Glossary
Network Adequacy
Regulatory standards requiring a health plan to maintain enough in-network providers for reasonable member access.
Network adequacy refers to the requirements that obligate a health plan to contract with a sufficient number and mix of in-network providers so members can access care within reasonable time and distance. Regulators evaluate factors like specialty coverage, geographic reach, and appointment availability when judging whether a network meets the standard. Accurate roster and provider directory data are essential here, because listings that overstate available providers, sometimes called a ghost network, can mask real access problems even when a plan appears adequate on paper.