H-3553.1  _______________________________________________

                          HOUSE BILL 2681

          _______________________________________________

State of Washington      53rd Legislature     1994 Regular Session

By Representatives Flemming, Dyer, Sheldon, Peery, Lisk, Cooke, B. Thomas, Backlund, Ballasiotes, Sehlin, Silver, Foreman, Sheahan, Horn, Brumsickle, Long, Reams, L. Thomas, Tate, Carlson, Wood, Schmidt, Mielke, Campbell, Van Luven, Zellinsky, Edmondson, Casada, Mastin, Anderson, Lemmon, Shin, Finkbeiner, Padden, Stevens, Ballard, Forner, Fuhrman, Schoesler, Morris, Wineberry, Talcott, Brough, Basich, Roland, Johanson, Pruitt, Rayburn, Chandler, Kremen, King, Conway and Springer

Read first time 01/21/94.  Referred to Committee on Health Care.

Providing for limited certified health plans for vision services.

    AN ACT Relating to a limited certified health plan for vision services; and adding a new section to chapter 43.72 RCW.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:

NEW SECTION. Sec. 1.  A new section is added to chapter 43.72 RCW to read as follows:

    (1) For the purposes of this section, "limited certified vision plan" or "vision plan" means a certified health plan offering comprehensive vision services only and that, but for the exclusion of all health services required under the uniform benefits package except vision coverage, qualifies as a certified health plan and complies with all provisions governing certified health plans including but not limited to requirements for managed care, community rating, and nondiscrimination.  However, the insurance commissioner may exempt a vision plan from certified health plan requirements only to the extent the certified health plan requirements would prevent the operation of the vision plan.

    (2) A vision plan may provide coverage for vision services directly to individuals or to employers for the benefit of employees.  If an individual or an employer purchases comprehensive vision services from a vision plan, the certified health plan covering the individual or the employees need not provide vision services required under the uniform benefits package.  A certified health plan may subcontract with a vision plan to provide the vision benefits required under the uniform benefits package.

    (3) The commission shall establish maximum premiums and maximum enrollee financial participation amounts that may be charged by vision plans and shall adopt rules defining the minimum, uniform vision services that must be offered by vision plans.  The commission shall adopt rules governing the percentage adjustment of the maximum premium for certified health plans not providing vision benefits by virtue of the individual's or employee's coverage by a vision plan and rules governing the percentage change in the maximum premium that may be charged by a vision plan subcontracting with a certified health plan.

    (4) Rules governing vision plan premiums and financial participation amounts, and rules defining minimum, uniform vision services shall be adopted by the commission and shall apply to vision plans in accordance with the implementation dates applicable to certified health plans with respect to similar requirements.

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