1876.E

AN ACT Relating to the modification of provisions governing certified health plans providing dental benefits only; adding a new section to chapter 48.01 RCW; repealing RCW 48.01.210 and 43.72.110; providing an effective date; and declaring an emergency.

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

NEW SECTION. Sec. 1. A new section is added to chapter 48.01 RCW to read as follows:

(1) An insurer, health care service contractor, or health maintenance organization that offers coverage for dental services and that currently holds a certificate of authority or certificate of registration issued by the insurance commissioner under chapter 48.05, 48.44, or 48.46 RCW may provide coverage for dental services as authorized by chapter 48.05, 48.44, or 48.46 RCW and as provided in this section. Such a company is deemed certified and registered as a certified health plan under RCW 43.72.090 and 48.43.010 for the delivery of coverage for dental services. The Washington health services commission and the insurance commissioner shall adopt standards and procedures to permit, upon request, the prompt certification and registration of such a company, and the issuance of a certificate as a certified health plan. Such a certification and registration only authorizes the company to provide coverage for dental services and does not subject the company to requirements applicable to certified health plans except as specifically provided in this section. Such a company shall be known as a "Dental-Only CHP." The legislature does not intend by creating this designation to convey a market advantage over certified health plans providing coverage for dental services.

(2) A Dental-Only CHP may provide coverage for dental services to individuals, to employers for the benefit of employees or for the benefit of employees and their dependents, and to other persons, entities, and agencies authorized by law to purchase health care services from, or enroll in, a certified health plan. A Dental-Only CHP may provide such coverage by separate policy, contract, or rider issued directly to the purchaser, or it may subcontract to a certified health plan that provides the dental coverage as part of the uniform benefits package, supplemental benefits, or other arrangement delivered to the purchaser.

(3) If an individual, employer, or other purchaser purchases coverage for dental services from a Dental-Only CHP and that coverage is part of the uniform benefits package or supplemental benefits designed by the Washington health services commission and regulated by the commissioner, or part of a state-managed program of health care coverages, a certified health plan may provide to the purchaser the other coverages comprising the balance of the uniform benefits package, supplemental benefits, or state-managed program, by separate policy, contract, or rider. Notwithstanding any other provision of law, an individual, employer, or other purchaser may purchase coverage for dental services in the uniform benefits package, supplemental benefits, or state-managed program from a Dental-Only CHP and concurrently purchase the balance of the required coverages separately from a certified health plan. To foster such concurrent purchases, the Washington health services commission and the commissioner shall develop and enforce separate cost containment and filing systems and procedures for dental coverages and other coverages, including separate community-rated premium submaximums and enrollee financial participation submaximums.

(4) A Dental-Only CHP shall fully comply with all applicable laws under chapter 48.05, 48.44, or 48.46 RCW governing the financial supervision and solvency of such organizations, including but not limited to applicable laws concerning capital and surplus requirements, reserves, deposits, bonds, and indemnities. In the sale of coverage for dental services that is part of the uniform benefits package, a Dental-Only CHP shall comply with all applicable administrative rules prescribed by the health services commission, the insurance commissioner, and other state agencies governing certified health plans under RCW 43.72.100. The sale of dental coverages that are part of supplemental benefits are not subject to RCW 43.72.100, 43.72.160, or 43.72.170.

NEW SECTION. Sec. 2. The following acts or parts of acts are each repealed:

(1) RCW 48.01.210 and 1993 c 462 s 51; and

(2) RCW 43.72.110 and 1993 c 492 s 429.

NEW SECTION. Sec. 3. This act is necessary for the immediate preservation of the public peace, health, or safety, or support of the state government and its existing public institutions, and shall take effect July 1, 1995.