IL
Illinois Senate Bill SB1346

Illinois 2025-2026 Regular Session

Illinois Senate Bill SB1346 Compare Versions

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1-SB1346 EngrossedLRB104 07692 BAB 17736 b SB1346 Engrossed LRB104 07692 BAB 17736 b
2- SB1346 Engrossed LRB104 07692 BAB 17736 b
1+104TH GENERAL ASSEMBLY State of Illinois 2025 and 2026 SB1346 Introduced 1/28/2025, by Sen. Laura Fine SYNOPSIS AS INTRODUCED: 215 ILCS 134/15215 ILCS 134/90215 ILCS 139/15 Amends the Managed Care Reform and Patient Rights Act. Provides that a health care plan shall provide annually to enrollees and prospective enrollees, upon request, a statement of all basic health care services and all specific benefits and services mandated to be provided to enrollees by State law or administrative rule, highlighting any newly enacted State law or administrative rule. Provides that this requirement can be fulfilled by providing enrollees the most up-to-date accident and health checklist submitted to the Department of Insurance, reflecting statutory health care coverage compliance by the health care plan. Requires the Office of Consumer Health Insurance to post in a prominent location on the Department's publicly accessible website an annual report on the development and implementation of federal, State, and local laws, regulations, and other governmental policies and actions that pertain to the adequacy of health care plans, facilities, and services in the State and summary of all State health insurance benefit related legislation enacted in the prior calendar year that includes, at minimum, a link to the Public Act, the statutory citation, the subject, a brief summary, and the effective date. Amends the Uniform Health Care Services Benefit Information Card Act. Adds a health benefit plan offering dental coverage to the list of plans required to issue a health care benefit information card. Specifies health care benefit information cards may be electronic or physical. Requires uniform health care benefit information to display on the back of the card 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. Makes other changes. LRB104 07692 BAB 17736 b A BILL FOR 104TH GENERAL ASSEMBLY State of Illinois 2025 and 2026 SB1346 Introduced 1/28/2025, by Sen. Laura Fine SYNOPSIS AS INTRODUCED: 215 ILCS 134/15215 ILCS 134/90215 ILCS 139/15 215 ILCS 134/15 215 ILCS 134/90 215 ILCS 139/15 Amends the Managed Care Reform and Patient Rights Act. Provides that a health care plan shall provide annually to enrollees and prospective enrollees, upon request, a statement of all basic health care services and all specific benefits and services mandated to be provided to enrollees by State law or administrative rule, highlighting any newly enacted State law or administrative rule. Provides that this requirement can be fulfilled by providing enrollees the most up-to-date accident and health checklist submitted to the Department of Insurance, reflecting statutory health care coverage compliance by the health care plan. Requires the Office of Consumer Health Insurance to post in a prominent location on the Department's publicly accessible website an annual report on the development and implementation of federal, State, and local laws, regulations, and other governmental policies and actions that pertain to the adequacy of health care plans, facilities, and services in the State and summary of all State health insurance benefit related legislation enacted in the prior calendar year that includes, at minimum, a link to the Public Act, the statutory citation, the subject, a brief summary, and the effective date. Amends the Uniform Health Care Services Benefit Information Card Act. Adds a health benefit plan offering dental coverage to the list of plans required to issue a health care benefit information card. Specifies health care benefit information cards may be electronic or physical. Requires uniform health care benefit information to display on the back of the card 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. Makes other changes. LRB104 07692 BAB 17736 b LRB104 07692 BAB 17736 b A BILL FOR
2+104TH GENERAL ASSEMBLY State of Illinois 2025 and 2026 SB1346 Introduced 1/28/2025, by Sen. Laura Fine SYNOPSIS AS INTRODUCED:
3+215 ILCS 134/15215 ILCS 134/90215 ILCS 139/15 215 ILCS 134/15 215 ILCS 134/90 215 ILCS 139/15
4+215 ILCS 134/15
5+215 ILCS 134/90
6+215 ILCS 139/15
7+Amends the Managed Care Reform and Patient Rights Act. Provides that a health care plan shall provide annually to enrollees and prospective enrollees, upon request, a statement of all basic health care services and all specific benefits and services mandated to be provided to enrollees by State law or administrative rule, highlighting any newly enacted State law or administrative rule. Provides that this requirement can be fulfilled by providing enrollees the most up-to-date accident and health checklist submitted to the Department of Insurance, reflecting statutory health care coverage compliance by the health care plan. Requires the Office of Consumer Health Insurance to post in a prominent location on the Department's publicly accessible website an annual report on the development and implementation of federal, State, and local laws, regulations, and other governmental policies and actions that pertain to the adequacy of health care plans, facilities, and services in the State and summary of all State health insurance benefit related legislation enacted in the prior calendar year that includes, at minimum, a link to the Public Act, the statutory citation, the subject, a brief summary, and the effective date. Amends the Uniform Health Care Services Benefit Information Card Act. Adds a health benefit plan offering dental coverage to the list of plans required to issue a health care benefit information card. Specifies health care benefit information cards may be electronic or physical. Requires uniform health care benefit information to display on the back of the card 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. Makes other changes.
