WSR 13-17-098 EMERGENCY RULES OFFICE OF INSURANCE COMMISSIONER [Insurance Commissioner No. R 2013-20—Filed August 21, 2013, 8:25 a.m., effective August 21, 2013, 8:25 a.m.] Effective Date of Rule: Immediately upon filing.
Purpose: Provide guidance to issuers of nongrandfathered individual and small group plans that are not offered through associations, related to the replacement of currently issued health benefit plans after the market reforms of 2014 become effective.
Other Authority: 45 C.F.R. 150.101(2).
Under RCW 34.05.350 the agency for good cause finds that immediate adoption, amendment, or repeal of a rule is necessary for the preservation of the public health, safety, or general welfare, and that observing the time requirements of notice and opportunity to comment upon adoption of a permanent rule would be contrary to the public interest.
Reasons for this Finding: The rules are required for an orderly market transition from noncompliant plans, that must be discontinued, to replacement plans that must be in place by the next renewal date for each group or individual after January 1, 2014. Of particular concern is that health plan issuers will adjust renewal dates to lengthen the period of time enrollees are on noncompliant plans after January 1, 2014. The rules also implement 45 C.F.R. 147.140.
Number of Sections Adopted in Order to Comply with Federal Statute: New 2, Amended 0, Repealed 0; Federal Rules or Standards: New 2, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.
Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.
Number of Sections Adopted on the Agency's Own Initiative: New 2, Amended 0, Repealed 0.
Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 0, Repealed 0.
Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 2, Amended 0, Repealed 0.
Date Adopted: August 21, 2013.
Mike Kreidler
Insurance Commissioner
NEW SECTION
WAC 284-170-954 Small group coverage market transition requirements.
(1) For all nongrandfathered small group plans issued and in effect prior to January 1, 2014, issuers must replace issued nongrandfathered small group health benefit plans with health benefit plans approved by the commissioner as follows: (a) An issuer may elect to withdraw a product, pursuant to RCW 48.43.035, and discontinue each small group's plan under that product on the same date, substituting a replacement plan effective on the date of discontinuation; or (b) An issuer may discontinue a small group's coverage and offer the full range of plans the issuer offers in the small group market as replacement options, to take effect on the small group's renewal date. For small groups covered by nongrandfathered health benefit plans purchased through an association, the requirements of WAC 284-170-955 and WAC 284-170-958 apply. (c) If an issuer does not have a replacement plan approved by the commissioner to offer in place of the discontinued plan, the issuer must assist each enrollee in identifying a replacement option offered by another issuer. (2) If an issuer selects the replacement option described in subsection (1)(b) of this section, ninety days before the renewal date for the small group's coverage, the issuer must provide the small group plan sponsor with written notice of the discontinuation containing the following information: (a) Specific descriptions of the replacement plans for which the small group and its enrollees are eligible, both on or off the health benefit exchange; (b) Electronic link information to the Summary of Benefits and Explanation of Coverage for each replacement plan option; (c) Contact information to access assistance from the issuer in selecting the replacement plan option or answering enrollee questions about the replacement plans made available to them by their employer. (3) For either replacement option set forth in subsection (1) of this section, the issuer must provide a separate written notice to each enrollee notifying the enrollee that their small group plan coverage will be discontinued and replaced. The notice must be provided not later than ninety days prior to the discontinuation and replacement date. (4) If an issuer has electronic mail contact information for the small group plan sponsor or the enrollees, the written notice may be provided electronically. The issuer must be able to document to the commissioner's satisfaction both the content and timing of transmission. The issuer must send written notice by U.S. mail to a sponsor or enrollee for whom the electronic mail message was rejected. (5) An issuer may offer small groups the option to voluntarily discontinue and replace prior to their renewal date. (a) An issuer must not selectively offer early renewal to small groups, but must make this option universally available. (b) An issuer must not alter or change a small group's renewal date to lengthen the period of time before discontinuation and replacement occurs in 2014. For example, if a small group's renewal date is March 31 of each year, the issuer may not adjust the benefit year in 2013 to apply a renewal date of November 30.
NEW SECTION
WAC 284-170-959 Individual coverage market transition requirements.
(1) For all nongrandfathered individual health benefit plans issued and in effect prior to January 1, 2014, issuers must replace issued the plans with health benefit plans approved by the commissioner as follows: (a) An issuer may elect to withdraw a product, pursuant to RCW 48.43.038, and discontinue each health benefit plan in force under that product on the same date, requiring selection of a replacement plan to be effective on the date of discontinuation; or (b) An issuer may discontinue an individual's coverage and offer the full range of plans the issuer offers in the individual market as replacement options, to take effect on the individual's renewal date. (c) If an issuer does not have a replacement plan approved by the commissioner to offer in place of the discontinued plan, the issuer must assist each enrollee in identifying a replacement option offered by another issuer. (2) If an issuer selects the replacement option described in subsection (1)(b) of this section, ninety days before the renewal date for the coverage, the issuer must provide the individual and each enrollee under the health benefit plan with written notice containing the following information: (a) Specific descriptions of the replacement plans for which the enrollees are eligible, both on or off the health benefit exchange; (b) Electronic link information to the Summary of Benefits and Explanation of Coverage for each replacement plan option; (c) Contact information for assistance from the issuer in selecting the replacement plan option or answering enrollee questions about the replacement plans; (d) If a renewal date is later than January 1, 2014, the issuer's ninety-day discontinuation and replacement notice must notify the individual and any other enrollees on the plan of the shortened plan year for 2014 under the replacement coverage. (3) For either replacement option set forth in subsection (1) of this section, the issuer must provide a separate written notice to each enrollee notifying the enrollee that their existing coverage will be discontinued and replaced. The notice must be provided not later than ninety days prior to the discontinuation and replacement date. (4) If an issuer has electronic mail contact information for the enrollees, the notice may be provided electronically. The issuer must be able to document to the commissioner's satisfaction both the content and timing of transmission. The issuer must send written notice by U.S. mail to an enrollee for whom the electronic mail message was rejected. (5) Prior to September 30, 2013, and between September 1 and September 30 for each year thereafter, an issuer must provide written notice to each enrollee under an individual health benefit plan of the availability of health benefit exchange coverage, and contact information for the health benefit exchange.
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