BILL NUMBER: AB 207 CHAPTERED 10/09/01 CHAPTER 622 FILED WITH SECRETARY OF STATE OCTOBER 9, 2001 APPROVED BY GOVERNOR OCTOBER 8, 2001 PASSED THE ASSEMBLY SEPTEMBER 10, 2001 PASSED THE SENATE SEPTEMBER 4, 2001 AMENDED IN SENATE AUGUST 30, 2001 AMENDED IN SENATE AUGUST 27, 2001 AMENDED IN SENATE JULY 16, 2001 AMENDED IN SENATE JULY 3, 2001 AMENDED IN ASSEMBLY APRIL 17, 2001 AMENDED IN ASSEMBLY MARCH 15, 2001 INTRODUCED BY Assembly Member Matthews FEBRUARY 9, 2001 An act to add Section 1363.03 to the Health and Safety Code, and to add Section 10123.194 to the Insurance Code, relating to health insurance. LEGISLATIVE COUNSEL'S DIGEST AB 207, Matthews. Health insurance: prescription drug benefits: identification cards. Existing law provides for regulation of health care service plans by the Department of Managed Health Care, and provides for regulation of insurers by the Department of Insurance. A willful violation of the provisions governing health care service plans is a crime. Existing law contains various provisions governing health care service plans and disability insurers that offer coverage for prescription drug benefits. This bill would require certain health care service plans and disability insurers that offer coverage for prescription drug benefits and that issue identification cards to enrollees and insureds to issue a card containing uniform information necessary to process claims for prescription drug benefits by a specified date. The bill would require that, if a health care service plan or disability insurer delegates responsibility for issuing the card, the contract between the health care service plan or disability insurer and its contractor or agent require compliance with these provisions. Because a willful violation of this provision with respect to health care service plans would be a crime, this bill would impose a state-mandated local program by creating a new crime. The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement. This bill would provide that no reimbursement is required by this act for a specified reason. THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS: SECTION 1. Section 1363.03 is added to the Health and Safety Code, to read: 1363.03. (a) Every health care service plan that covers prescription drug benefits and that issues a card to enrollees for claims processing purposes shall issue to each of its enrollees a uniform card containing uniform prescription drug information. The uniform prescription drug information card shall, at a minimum, include the following information: (1) The name or logo of the benefit administrator or health care service plan issuing the card, which shall be displayed on the front side of the card. (2) The enrollee's identification number, or the subscriber's identification number when the enrollee is a dependent who accesses services using the subscriber's identification number, which shall be displayed on the front side of the card. (3) A telephone number that pharmacy providers may call for assistance. (4) Information required by the benefit administrator or health care service plan that is necessary to commence processing the pharmacy claim, except as provided for in paragraph (5). (5) A health care service plan shall not be required to print any of the following information on a member card: (A) Any number that is the same for all of its members, provided that the health care service plan provides this number to the pharmacy on an annual basis. (B) Any information that may result in fraudulent use of the card. (C) Any information that is otherwise prohibited from being included on the card. (b) Beginning July 1, 2002, the new uniform prescription drug information card required by subdivision (a) shall be issued by a health care service plan to an enrollee upon enrollment or upon any change in the enrollee's coverage that impacts the data content or format of the card. (c) Nothing in this section requires a health care service plan to issue a separate card for prescription drug coverage if the plan issues a card for health care coverage in general and the card is able to accommodate the information required by subdivision (a). (d) This bill shall not apply to a nonprofit health care service plan with at least 3.5 million enrollees that owns or operates its own pharmacies and that provides health care services to enrollees in a specific geographic area through a mutually exclusive contract with a single medical group. (e) "Card" as used in this section includes other technology that performs substantially the same function as a card. (f) For purposes of this section, if a health care service plan delegates responsibility for issuing the uniform prescription drug information card to a contractor or agent, then the contract between the health care service plan and its contractor or agent shall require compliance with this section. SEC. 2. Section 10123.194 is added to the Insurance Code, to read: 10123.194. (a) Every disability insurer that covers hospital, medical, or surgical expenses, and, as part of that coverage, also covers prescription drug benefits, and that issues a card to insureds for claims processing purposes, shall issue to each of its insureds a uniform card containing uniform prescription drug information. The uniform prescription drug information card shall, at a minimum, include the following information: (1) The name or logo of the benefit administrator or disability insurer issuing the card, which shall be displayed on the front side of the card. (2) The insured's identification number, or the policyholder's identification number when the insured is a dependent who accesses services using the policy holder's identification number, which shall be displayed on the front side of the card. (3) A telephone number that pharmacy providers may call for assistance. (4) Information required by the benefit administrator or disability insurer that is necessary to commence processing the pharmacy claim, except as provided for in paragraph (5). (5) A disability insurer shall not be required to print any of the following information on an insured's card: (A) Any number that is the same for all of its insured, provided that the disability insurer provides this number to the pharmacy on an annual basis. (B) Any information that may result in fraudulent use of the card. (C) Any information that is otherwise prohibited from being included on the card. (b) Beginning July 1, 2002, the new uniform prescription drug information card required by subdivision (a) shall be issued by an insurer to an insured upon enrollment or upon any change in the insured's coverage that impacts the data content or format of the card. (c) Nothing in this section requires an insurer to issue a separate card for prescription drug coverage if the insurer issues a card for health care coverage in general and the card is able to accommodate the information required by subdivision (a). (d) "Card" as used in this section includes other technology that performs substantially the same function as a card. (e) For purposes of this section, if a disability insurer delegates responsibility for issuing the uniform prescription drug information card to a contractor or agent, then the contract between the disability insurer and its contractor or agent shall require compliance with this section. SEC. 3. No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution.