Illinois Code § 15

§ 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; (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) 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. 102-902, eff. 1-1-24.) (Text of Section after amendment by P.A. 104-375) Sec. 15. Uniform health care benefit information cards required. (a) A health benefit plan, health benefit plan offering dental coverage, or 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 physical card, electronic card, and other technology shall specifically identify and display the following mandatory data elements on the physical and electronic cards: (1) processor control number, if required for claims adjudication; (2) group number; (3) card issuer identifier; (4) cardholder ID number; (5) (blank); (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) cardholder name. (b) The uniform health care benefit information physical card, electronic card, and other technology shall specifically identify and display the following mandatory data elements on the back of the card: (1) claims submission names and addresses; (2) help desk telephone numbers and names; and (3) a statement indicating whether the plan is self-insured or fully funded and if the plan is subject to regulation by the Department of Insurance. 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. (c) A new uniform health care benefit information physical card, electronic card, and 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. 104-375, eff. 1-1-26.)