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313 1 AN ACT concerning regulation.
414 2 Be it enacted by the People of the State of Illinois,
515 3 represented in the General Assembly:
616 4 Section 5. The Managed Care Reform and Patient Rights Act
717 5 is amended by changing Sections 15 and 90 as follows:
818 6 (215 ILCS 134/15)
919 7 Sec. 15. Provision of information.
1020 8 (a) A health care plan shall provide annually to enrollees
1121 9 and prospective enrollees, upon request, a complete list of
1222 10 participating health care providers in the health care plan's
1323 11 service area and a description of the following terms of
1424 12 coverage:
1525 13 (1) the service area;
1626 14 (2) the covered benefits and services with all
1727 15 exclusions, exceptions, and limitations;
1828 16 (3) the pre-certification and other utilization review
1929 17 procedures and requirements;
2030 18 (4) a description of the process for the selection of
2131 19 a primary care physician, any limitation on access to
2232 20 specialists, and the plan's standing referral policy;
2333 21 (5) the emergency coverage and benefits, including any
2434 22 restrictions on emergency care services;
2535 23 (6) the out-of-area coverage and benefits, if any;
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39+104TH GENERAL ASSEMBLY State of Illinois 2025 and 2026 SB1346 Introduced 1/28/2025, by Sen. Laura Fine SYNOPSIS AS INTRODUCED:
40+215 ILCS 134/15215 ILCS 134/90215 ILCS 139/15 215 ILCS 134/15 215 ILCS 134/90 215 ILCS 139/15
41+215 ILCS 134/15
42+215 ILCS 134/90
43+215 ILCS 139/15
44+Amends the Managed Care Reform and Patient Rights Act. Provides that a health care plan shall provide annually to enrollees and prospective enrollees, upon request, a statement of all basic health care services and all specific benefits and services mandated to be provided to enrollees by State law or administrative rule, highlighting any newly enacted State law or administrative rule. Provides that this requirement can be fulfilled by providing enrollees the most up-to-date accident and health checklist submitted to the Department of Insurance, reflecting statutory health care coverage compliance by the health care plan. Requires the Office of Consumer Health Insurance to post in a prominent location on the Department's publicly accessible website an annual report on the development and implementation of federal, State, and local laws, regulations, and other governmental policies and actions that pertain to the adequacy of health care plans, facilities, and services in the State and summary of all State health insurance benefit related legislation enacted in the prior calendar year that includes, at minimum, a link to the Public Act, the statutory citation, the subject, a brief summary, and the effective date. Amends the Uniform Health Care Services Benefit Information Card Act. Adds a health benefit plan offering dental coverage to the list of plans required to issue a health care benefit information card. Specifies health care benefit information cards may be electronic or physical. Requires uniform health care benefit information to display on the back of the card 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. Makes other changes.
