215 ILCS 124/1
Short title
Short title. This Act may be cited as the Network Adequacy and Transparency Act. (Source: P.A. 100-502, eff. 9-15-17.)
Illinois Compiled Statutes 215 ILCS 124 — Network Adequacy and Transparency Act.
Illinois · statute · 215 ILCS 124 · 14 active provisions
215 ILCS 124/3
Applicability of Act
Applicability of Act. This Act applies to an individual or group policy of health insurance coverage with a network plan amended, delivered, issued, or renewed in this State on or after January 1, 2019. This Act does not apply to an individual or group policy for excepted benefits or short-term, limited-duration health…
215 ILCS 124/5
Definitions
Definitions. In this Act: "Authorized representative" means a person to whom a beneficiary has given express written consent to represent the beneficiary; a person authorized by law to provide substituted consent for a beneficiary; or the beneficiary's treating provider only when the beneficiary or his or her family me…
215 ILCS 124/10
(Text of Section from P
(Text of Section from P.A. 103-650 and 104-28) Sec. 10. Network adequacy. (a) Before issuing, delivering, or renewing a network plan, an issuer providing a network plan shall file a description of all of the following with the Director: (1) The written policies and procedures for adding providers to meet patient needs…
215 ILCS 124/15
Notice of nonrenewal or termination
Notice of nonrenewal or termination. (a) A network plan must give at least 60 days' notice of nonrenewal or termination of a provider to the provider and to the beneficiaries served by the provider. The notice shall include a name and address to which a beneficiary or provider may direct comments and concerns regarding…
215 ILCS 124/20
(Text of Section before amendment by P
(Text of Section before amendment by P.A. 104-333) Sec. 20. Transition of services. (a) A network plan shall provide for continuity of care for its beneficiaries as follows: (1) If a beneficiary's provider leaves the network plan's network of providers for reasons other than termination of a contract in situations invo…
215 ILCS 124/25
Network transparency
Network transparency. (a) A network plan shall post electronically an up-to-date, accurate, and complete provider directory for each of its network plans, with the information and search functions, as described in this Section. (1) In making the directory available electronically, the network plans shall ensure that th…
215 ILCS 124/30
Administration and enforcement
Administration and enforcement. (a) Issuers, as defined in this Act, have a continuing obligation to comply with the requirements of this Act. Other than the duties specifically created in this Act, nothing in this Act is intended to preclude, prevent, or require the adoption, modification, or termination of any utiliz…
215 ILCS 124/35
Provider requirements
Provider requirements. Providers shall comply with 42 U.S.C. 300gg-138 and 300gg-139 and the regulations promulgated thereunder, as well as Section 20, paragraph (2) of subsection (a) of Section 25, subsections (h) and (j) of Section 25, and Section 36 of this Act, except that "provider directory information" includes…
215 ILCS 124/36
Complaint of incorrect charges
Complaint of incorrect charges. (a) A beneficiary who, taking into account the reimbursement, if any, by the issuer, incurs a cost in excess of the in-network cost-sharing for a covered service from a provider, facility, or hospital that was listed as in-network in the plan's provider directory prior to or at the time…
215 ILCS 124/40
Confidentiality
Confidentiality. (a) All records in the custody or possession of the Department are presumed to be open to public inspection or copying unless exempt from disclosure by Section 7 or 7.5 of the Freedom of Information Act. Except as otherwise provided in this Section or other applicable law, the filings required under th…
215 ILCS 124/50
Funds for enforcement
Funds for enforcement. Moneys from fines and penalties collected from issuers for violations of this Act shall be deposited into the Insurance Producer Administration Fund for appropriation by the General Assembly to the Department to be used for providing financial support of the Department's enforcement of this Act.(…
215 ILCS 124/55
Uniform electronic provider directory information notification forms
Uniform electronic provider directory information notification forms. (a) On or before January 1, 2026, the Department shall develop and publish a uniform electronic provider directory information form that issuers shall make available to onboarding, current, and former preferred providers to notify the issuer of the p…
215 ILCS 124/99
Effective date
Effective date. This Act takes effect upon becoming law. (Source: P.A. 100-502, eff. 9-15-17.)