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Network Adequacy
The requirement that an insurance plan's provider network has enough doctors and facilities to serve its members.
Full Definition
Network adequacy refers to federal and state standards that require health insurance plans to maintain a sufficient number and type of in-network providers to ensure members can access covered services without unreasonable delay or travel. Standards typically include maximum travel distance and wait time requirements for primary care, specialists, mental health, and hospital services. The ACA strengthened network adequacy standards for marketplace plans. Narrow network plans — which have smaller provider networks in exchange for lower premiums — have faced scrutiny for potentially inadequate access, particularly for mental health and specialty care.
Real-World Example
A state insurance regulator requires that marketplace plans ensure members can access a primary care doctor within 15 miles and 10 business days. An insurer with only 2 primary care doctors in a rural county fails this standard and must expand their network or exit that market.
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