IL SB3491

Excludes dental and vision insurance policies and limited health service organizations from the Network Adequacy and Transparency Act requirements, effective January 1, 2019.

Prohibits insurers from preventing preferred providers from discussing all treatment options with patients or advocating on behalf of patients in utilization review and appeals processes.

Requires insurers to establish provider-to-beneficiary ratios annually for 29 medical specialties (e.g., Primary Care, Cardiology, OB/GYN) based on federal Centers for Medicare and Medicaid Services guidance, with exemptions available for vision and dental-specific benefits.

Mandates that beneficiaries who make good faith efforts to use preferred providers but cannot due to insufficient availability, type, or unreasonable distance receive services at no greater cost than in-network care.

Requires insurers to maintain accurate, searchable online provider directories updated monthly with specific provider information, audit at least 25% of directories for accuracy, and provide print copies upon request.