to enroll beneficiaries 
13
or insureds in a preferred provider program marketed as an 
14
independently identifiable program based on marketing 
15
materials or member benefit identification cards.

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(Source: P.A. 91-777, eff. 1-1-01.)