§ 10123.194
381 words·~2 min read·
/ca/insurance-code/10123-194A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
(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.