WSR 15-11-082 EMERGENCY RULES OFFICE OF
INSURANCE COMMISSIONER
[Insurance Commissioner Matter No. R 2015-01—Filed May 19, 2015, 3:12 p.m., effective May 19, 2015, 3:12 p.m.] Effective Date of Rule: Immediately upon filing.
Purpose: The federal government announced its plans in March 2015 to adjust the essential health benefits standards for plan year 2017. The first step in this process is for each state to designate its base benchmark plan by June 1, 2015, and then engage in any further rule making necessary for supplementing the base benchmark plan; the result of this latter rule making would be published in fall 2015. The federal rules require choosing a base benchmark plan from a designated list of ten plans, based on enrollment in each plan as of March 31, 2014. RCW 48.43.715 further provides that the base benchmark plan must be the small group plan with the greatest enrollment. This rule making is solely for the purpose of meeting the federal government's June 1 deadline for designating a base benchmark plan; the subsequent supplementation is anticipated to be achieved by normal rule making.
Citation of Existing Rules Affected by this Order: Amending WAC 284-43-865.
Statutory Authority for Adoption: RCW 48.02.060 and 48.43.715.
Other Authority: P.L. 111-148, sec. 1302 (2010).
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; and that state or federal law or federal rule or a federal deadline for state receipt of federal funds requires immediate adoption of a rule.
Reasons for this Finding: New federal rules require choosing a base benchmark plan from a designated list of ten plans, based on enrollment in each plan as of March 31, 2014. This emergency rule making is solely for the purpose of meeting the federal government's June 1 deadline for designating a base benchmark plan; the subsequent supplementation is anticipated to be achieved by normal rule making.
Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 1, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.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 0, 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 0, Amended 0, Repealed 0.
Date Adopted: May 19, 2015.
Mike Kreidler
Insurance Commissioner
AMENDATORY SECTION (Amending WSR 12-19-099, filed 9/19/12, effective 10/20/12)
WAC 284-43-865 Essential health benefits package benchmark reference plan.
A not grandfathered individual or small group health benefit plan offered, issued, amended or renewed on or after January 1, 2014, must, at a minimum, include coverage for essential health benefits. "Essential health benefits" means all of the following:
(1) The benefits and services covered by health care service contractor Regence Blue Shield as the ((Innova)) Regence Direct Gold + small group plan policy form, policy form number ((WW0711CCONMS)) WW0114CCONMSD, and certificate form number ((WW0112BINNS)) WW0114BPPO1SD, offered during the first quarter of ((2012)) 2014. The SERFF filing number is ((RGWA-127372701)) RGWA-128968362.
(2) The services and items covered by a health benefit plan that are within the categories identified in Section 1302(b) of PPACA including, but not limited to, ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder services, including behavioral health treatment, prescription drugs, rehabilitative and habilitative services and devices, laboratory services, preventive and wellness services and chronic disease management, and pediatric services, including oral and vision care, and as supplemented by the commissioner or required by the secretary of the U.S. Department of Health and Human Services.
(3) Mandated benefits pursuant to Title 48 RCW enacted before December 31, 2011.
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