By McKay Moravick
On July 10, 2024, Governor J.B. Pritzker signed health insurance reforms into law under the Healthcare Protection Act. These new laws are meant to protect Illinois consumers by placing new controls on health insurance companies and banning certain practices that have long been criticized for putting profits over patient care.
Key Reforms Introduced:
- Ban on “Step Therapy” or “Fail First” Provisions:
- The new law prohibits insurance companies from requiring patients to try and fail on treatments preferred by the insurer before accessing the treatment recommended by their doctor. This allows patients to receive the most appropriate care without unnecessary delays.
- Prohibition of Prior Authorization for Psychiatric Emergency Treatment:
- Insurance companies can no longer require prior authorization before a patient can receive emergency inpatient treatment at a psychiatric facility. This makes Illinois the first state to enforce such a regulation for both adults and children.
- Improved Provider Network Accuracy:
- Insurers are now required to maintain accurate and up-to-date lists of providers in their networks. This reform targets so-called “ghost networks,” ensuring that patients have access to the healthcare providers listed by their insurance plans.
- Regulation of Premium Rate Changes:
- The Illinois Department of Insurance now has the authority to approve or reject proposed premium rate changes in large-group health insurance plans. This is similar to the authority it already holds over small-group plans, providing a further layer of protection for consumers against sudden rate hikes.
Ban on Short-Term, Limited-Duration Insurance Plans: House Bill 2499, signed alongside the Healthcare Protection Act, bans the sale of short-term, limited-duration insurance plans in Illinois. These plans, often labeled as “junk insurance,” are criticized for not meeting the minimum standards required under the Affordable Care Act. While marketed as a temporary solution for those between coverage plans, these policies often provide substandard coverage and can leave individuals with unexpected medical bills.
Impact on Illinois Residents: These reforms represent a big shift in how health insurance is regulated in Illinois, aiming to ensure that residents receive the care they deserve without falling victim to predatory practices by insurance companies. By addressing issues like step therapy, prior authorization, and ghost networks, the new laws prioritize patient care and transparency.
At Boettcher Insurance Agency, we are committed to keeping our clients informed about important legislative changes that may impact their healthcare. If you have any questions about how these new laws may affect your insurance coverage or if you need assistance navigating your healthcare options, feel free to contact us.
