Text: SF00231 Text: SF00233 Text: SF00200 - SF00299 Text: SF Index Bills and Amendments: General Index Bill History: General Index
PAG LIN
1 1 Section 1. NEW SECTION. 514L.1 DEFINITIONS.
1 2 As used in this chapter, unless the context otherwise
1 3 requires:
1 4 1. "Prescription drug" means prescription drug as defined
1 5 in section 155A.3 and includes a device as defined in section
1 6 155A.3.
1 7 2. "Provider of third-party payment or prepayment of
1 8 prescription drug expenses" or "provider" means a provider of
1 9 an individual or group policy of accident or health insurance
1 10 or an individual or group hospital or health care service
1 11 contract issued pursuant to chapter 509, 514, or 514A, a
1 12 provider of an individual or group health maintenance
1 13 organization contract issued and regulated under chapter 514B,
1 14 a provider of an organized delivery system contract regulated
1 15 under rules adopted by the director of public health, a
1 16 provider of a preferred provider contract issued pursuant to
1 17 chapter 514F, and any other entity providing health insurance
1 18 or health benefits which provide for payment or prepayment of
1 19 prescription drug expenses coverage subject to state insurance
1 20 regulation.
1 21 Sec. 2. NEW SECTION. 514L.2 UNIFORM PRESCRIPTION DRUG
1 22 INFORMATION CARDS.
1 23 1. a. A provider of third-party payment or prepayment of
1 24 prescription drug expenses that issues a card or other
1 25 technology for claims processing and an administrator of the
1 26 payor, including, but not limited to, third-party
1 27 administrators for self-insured plans and state-administered
1 28 plans, shall issue to its insureds a card or other technology
1 29 containing uniform prescription drug information. The uniform
1 30 prescription drug information card or technology shall be the
1 31 format approved by the national council for prescription drug
1 32 programs and shall include all of the required fields
1 33 necessary to submit a claim and shall conform to the most
1 34 recent pharmacy information card or technology implementation
1 35 guide produced by the national council for prescription drug
2 1 programs or conform to a national format acceptable to the
2 2 commissioner of insurance.
2 3 b. All information necessary for claims submission of
2 4 prescription drug benefits, exclusive of information provided
2 5 on the prescription as required by law or rule, shall be
2 6 included in a clear, readable, and understandable manner on
2 7 the card or other technology issued to the insured for claims
2 8 processing. Any information included on the card or other
2 9 technology required under this chapter, but not specified by
2 10 the national council for prescription drug programs, shall
2 11 conform to a content and format acceptable to the commissioner
2 12 of insurance.
2 13 c. Any information on the card shall be formatted and
2 14 arranged in a manner that corresponds to the current content
2 15 and format required by the provider for processing of claims.
2 16 d. If a provider includes a conditional or situational
2 17 field of payment or prepayment, the card or other technology
2 18 shall conform to the most recent pharmacy information card or
2 19 technology implementation guide produced by the national
2 20 council for prescription drug programs or shall conform to a
2 21 national format acceptable to the commissioner of insurance.
2 22 2. a. A new uniform prescription drug information card or
2 23 technology, as required pursuant to subsection 1, shall be
2 24 issued by a provider of third-party payment or prepayment upon
2 25 enrollment and reissued upon any change in the insured's
2 26 coverage that impacts data contained on the card or technology
2 27 or upon any change in the national council for prescription
2 28 drug program implementation guide or successor document,
2 29 provided that the change affects data elements contained on
2 30 the card or other technology.
2 31 b. Newly issued cards or technology shall be updated with
2 32 the latest coverage information and shall conform to the
2 33 national council for prescription drug program's standards and
2 34 implementation guide or shall conform to the format specified
2 35 by the commissioner of insurance. However, a provider may
3 1 update cards or other technology, on a temporary basis,
3 2 through the use of stickers or any other methodology approved
3 3 by the commissioner of insurance.
3 4 3. The card or other technology may be used for any health
3 5 insurance or health benefits coverage and nothing in this
3 6 chapter shall require a provider to issue a separate card for
3 7 prescription drug coverage if the card or other technology can
3 8 accommodate the information necessary to process claims.
3 9 Sec. 3. NEW SECTION. 514L.3 APPLICATION – ENFORCEMENT.
3 10 1. A health insurance or health benefits policy or
3 11 contract issued and delivered, amended, or renewed on or after
3 12 July 1, 2003, shall comply with this chapter.
3 13 2. The commissioner of insurance shall enforce this
3 14 chapter and shall adopt rules necessary to implement this
3 15 chapter.
3 16 EXPLANATION
3 17 This bill requires the use of a uniform prescription drug
3 18 card or technology by providers of third-party payment or
3 19 prepayment of prescription drug expenses. The format for the
3 20 card or technology is to be the format approved by the
3 21 national council for prescription drug programs or a national
3 22 format approved by the commissioner of insurance.
3 23 The bill provides that the card or other technology may be
3 24 used for any health insurance or health benefits coverage and
3 25 that the bill does not require a provider to issue a separate
3 26 card or other technology for prescription drug benefits, if
3 27 the card or other technology can accommodate the information
3 28 necessary to process claims.
3 29 The uniform card or other technology is to be issued upon
3 30 enrollment and reissued upon any change in the insured's
3 31 coverage that impacts data on the card or other technology, or
3 32 upon any change in the national requirements and only if the
3 33 change affects data on the card. Newly issued cards or other
3 34 technology are to conform with the latest coverage information
3 35 and with national standards and implementation guidance and
4 1 with the format specified by the commissioner of insurance.
4 2 Cards or other technology may be temporarily updated by any
4 3 methodology approved by the commissioner of insurance.
4 4 The requirements of the bill apply to any health insurance
4 5 or health benefits policy or contract issued and delivered,
4 6 amended, or renewed on or after July 1, 2003. The
4 7 commissioner of insurance is directed to enforce the bill.
4 8 LSB 2110SS 79
4 9 pf/gg/8
Text: SF00231 Text: SF00233 Text: SF00200 - SF00299 Text: SF Index Bills and Amendments: General Index Bill History: General Index
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