Network Adequacy and Transparency Act Summary

• Applies to individual and group health insurance network plans amended, delivered, issued, or renewed in Illinois on or after January 1, 2019

• Requires insurers to file descriptions with the Department of Insurance detailing network adequacy policies, procedures for adding providers, 24/7 access to primary care and emergency services, and referral processes

• Mandates insurers maintain up-to-date electronic and print provider directories with specific searchable information including provider names, specialties, locations, hospital affiliations, and board certifications, with updates at least monthly and quarterly audits of accuracy

• Establishes minimum provider-to-beneficiary ratios and maximum travel/distance standards for various medical specialties, set annually by the Department of Insurance in consultation with the Department of Public Health

• Requires 60 days' notice before terminating or not renewing a provider's network participation and provides beneficiaries with 90-day transition periods to continue treatment with departing providers during ongoing courses of care or pregnancy