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Illinois Patients Who Purchase Health Insurance Will Be Protected
Posted on: 9/22/2017


A big win! ISMS fought long and hard to help enact the Network Adequacy and Transparency Act (NAT Act), which was just signed into law. 

This legislation will protect patients who purchase state-regulated private health plans. ISMS heard from many of you who were concerned that commercial health insurers were increasingly downsizing patient options by establishing "narrow networks."

"The NAT Act ensures Illinois patients have the information they need to make the right choice about the health insurance they're purchasing, and the relief of knowing they'll receive the coverage they’re paying for," said ISMS President Nestor A. Ramirez, MD, MPH. 

The NAT Act provisions will apply to plans issued in 2019.

Here are the new protections now guaranteed in the law: 

  1. Insurance companies must ensure their networks meet patients' needs. That means insurance plan networks must have enough health facilities and doctors, including specialists, in close proximity to where their policyholders live.

  2. Health plans must be more transparent. Insurers are now obligated to maintain updated provider directories. If a doctor or hospital is dropped from a network, the insurance company must notify patients in a timely fashion. Doctors also face new patient notification requirements if they choose to leave a network.

  3. A patient's doctor may be dropped from the network, but pregnant women and patients with complex conditions will be able to stay with their doctors long enough to make a smooth transition – without getting charged extra. 

ISMS thanks Gov. Rauner and the Illinois General Assembly, along with numerous other organizations, for standing up for our patients!

Read ISMS' News Release.

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