Fallacy: ICHRA Networks Are Inadequate

An attorney called us several months ago. He represents a Texas brokerage active in the Texas school district market. The brokerage apparently felt threatened by our ICHRA marketing efforts for Texas school districts struggling for solutions to high cost health insurance.

“Bill, how is the world are you going to sell a plan in Beaumont for example when a member would have to drive miles and miles towards Houston to find an in-network primary care physician.”

He nor his client did their homework:

HB 3359 – Network adequacy and access plan requirements

Adds network adequacy framework, data requirements, and requirements for travel time, distance, and appointment wait times. HB 3359 requires a public hearing before approving a waiver to determine whether there is good cause for a waiver.

HB 3359 also expands annual report requirements to include data on waivers; deviation from network adequacy standards; and corrective actions, sanctions, or penalties related to deficiencies.​

 An insurer offering a preferred provider benefit plan 
 shall ensure that both preferred provider benefits and basic level
 benefits, including benefits for emergency care, as defined by
 Section 1301.155, and post-emergency stabilization care, are
 reasonably available to all insureds within a designated service
 area.