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3474 1 (7) the enrollee's financial responsibility for
3575 2 copayments, deductibles, premiums, and any other
3676 3 out-of-pocket expenses;
3777 4 (8) the provisions for continuity of treatment in the
3878 5 event a health care provider's participation terminates
3979 6 during the course of an enrollee's treatment by that
4080 7 provider;
4181 8 (9) the appeals process, forms, and time frames for
4282 9 health care services appeals, complaints, and external
4383 10 independent reviews, administrative complaints, and
4484 11 utilization review complaints, including a phone number to
4585 12 call to receive more information from the health care plan
4686 13 concerning the appeals process; and
4787 14 (10) a statement of all basic health care services and
4888 15 all specific benefits and services mandated to be provided
4989 16 to enrollees by any State law or administrative rule,
5090 17 highlighting any newly enacted State law or administrative
5191 18 rule, must be provided annually to enrollees. This
5292 19 requirement can be fulfilled by providing enrollees the
5393 20 most up-to-date accident and health checklist submitted to
5494 21 the Department, reflecting statutory health care coverage
55-22 compliance by the health care plan. The requirement to
56-23 highlight any newly enacted State laws or administrative
57-24 rules does not apply to plans for beneficiaries of
58-25 Medicaid.
59-26 (a-5) Without limiting the generality of subsection (a) of
95+22 compliance by the health care plan.
96+23 (a-5) Without limiting the generality of subsection (a) of
97+24 this Section, no qualified health plans shall be offered for
98+25 sale directly to consumers through the health insurance
99+26 marketplace operating in the State in accordance with Sections
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70-1 this Section, no qualified health plans shall be offered for
71-2 sale directly to consumers through the health insurance
72-3 marketplace operating in the State in accordance with Sections
73-4 1311 and 1321 of the federal Patient Protection and Affordable
74-5 Care Act (Public Law 111-148), as amended by the federal
75-6 Health Care and Education Reconciliation Act of 2010 (Public
76-7 Law 111-152), and any amendments thereto, or regulations or
77-8 guidance issued thereunder (collectively, "the Federal Act"),
78-9 unless, in addition to the information required under
79-10 subsection (a) of this Section, the following information is
80-11 available to the consumer at the time he or she is comparing
81-12 health care plans and their premiums:
82-13 (1) With respect to prescription drug benefits, the
83-14 most recently published formulary where a consumer can
84-15 view in one location covered prescription drugs;
85-16 information on tiering and the cost-sharing structure for
86-17 each tier; and information about how a consumer can obtain
87-18 specific copayment amounts or coinsurance percentages for
88-19 a specific qualified health plan before enrolling in that
89-20 plan. This information shall clearly identify the
90-21 qualified health plan to which it applies.
91-22 (2) The most recently published provider directory
92-23 where a consumer can view the provider network that
93-24 applies to each qualified health plan and information
94-25 about each provider, including location, contact
95-26 information, specialty, medical group, if any, any
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110+1 1311 and 1321 of the federal Patient Protection and Affordable
111+2 Care Act (Public Law 111-148), as amended by the federal
112+3 Health Care and Education Reconciliation Act of 2010 (Public
113+4 Law 111-152), and any amendments thereto, or regulations or
114+5 guidance issued thereunder (collectively, "the Federal Act"),
115+6 unless, in addition to the information required under
116+7 subsection (a) of this Section, the following information is
117+8 available to the consumer at the time he or she is comparing
118+9 health care plans and their premiums:
119+10 (1) With respect to prescription drug benefits, the
120+11 most recently published formulary where a consumer can
121+12 view in one location covered prescription drugs;
122+13 information on tiering and the cost-sharing structure for
123+14 each tier; and information about how a consumer can obtain
124+15 specific copayment amounts or coinsurance percentages for
125+16 a specific qualified health plan before enrolling in that
126+17 plan. This information shall clearly identify the
127+18 qualified health plan to which it applies.
128+19 (2) The most recently published provider directory
129+20 where a consumer can view the provider network that
130+21 applies to each qualified health plan and information
131+22 about each provider, including location, contact
132+23 information, specialty, medical group, if any, any
133+24 institutional affiliation, and whether the provider is
134+25 accepting new patients. The information shall clearly
135+26 identify the qualified health plan to which it applies.
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106-1 institutional affiliation, and whether the provider is
107-2 accepting new patients. The information shall clearly
108-3 identify the qualified health plan to which it applies.
109-4 In the event of an inconsistency between any separate
110-5 written disclosure statement and the enrollee contract or
111-6 certificate, the terms of the enrollee contract or certificate
112-7 shall control.
