HOUSE BILL REPORT
SSB 5023
This analysis was prepared by non-partisan legislative staff for the use of legislative members in their deliberations. This analysis is not a part of the legislation nor does it constitute a statement of legislative intent. |
As Reported by House Committee On:
Health Care & Wellness
Title: An act relating to the filing of group health benefit plans other than small group plans, stand-alone dental plans, and stand-alone vision plans by disability insurers, health care service contractors, and health maintenance organizations.
Brief Description: Concerning the filing of group health benefit plans other than small group plans, stand-alone dental plans, and stand-alone vision plans by disability insurers, health care service contractors, and health maintenance organizations.
Sponsors: Senate Committee on Health Care (originally sponsored by Senators Parlette and Keiser).
Brief History:
Committee Activity:
Health Care & Wellness: 3/17/15, 3/18/15 [DP].
Brief Summary of Substitute Bill |
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HOUSE COMMITTEE ON HEALTH CARE & WELLNESS |
Majority Report: Do pass. Signed by 15 members: Representatives Cody, Chair; Riccelli, Vice Chair; Schmick, Ranking Minority Member; Harris, Assistant Ranking Minority Member; Caldier, Clibborn, DeBolt, Jinkins, Johnson, Moeller, Robinson, Rodne, Short, Tharinger and Van De Wege.
Staff: Jim Morishima (786-7191).
Background:
Contract Forms and Rate Schedules Submitted by Health Service Contractors and Health Maintenance Organizations.
A health service contractor or a health maintenance organization must file every contract form and rate schedule (and modifications thereof) with the Insurance Commissioner. The filing must be made before the contract form is offered for sale to the public or the rate schedule is used, unless the contract form is negotiated. Negotiated contract forms, and their applicable rate schedules, that are placed in effect at the time of negotiation or that have a retroactive effective date must be filed within 30 days of the earlier of: (a) the date contract negotiations are completed; or (b) the date renewal premiums are implemented.
The Insurance Commissioner may disapprove a contract form for a variety of reasons, including:
it contains inconsistent, ambiguous, or misleading content;
the carrier is soliciting purchase of the product through deceptive advertising;
it contains unreasonable restrictions on the treatment of patients; or
the benefits are unreasonable in relation to the amount charged.
Contract Forms and Rate Schedules Submitted by Disability Insurers.
Contract forms and rate schedules filed by a disability insurer must be filed and approved by the Insurance Commissioner prior to issuance, delivery, or use. The disability insurer must make the filing at least 30 days prior to the contract's issuance, delivery, or use. The filing is deemed approved after 30 days, unless the Insurance Commissioner affirmatively approves or disapproves the filing. The Insurance Commissioner may extend the 30-day approval period by 15 days.
The Insurance Commissioner may disapprove a contract form for a variety of reasons, including:
it contains inconsistent, ambiguous, or misleading content;
the carrier is soliciting purchase of the product through deceptive advertising;
it contains unreasonable restrictions on the treatment of patients; or
the benefits are unreasonable in relation to the amount charged.
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Summary of Bill:
For plans issued or renewed on or after January 1, 2016, all rates and forms of group plans other than small group plans (i.e., large group plans) and all stand-alone dental and stand-alone vision plans offered by a health carrier or a limited service health service contractor must be filed with the Insurance Commissioner before the contract form is offered for sale to the public and before the rate schedule is used.
Negotiated contract forms, and their applicable rate schedules, that are placed in effect at the time of negotiation or that have a retroactive effective date must be filed within 30 days of the earlier of: (a) the date contract negotiations are completed; or (b) the date renewal premiums are implemented. Negotiated forms must otherwise comply with state and federal law. Stand-alone dental and stand-alone vision plans offered to out-of-state groups may be negotiated, but must meet Washington standards applicable to group disability insurance coverage issued in other states. "Negotiated contract forms" are defined as health benefit plans, stand-alone dental plans, or stand-alone vision plans where terms and conditions are negotiated and agreed to by the insurer and the policy or contract holder.
The Insurance Commissioner may disapprove of a filing for the same reasons he or she may reject filings made by health service contractors, health maintenance organizations, and disability insurers.
The Insurance Commissioner must adopt rules to standardize the rate and form filing requirements. When adopting the rules, the Insurance Commissioner may use the already adopted standards in place for health care service contractors and health maintenance organizations.
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Appropriation: None.
Fiscal Note: Available.
Effective Date: The bill takes effect 90 days after adjournment of the session in which the bill is passed.
Staff Summary of Public Testimony:
(In support) This bill seeks to provide parallel treatment for carriers doing the same thing in the same marketplace. Currently, disability insurers are subject to a different regulatory process than health care services contractors and health maintenance organizations. This different treatment is anachronistic and has no rational basis. Carriers in the same market should have the same regulatory requirements.
(Opposed) None.
Persons Testifying: Mel Sorensen, Cigna Healthcare and America's Health Insurance Plans; and Sydney Smith-Zvara, Association of Washington Healthcare Plans.
Persons Signed In To Testify But Not Testifying: None.