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Section 1363.03 Of Article 4. Solicitation And Enrollment From California Health And Safety Code >> Division 2. >> Chapter 2.2. >> Article 4.
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.
(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.