113-8 (b) Upon written request, a health care plan shall provide
114-9 to enrollees a description of the financial relationships
115-10 between the health care plan and any health care provider and,
116-11 if requested, the percentage of copayments, deductibles, and
117-12 total premiums spent on healthcare related expenses and the
118-13 percentage of copayments, deductibles, and total premiums
119-14 spent on other expenses, including administrative expenses,
120-15 except that no health care plan shall be required to disclose
121-16 specific provider reimbursement.
122-17 (c) A participating health care provider shall provide all
123-18 of the following, where applicable, to enrollees upon request:
124-19 (1) Information related to the health care provider's
125-20 educational background, experience, training, specialty,
126-21 and board certification, if applicable.
127-22 (2) The names of licensed facilities on the provider
128-23 panel where the health care provider presently has
129-24 privileges for the treatment, illness, or procedure that
130-25 is the subject of the request.
131-26 (3) Information regarding the health care provider's
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146+1 In the event of an inconsistency between any separate
147+2 written disclosure statement and the enrollee contract or
148+3 certificate, the terms of the enrollee contract or certificate
149+4 shall control.
150+5 (b) Upon written request, a health care plan shall provide
151+6 to enrollees a description of the financial relationships
152+7 between the health care plan and any health care provider and,
153+8 if requested, the percentage of copayments, deductibles, and
154+9 total premiums spent on healthcare related expenses and the
155+10 percentage of copayments, deductibles, and total premiums
156+11 spent on other expenses, including administrative expenses,
157+12 except that no health care plan shall be required to disclose
158+13 specific provider reimbursement.
159+14 (c) A participating health care provider shall provide all
160+15 of the following, where applicable, to enrollees upon request:
161+16 (1) Information related to the health care provider's
162+17 educational background, experience, training, specialty,
163+18 and board certification, if applicable.
164+19 (2) The names of licensed facilities on the provider
165+20 panel where the health care provider presently has
166+21 privileges for the treatment, illness, or procedure that
167+22 is the subject of the request.
168+23 (3) Information regarding the health care provider's
169+24 participation in continuing education programs and
170+25 compliance with any licensure, certification, or
171+26 registration requirements, if applicable.
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142-1 participation in continuing education programs and
143-2 compliance with any licensure, certification, or
144-3 registration requirements, if applicable.
145-4 (d) A health care plan shall provide the information
146-5 required to be disclosed under this Act upon enrollment and
147-6 annually thereafter in a legible and understandable format.
148-7 The Department shall promulgate rules to establish the format
149-8 based, to the extent practical, on the standards developed for
150-9 supplemental insurance coverage under Title XVIII of the
151-10 federal Social Security Act as a guide, so that a person can
152-11 compare the attributes of the various health care plans.
153-12 (e) The written disclosure requirements of this Section
154-13 may be met by disclosure to one enrollee in a household.
155-14 (f) Each issuer of qualified health plans for sale
156-15 directly to consumers through the health insurance marketplace
157-16 operating in the State shall make the information described in
158-17 subsection (a) of this Section, for each qualified health plan
159-18 that it offers, available and accessible to the general public
160-19 on the company's Internet website and through other means for
161-20 individuals without access to the Internet.
162-21 (g) The Department shall ensure that State-operated
163-22 Internet websites, in addition to the Internet website for the
164-23 health insurance marketplace established in this State in
165-24 accordance with the Federal Act and its implementing
166-25 regulations, prominently provide links to Internet-based
167-26 materials and tools to help consumers be informed purchasers
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182+1 (d) A health care plan shall provide the information
183+2 required to be disclosed under this Act upon enrollment and
184+3 annually thereafter in a legible and understandable format.
185+4 The Department shall promulgate rules to establish the format
186+5 based, to the extent practical, on the standards developed for
187+6 supplemental insurance coverage under Title XVIII of the
188+7 federal Social Security Act as a guide, so that a person can
189+8 compare the attributes of the various health care plans.
190+9 (e) The written disclosure requirements of this Section
191+10 may be met by disclosure to one enrollee in a household.
