Illinois Compiled Statutes 215 ILCS 138/15 – Uniform prescription drug information cards required
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(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
(1) BIN number;
Terms Used In Illinois Compiled Statutes 215 ILCS 138/15
- Contract: A legal written agreement that becomes binding when signed.
- Corporation: A legal entity owned by the holders of shares of stock that have been issued, and that can own, receive, and transfer property, and carry on business in its own name.
- Partnership: A voluntary contract between two or more persons to pool some or all of their assets into a business, with the agreement that there will be a proportional sharing of profits and losses.
(2) Processor control number if required for claims
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adjudication;
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(3) Group number;
(4) Card issuer identifier;
(5) Cardholder ID number;
(6) The regulatory entity that holds authority over
(4) Card issuer identifier;
(5) Cardholder ID number;
(6) The regulatory entity that holds authority over
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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;
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(7) Any deductible applicable to the plan; if there
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is a deductible specific to prescription drugs, that shall be the applicable deductible for this card;
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(8) Any out-of-pocket maximum limitation applicable
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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;
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(9) A toll-free telephone number and Internet website
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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
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(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
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
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up-to-date lists of preferred providers;
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(2) a toll-free help desk number for beneficiaries
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and providers to access up-to-date lists of preferred providers and additional information about the discounted health care services plan;
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(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
(4) a group number;
(5) a cardholder ID number;
(6) the cardholder’s name or a space to permit the
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cardholder to print his or her name, if the cardholder pays a periodic charge for use of the card;
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(7) a processor control number, if required for
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claims adjudication; and
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(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.
(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.