SB2412_H_Amend

SECTION 1. (1) Every health benefit plan that provides coverage for prescription drugs or devices, or that administers such a plan, including, but not limited to, health maintenance organizations and third party administrators for self-insured plans, shall issue to each insured a card or other technology containing standardized pharmacy benefit identification information. The card shall contain at a minimum the following information:

(a) The card issuer's name or logo on the front of the card;

(b) The cardholder's name and identification number, which shall be displayed on the front side of the card;

(c) The American National Standards Institute Issuer Identification Number assigned to the administrator or pharmacy benefit manager of the plan, when required for proper claims adjudication;

(d) The processor's control number, when required for proper claims adjudication;

(e) The insured's group number, when required for proper claims adjudication;

(f) The name and address of the benefits administrator or other entity responsible for prescription claims submission, adjudication or pharmacy provider correspondence for prescription benefits; and

(g) A help desk telephone number that pharmacy providers may call for pharmacy benefit claims assistance.

(2) This section does not require a health benefit plan to issue an identification card separate from any identification card issued to an enrollee to evidence coverage under the health benefit plan if the identification card contains the elements required by subsection (1) of this section.

(3) In order to ensure that insurance identification cards issued under this section contain accurate and updated information, each health benefit plan shall provide each subscriber with a new insurance identification card within a reasonable time after any information required for proper claims adjudication is changed.

(4) As used in this section, "health benefit plan" means any hospital or medical policy or certificate, hospital or medical service contract or health maintenance organization, a plan provided by a fully insured multiple employer welfare arrangement or any other entity providing a plan of health insurance subject to the jurisdiction of the Commissioner of Insurance and to the extent permitted by the Employee Retirement Income Security Act of 1974, as amended, or by the Health Insurance Portability and Accountability Act of 1996. A health benefit plan does not include the following:

(a) Accident;

(b) Credit;

(d) Long-term or nursing home care;

(e) Specified disease;

(f) Dental or vision;

(g) Coverage issued as a supplement to liability insurance;

(h) Medical payments under automobile or homeowners;

(i) Insurance under which benefits are payable with or without regard to fault and that is required statutorily to be contained in any liability or equivalent self-insurance; and

(j) Hospital income or indemnity.

(5) The Commissioner of Insurance may issue any rules or regulations necessary to implement the provisions of this act, and he may use the standards produced by the National Council for Prescription Drugs Programs as a guide in developing such rules and regulations.

(6) This act applies to plans that are delivered, issued for delivery or renewed on or after January 1, 2003. For purposes of this act, renewal of a health benefit policy, contract or plan is presumed to occur on the anniversary date.

SECTION 2. This act shall take effect and be in force from and after January 1, 2003.