192+11 (f) Each issuer of qualified health plans for sale
193+12 directly to consumers through the health insurance marketplace
194+13 operating in the State shall make the information described in
195+14 subsection (a) of this Section, for each qualified health plan
196+15 that it offers, available and accessible to the general public
197+16 on the company's Internet website and through other means for
198+17 individuals without access to the Internet.
199+18 (g) The Department shall ensure that State-operated
200+19 Internet websites, in addition to the Internet website for the
201+20 health insurance marketplace established in this State in
202+21 accordance with the Federal Act and its implementing
203+22 regulations, prominently provide links to Internet-based
204+23 materials and tools to help consumers be informed purchasers
205+24 of health care plans.
206+25 (h) Nothing in this Section shall be interpreted or
207+26 implemented in a manner not consistent with the Federal Act.
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178-1 of health care plans.
179-2 (h) Nothing in this Section shall be interpreted or
180-3 implemented in a manner not consistent with the Federal Act.
181-4 This Section shall apply to all qualified health plans offered
182-5 for sale directly to consumers through the health insurance
183-6 marketplace operating in this State for any coverage year
184-7 beginning on or after January 1, 2015.
185-8 (Source: P.A. 103-154, eff. 6-30-23.)
186-9 (215 ILCS 134/90)
187-10 Sec. 90. Office of Consumer Health Insurance.
188-11 (a) The Director of Insurance shall establish the Office
189-12 of Consumer Health Insurance within the Department of
190-13 Insurance to provide assistance and information to all health
191-14 care consumers within the State. Within the appropriation
192-15 allocated, the Office shall provide information and assistance
193-16 to all health care consumers by:
194-17 (1) assisting consumers in understanding health
195-18 insurance marketing materials and the coverage provisions
196-19 of individual plans;
197-20 (2) educating enrollees about their rights within
198-21 individual plans;
199-22 (3) assisting enrollees with the process of filing
200-23 formal grievances and appeals;
201-24 (4) establishing and operating a toll-free "800"
202-25 telephone number line to handle consumer inquiries;
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218+1 This Section shall apply to all qualified health plans offered
219+2 for sale directly to consumers through the health insurance
220+3 marketplace operating in this State for any coverage year
221+4 beginning on or after January 1, 2015.
222+5 (Source: P.A. 103-154, eff. 6-30-23.)
223+6 (215 ILCS 134/90)
224+7 Sec. 90. Office of Consumer Health Insurance.
225+8 (a) The Director of Insurance shall establish the Office
226+9 of Consumer Health Insurance within the Department of
227+10 Insurance to provide assistance and information to all health
228+11 care consumers within the State. Within the appropriation
229+12 allocated, the Office shall provide information and assistance
230+13 to all health care consumers by:
231+14 (1) assisting consumers in understanding health
232+15 insurance marketing materials and the coverage provisions
233+16 of individual plans;
234+17 (2) educating enrollees about their rights within
235+18 individual plans;
236+19 (3) assisting enrollees with the process of filing
237+20 formal grievances and appeals;
238+21 (4) establishing and operating a toll-free "800"
239+22 telephone number line to handle consumer inquiries;
240+23 (5) making related information available in languages
241+24 other than English that are spoken as a primary language
242+25 by a significant portion of the State's population, as
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213-1 (5) making related information available in languages
214-2 other than English that are spoken as a primary language
215-3 by a significant portion of the State's population, as
216-4 determined by the Department;
217-5 (6) analyzing, commenting on, monitoring, and making
218-6 publicly available an annual report, posted in a prominent
219-7 location on the Department's publicly accessible website,
220-8 reports on the development and implementation of federal,
221-9 State, and local laws, regulations, and other governmental
222-10 policies and actions that pertain to the adequacy of
223-11 health care plans, facilities, and services in the State
224-12 and summary of all State health insurance benefit related
225-13 legislation enacted in the prior calendar year that
226-14 includes, at minimum, a link to the Public Act, the
227-15 statutory citation, the subject, a brief summary, and the
228-16 effective date;
229-17 (7) filing an annual report with the Governor, the
230-18 Director, and the General Assembly, which shall contain
231-19 recommendations for improvement of the regulation of
232-20 health insurance plans, including recommendations on
233-21 improving health care consumer assistance and patterns,
234-22 abuses, and progress that it has identified from its
235-23 interaction with health care consumers; and
236-24 (8) performing all duties assigned to the Office by
237-25 the Director.
