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- Illinois updates health plan standards
After years of continued advocacy, Illinois is adopting stronger network adequacy standards for patients to access essential hospital-based specialists.
The Illinois Department of Insurance is incorporating new standards into the 2026 Health Plan Network Adequacy checklist.
Background: The checklist changes are a result of advocacy by the Illinois Society of Pathologists and the CAP to pass 2024's network adequacy law.
Zoom in: Starting January 1, all state insurers must demonstrate that in-network hospitals include essential specialists like radiologists, pathologists, anesthesiologists, and emergency room physicians.
- These changes aim to enhance patient access to comprehensive health care services.
Details: Insurers in the state are required to show compliance by having these specialists as preferred providers within each in-network hospital.
- The Illinois Department of Insurance may extend requirements to include additional hospital-based specialists.
- The department updates checklists annually and will be making applicable revisions reflecting this new policy in the new year.
- All required mandates/rules are still enforced upon the effective date, regardless of their inclusion on the checklists, and all applicable regulations are enforced by the department, including network adequacy. Discrepancies can be addressed with the department by submitting a complaint.
What's next: The department will establish a review process to assess the adequacy of standards and consider adding more specialties.