Bill Text: IL HB5527 | 2009-2010 | 96th General Assembly | Enrolled

---

Bill Title: 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. Sets forth the mandatory data elements that the card or other technology issued by a discounted health care services plan administrator shall display. Sets forth a definition for "discounted health care services plan administrator".

Sponsorship: Slight Partisan Bill (Democrat 3-1)

Status: (Passed) 2010-07-27 - Public Act . . . . . . . . . 96-1326 [HB5527 Detail]

Download: Illinois-2009-HB5527-Enrolled.html

---

HB5527 Enrolled LRB096 20211 RPM 35782 b
AN ACT concerning insurance.
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 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

HB5527 Enrolled - 2 - LRB096 20211 RPM 35782 b
(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

HB5527 Enrolled - 3 - LRB096 20211 RPM 35782 b
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

HB5527 Enrolled - 4 - LRB096 20211 RPM 35782 b
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. 91-777, eff. 1-1-01.)
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 that issues a 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;

HB5527 Enrolled - 5 - LRB096 20211 RPM 35782 b
(2) group number;
(3) card issuer identifier;
(4) cardholder ID number; and
(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.
(c) A new uniform health care benefit 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.
(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

HB5527 Enrolled - 6 - LRB096 20211 RPM 35782 b
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

HB5527 Enrolled - 7 - LRB096 20211 RPM 35782 b
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. 92-106, eff. 1-1-02.)