238-26 (a-5) The report required under paragraph (6) of
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253+1 determined by the Department;
254+2 (6) analyzing, commenting on, monitoring, and making
255+3 publicly available an annual report, posted in a prominent
256+4 location on the Department's publicly accessible website,
257+5 reports on the development and implementation of federal,
258+6 State, and local laws, regulations, and other governmental
259+7 policies and actions that pertain to the adequacy of
260+8 health care plans, facilities, and services in the State
261+9 and summary of all State health insurance benefit related
262+10 legislation enacted in the prior calendar year that
263+11 includes, at minimum, a link to the Public Act, the
264+12 statutory citation, the subject, a brief summary, and the
265+13 effective date;
266+14 (7) filing an annual report with the Governor, the
267+15 Director, and the General Assembly, which shall contain
268+16 recommendations for improvement of the regulation of
269+17 health insurance plans, including recommendations on
270+18 improving health care consumer assistance and patterns,
271+19 abuses, and progress that it has identified from its
272+20 interaction with health care consumers; and
273+21 (8) performing all duties assigned to the Office by
274+22 the Director.
275+23 (a-5) The report required under paragraph (6) of
276+24 subsection (a) shall be posted by January 31, 2026 and each
277+25 January 31 thereafter on the Department's publicly accessible
278+26 website.
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249-1 subsection (a) shall be posted by January 31, 2026 and each
250-2 January 31 thereafter on the Department's publicly accessible
251-3 website.
252-4 (b) The report required under paragraph (7) of subsection
253-5 (a) subsection (a)(7) shall be filed and posted by January 31,
254-6 2026 January 31, 2001 and each January 31 thereafter on the
255-7 Department's publicly accessible website.
256-8 (c) Nothing in this Section shall be interpreted to
257-9 authorize access to or disclosure of individual patient or
258-10 health care professional or provider records.
259-11 (Source: P.A. 91-617, eff. 1-1-00.)
260-12 Section 10. The Uniform Health Care Service Benefits
261-13 Information Card Act is amended by changing Section 15 as
262-14 follows:
263-15 (215 ILCS 139/15)
264-16 Sec. 15. Uniform health care benefit information cards
265-17 required.
266-18 (a) A health benefit plan, health benefit plan offering
267-19 dental coverage, or a dental plan that issues a physical or
268-20 electronic card or other technology and provides coverage for
269-21 health care services including prescription drugs or devices
270-22 also referred to as health care benefits and an administrator
271-23 of such a plan including, but not limited to, third-party
272-24 administrators for self-insured plans and state-administered
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289+1 (b) The report required under paragraph (7) of subsection
290+2 (a) subsection (a)(7) shall be filed and posted by January 31,
291+3 2026 January 31, 2001 and each January 31 thereafter on the
292+4 Department's publicly accessible website.
293+5 (c) Nothing in this Section shall be interpreted to
294+6 authorize access to or disclosure of individual patient or
295+7 health care professional or provider records.
296+8 (Source: P.A. 91-617, eff. 1-1-00.)
297+9 Section 10. The Uniform Health Care Service Benefits
298+10 Information Card Act is amended by changing Section 15 as
299+11 follows:
300+12 (215 ILCS 139/15)
301+13 Sec. 15. Uniform health care benefit information cards
302+14 required.
