IL| Illinois Department of Insurance Company Bulletin 2025-19 requires health insurance issuers subject to NATA to implement a process, effective for plans on or after January 1, 2026, to provide reasonable reimbursement of travel, food, lodging, and mileage when beneficiaries with an approved MHSUD network exception must go out-of-network due to lack of timely or proximate in-network care, with specific standards for “good faith effort,” appeal rights, claim timing, reimbursement rates, and mandated notice content to beneficiaries.
- Issuers must reimburse reasonable travel, food, lodging, and vehicle mileage for beneficiaries granted an MHSUD-related network exception when in-network care would require over 10 business days’ wait or exceed time/distance standards, using GSA per diem and IRS mileage rates and allowing at least 60 days after the last service date to submit reimbursement claims.
- For travel outside Illinois or more than 100 miles from the beneficiary’s residence, issuers may deny reimbursement unless the beneficiary shows a “good faith effort” to locate a closer available provider (via provider directory, calling the plan, and calling providers), and denials must allow at least 60 days to appeal.
- At the time the network exception is granted, issuers must send a written “Notice of Potential Eligibility for Travel Reimbursement” using a specified template (plain language, ≥14‑point font) that includes issuer identity, claim instructions, 60‑day filing deadline, good‑faith effort disclosure, reimbursement standards, and notice of appeal rights.