What is one requirement of network adequacy?

The requirement of availability of adequate in-network healthcare providers is essential for network adequacy, which ensures that health insurance plan members have reasonable access to healthcare services without excessive delays or distances. Network adequacy standards are put in place to safeguard consumers by requiring insurers to maintain a sufficient number of providers to meet the expected needs of their enrollees. This includes primary care doctors and specialists who are available to provide necessary care in a timely manner.

Having a robust network of in-network providers is crucial because it allows members to receive care at reduced costs compared to out-of-network services, thereby supporting both health outcomes and financial protection. The presence of an adequate number of providers in the network directly influences the quality of care members experience and ensures that they receive timely treatments for various medical conditions.