303+15 (a) A health benefit plan, health benefit plan offering
304+16 dental coverage, or a dental plan that issues a physical or
305+17 electronic card or other technology and provides coverage for
306+18 health care services including prescription drugs or devices
307+19 also referred to as health care benefits and an administrator
308+20 of such a plan including, but not limited to, third-party
309+21 administrators for self-insured plans and state-administered
310+22 plans shall issue to its insureds a card or other technology
311+23 containing uniform health care benefit information. The health
312+24 care benefit information physical card, electronic card, and
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283-1 plans shall issue to its insureds a card or other technology
284-2 containing uniform health care benefit information. The health
285-3 care benefit information physical card, electronic card, and
286-4 or other technology shall specifically identify and display
287-5 the following mandatory data elements on the physical and
288-6 electronic cards card:
289-7 (1) processor control number, if required for claims
290-8 adjudication;
291-9 (2) group number;
292-10 (3) card issuer identifier;
293-11 (4) cardholder ID number;
294-12 (5) (blank); except for dental plans, the regulatory
295-13 entity that holds authority over the plan; for the purpose
296-14 of this requirement, the Department of Healthcare and
297-15 Family Services is the regulatory entity that holds
298-16 authority over plans that the Department of Healthcare and
299-17 Family Services has contracted with to provide services
300-18 under the medical assistance program;
301-19 (6) except for dental plans, any deductible applicable
302-20 to the plan;
303-21 (7) except for dental plans, any out-of-pocket maximum
304-22 limitation applicable to the plan;
305-23 (8) a toll-free telephone number and Internet website
306-24 address through which the cardholder may seek consumer
307-25 assistance information, such as up-to-date lists of
308-26 preferred providers, including health care professionals,
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323+1 or other technology shall specifically identify and display
324+2 the following mandatory data elements on the physical and
325+3 electronic cards card:
326+4 (1) processor control number, if required for claims
327+5 adjudication;
328+6 (2) group number;
329+7 (3) card issuer identifier;
330+8 (4) cardholder ID number;
331+9 (5) (blank); except for dental plans, the regulatory
332+10 entity that holds authority over the plan; for the purpose
333+11 of this requirement, the Department of Healthcare and
334+12 Family Services is the regulatory entity that holds
335+13 authority over plans that the Department of Healthcare and
336+14 Family Services has contracted with to provide services
337+15 under the medical assistance program;
338+16 (6) except for dental plans, any deductible applicable
339+17 to the plan;
340+18 (7) except for dental plans, any out-of-pocket maximum
341+19 limitation applicable to the plan;
342+20 (8) a toll-free telephone number and Internet website
343+21 address through which the cardholder may seek consumer
344+22 assistance information, such as up-to-date lists of
345+23 preferred providers, including health care professionals,
346+24 hospitals, and other facilities, offices, or sites that
347+25 are contracted to furnish items or services under the
348+26 plan, and additional information about the plan; and
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319-1 hospitals, and other facilities, offices, or sites that
320-2 are contracted to furnish items or services under the
321-3 plan, and additional information about the plan; and
322-4 (9) cardholder name.
323-5 (b) The uniform health care benefit information physical
324-6 card, electronic card, and or other technology shall
325-7 specifically identify and display the following mandatory data
326-8 elements on the back of the card:
327-9 (1) claims submission names and addresses; and
328-10 (2) help desk telephone numbers and names; and .
329-11 (3) (b-5) A uniform health care benefit information
330-12 card or other technology for a health benefit plan
331-13 offering dental coverage or dental plan shall include a
332-14 statement indicating whether the health benefit plan
333-15 offering dental coverage or dental plan is self-insured or
334-16 fully funded and if the plan is subject to regulation by
335-17 the Department of Insurance. For the purpose of this
336-18 requirement, the Department of Healthcare and Family
337-19 Services is the regulatory entity that holds authority
338-20 over plans that the Department of Healthcare and Family
339-21 Services has contracted with to provide services under the
340-22 medical assistance program.
341-23 (c) A new uniform health care benefit information physical
342-24 card, electronic card, and or other technology shall be issued
343-25 by a health benefit plan or dental plan upon enrollment and
344-26 reissued upon any change in the insured's coverage that
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359+1 (9) cardholder name.
360+2 (b) The uniform health care benefit information physical
361+3 card, electronic card, and or other technology shall
362+4 specifically identify and display the following mandatory data
363+5 elements on the back of the card:
364+6 (1) claims submission names and addresses; and
365+7 (2) help desk telephone numbers and names; and .
366+8 (3) (b-5) A uniform health care benefit information
367+9 card or other technology for a health benefit plan
368+10 offering dental coverage or dental plan shall include a
369+11 statement indicating whether the health benefit plan
370+12 offering dental coverage or dental plan is self-insured or
371+13 fully funded and if the plan is subject to regulation by
372+14 the Department of Insurance. For the purpose of this
373+15 requirement, the Department of Healthcare and Family
374+16 Services is the regulatory entity that holds authority
375+17 over plans that the Department of Healthcare and Family
376+18 Services has contracted with to provide services under the
377+19 medical assistance program.
