2023 Illinois Compiled Statutes › Chapter 215 - INSURANCE › 215 ILCS 138/ - Uniform Prescription Drug Information Card Act.

(215 ILCS 138/1)
Sec. 1. 
		Short title. 
		This Act may be cited as the Uniform Prescription Drug Information Card Act.
(Source: P.A. 91-777, eff. 1-1-01.)
(215 ILCS 138/5)
Sec. 5. 
		Legislative intent. 
		It is the intent of the legislature to
lessen patients'
waiting times, decrease administrative burdens for pharmacies, and improve care
to
patients by minimizing confusion, eliminating unnecessary paperwork, and
streamlining
the dispensing of prescription products paid for by third-party payors. This
Act
shall be
broadly applied and interpreted to effectuate this purpose.
(Source: P.A. 91-777, eff. 1-1-01.)
(215 ILCS 138/10)
Sec. 10. 
		Definitions. 
		As used in this Act, the following terms have the
meanings given in this Section.
"Department" means the Department of Insurance.
"Director" means the Director of Insurance.
"Health benefit plan" means an accident and health insurance policy or
certificate
subject to the Illinois Insurance Code, a voluntary health services plan
subject to the
Voluntary Health Services Plans Act, a health maintenance organization
subscriber
contract subject to the Health Maintenance Organization Act, a plan provided by
a
multiple employer welfare arrangement, or a plan provided by another benefit
arrangement.
Without limitation, "health benefit plan" does not
mean any of
the following types of insurance:
(1) accident;
(2) credit;
(3) disability income;
(4) long-term or nursing home care;
(5) specified disease;
(6) dental or vision;
(7) coverage issued as a supplement to liability     insurance;
(8) medical payments under automobile or homeowners;
(9) insurance under which benefits are payable with     or without regard to fault as statutorily required to be contained in any liability policy or equivalent self-insurance;
(10) hospital income or indemnity;
(11) self-insured health benefit plans under the     federal Employee Retirement Income Security Act of 1974.
(Source: P.A. 91-777, eff. 1-1-01.)
(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;
(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) 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. 102-902, eff. 1-1-24.)
(215 ILCS 138/20)
Sec. 20. 
		Applicability and enforcement.
(a) This Act applies to health benefit plans that are amended, delivered,
issued, or renewed on and after the effective date of this amendatory Act  of
the 91st General Assembly.
(b) The Director may adopt rules necessary to implement the
Department's
responsibilities under this Act.  To enforce the provisions of this Act, the
Director may issue a cease and desist order or require a health benefit plan to
submit a plan of correction for violations of this Act, or both.  Subject to
the provisions of the Illinois Administrative Procedure Act, the Director may,
pursuant to Section 403A of the Illinois Insurance Code, impose upon a health
benefit plan an administrative fine not to exceed $250,000 for failure to
submit a requested plan of correction, failure to comply with its plan or
correction, or repeated violations of this Act.
(Source: P.A. 91-777, eff. 1-1-01.)
(215 ILCS 138/99)
Sec. 99. 
		Effective date. 
		This Act takes effect on January 1, 2001.
(Source: P.A. 91-777, eff. 1-1-01.)