Network Adequacy and Transparency Act (NAT Act)

House Bill 311 has passed the House of Representatives. The bill was previously approved by the Senate and will now be sent to the Governor Bruce Rauner for signature.

This legislation creates several new protections for consumers who purchase state regulated private health insurance plans. The NAT Act empowers consumers to make more informed choices when purchasing health insurance, and offers peace of mind that they are actually getting what they pay for, Dr. Nestor Ramirez, ISMS President was quoted as saying.

Here are a few highlights of the bill:

  1. Insurance companies will have to make sure their networks meet patient needs. They must have enough health facilities and doctors, including specialists, in close proximity to where their policyholders reside.
  2. Health plans must be more transparent. Insurers must maintain updated provider directories. If a doctor or hospital is droppedĀ  from network, they will have to notify patients in a timely matter to avoid surprise out-of-network charges. Doctors will haveĀ  new patient notification requirements if they choose to leave a network.
  3. Patient care will not be disrupted due to changes in health insurance networks. A patient’s doctor may be dropped from the network, but pregnant women or patients with complex medical conditions will be able to stay with their doctor long enough to make a smooth transition – without getting charged extra.

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