378+20 (c) A new uniform health care benefit information physical
379+21 card, electronic card, and or other technology shall be issued
380+22 by a health benefit plan or dental plan upon enrollment and
381+23 reissued upon any change in the insured's coverage that
382+24 affects mandatory data elements contained on the card.
383+25 (d) Notwithstanding subsections (a), (b), and (c) of this
384+26 Section, a discounted health care services plan administrator
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355-1 affects mandatory data elements contained on the card.
356-2 (d) Notwithstanding subsections (a), (b), and (c) of this
357-3 Section, a discounted health care services plan administrator
358-4 shall issue to its beneficiaries a card containing the
359-5 following mandatory data elements:
360-6 (1) an Internet website for beneficiaries to access
361-7 up-to-date lists of preferred providers;
362-8 (2) a toll-free help desk number for beneficiaries and
363-9 providers to access up-to-date lists of preferred
364-10 providers and additional information about the discounted
365-11 health care services plan;
366-12 (3) the name or logo of the provider network;
367-13 (4) a group number, if necessary for the processing of
368-14 benefits;
369-15 (5) a cardholder ID number;
370-16 (6) the cardholder's name or a space to permit the
371-17 cardholder to print his or her name, if the cardholder
372-18 pays a periodic charge for use of the card;
373-19 (7) a processor control number, if required for claims
374-20 adjudication; and
375-21 (8) a statement that the plan is not insurance.
376-22 (e) As used in this Section, "discounted health care
377-23 services plan administrator" means any person, partnership, or
378-24 corporation, other than an insurer, health service
379-25 corporation, limited health service organization holding a
380-26 certificate of authority under the Limited Health Service
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395+1 shall issue to its beneficiaries a card containing the
396+2 following mandatory data elements:
397+3 (1) an Internet website for beneficiaries to access
398+4 up-to-date lists of preferred providers;
399+5 (2) a toll-free help desk number for beneficiaries and
400+6 providers to access up-to-date lists of preferred
401+7 providers and additional information about the discounted
402+8 health care services plan;
403+9 (3) the name or logo of the provider network;
404+10 (4) a group number, if necessary for the processing of
405+11 benefits;
406+12 (5) a cardholder ID number;
407+13 (6) the cardholder's name or a space to permit the
408+14 cardholder to print his or her name, if the cardholder
409+15 pays a periodic charge for use of the card;
410+16 (7) a processor control number, if required for claims
411+17 adjudication; and
412+18 (8) a statement that the plan is not insurance.
413+19 (e) As used in this Section, "discounted health care
414+20 services plan administrator" means any person, partnership, or
415+21 corporation, other than an insurer, health service
416+22 corporation, limited health service organization holding a
417+23 certificate of authority under the Limited Health Service
418+24 Organization Act, or health maintenance organization holding a
419+25 certificate of authority under the Health Maintenance
420+26 Organization Act that arranges, contracts with, or administers
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391-1 Organization Act, or health maintenance organization holding a
392-2 certificate of authority under the Health Maintenance
393-3 Organization Act that arranges, contracts with, or administers
394-4 contracts with a provider whereby insureds or beneficiaries
395-5 are provided an incentive to use health care services provided
396-6 by health care services providers under a discounted health
397-7 care services plan in which there are no other incentives,
398-8 such as copayment, coinsurance, or any other reimbursement
399-9 differential, for beneficiaries to utilize the provider.
400-10 "Discounted health care services plan administrator" also
401-11 includes any person, partnership, or corporation, other than
402-12 an insurer, health service corporation, limited health service
403-13 organization holding a certificate of authority under the
404-14 Limited Health Service Organization Act, or health maintenance
405-15 organization holding a certificate of authority under the
406-16 Health Maintenance Organization Act that enters into a
407-17 contract with another administrator to enroll beneficiaries or
408-18 insureds in a preferred provider program marketed as an
409-19 independently identifiable program based on marketing
410-20 materials or member benefit identification cards.
411-21 (Source: P.A. 102-902, eff. 1-1-24.)
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