WSR 17-01-145 PERMANENT RULES OFFICE OF INSURANCE COMMISSIONER [Insurance Commissioner Matter No. R 2016-21—Filed December 20, 2016, 5:11 p.m., effective January 20, 2017] Effective Date of Rule: Thirty-one days after filing.
Purpose: Special enrollment rule: Expanded health benefit exchange request.
Citation of Existing Rules Affected by this Order: Amending WAC 284-43-1140.
Adopted under notice filed as WSR 16-22-098 on November 2, 2016.
A final cost-benefit analysis is available by contacting Bianca Stoner, P.O. Box 40260, Olympia, WA 98504, phone (360) 725-7041, fax (360) 586-3109, email rulescoordinator@oic.wa.gov.
Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.
Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 1, Repealed 0.
Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 0.
Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 0, Repealed 0.
Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 1, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 0, Amended 0, Repealed 0.
Date Adopted: December 20, 2016.
Mike Kreidler
Insurance Commissioner
AMENDATORY SECTION (Amending WSR 16-14-106, filed 7/6/16, effective 8/6/16)
WAC 284-43-1140 Duration, notice requirements and effective dates of coverage for individual market special enrollment periods.
(1) Special enrollment periods must not be shorter than sixty days from the date of the qualifying event.
(2) The effective date of coverage for those enrolling in an individual health plan through a special enrollment period is the first date of the next month after the premium is received by the issuer, unless one of the following exceptions applies:
(a) For those enrolling after the ((twentieth)) fifteenth of the month, the issuer must begin coverage not later than the first date of the second month after the application is received. Issuers may establish an earlier effective date at their discretion;
(b) For special enrollment of newborn, adopted or placed for adoption children, the date of birth, date of adoption or date of placement for adoption, as applicable, becomes the first effective date of coverage. The same requirement applies to foster children or children placed for foster care on qualified health plans;
(c) For special enrollment based on marriage or the beginning of a domestic partnership, and for special enrollment based on loss of minimum essential coverage, coverage must begin on the first day of the next month.
(3) For individual plans offered either on or off the health benefit exchange, an issuer must include detailed information about special enrollment options and rights in its health plan documents provided pursuant to WAC 284-43-5130, and in the policy, contract or certificate of coverage provided to an employer, plan sponsor or enrollee. The notice must be substantially similar to the model notice provided by the U.S. Department of Health and Human Services.
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