S-0153.1 _______________________________________________
SENATE BILL 5298
_______________________________________________
State of Washington 55th Legislature 1997 Regular Session
By Senators Franklin, Kohl, Prentice, Wood, Spanel, Winsley, Wojahn, Sheldon, Snyder, Patterson, Brown, Heavey, Rasmussen, McAuliffe, Fairley and Goings
Read first time 01/22/97. Referred to Committee on Health & Long‑Term Care.
AN ACT Relating to health insurance discrimination on the basis of genetic information; amending RCW 48.43.005; and adding a new section to chapter 48.43 RCW.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:
Sec. 1. RCW 48.43.005 and 1995 c 265 s 4 are each amended to read as follows:
Unless otherwise specifically provided, the definitions in this section apply throughout this chapter.
(1) "Adjusted community rate" means the rating method used to establish the premium for health plans adjusted to reflect actuarially demonstrated differences in utilization or cost attributable to geographic region, age, family size, and use of wellness activities.
(2) "Covered person" or "enrollee" means a person covered by a health plan including an enrollee, subscriber, policyholder, beneficiary of a group plan, or individual covered by any other health plan.
(3) "Eligible employee" means an employee who works on a full-time basis with a normal work week of thirty or more hours. The term includes a self-employed individual, including a sole proprietor, a partner of a partnership, and may include an independent contractor, if the self-employed individual, sole proprietor, partner, or independent contractor is included as an employee under a health benefit plan of a small employer, but does not work less than thirty hours per week and derives at least seventy-five percent of his or her income from a trade or business through which he or she has attempted to earn taxable income and for which he or she has filed the appropriate internal revenue service form. Persons covered under a health benefit plan pursuant to the consolidated omnibus budget reconciliation act of 1986 shall not be considered eligible employees for purposes of minimum participation requirements of chapter 265, Laws of 1995.
(4) "Enrollee point-of-service cost-sharing" means amounts paid to health carriers directly providing services, health care providers, or health care facilities by enrollees and may include copayments, coinsurance, or deductibles.
(5) "Genetic information" means information about genes, gene products, or inherited characteristics.
(6) "Genetic services" means health services to obtain, assess, and interpret genetic information for diagnostic and therapeutic purposes and for genetic education and counselling.
(7) "Health care facility" or "facility" means hospices licensed under chapter 70.127 RCW, hospitals licensed under chapter 70.41 RCW, rural health care facilities as defined in RCW 70.175.020, psychiatric hospitals licensed under chapter 71.12 RCW, nursing homes licensed under chapter 18.51 RCW, community mental health centers licensed under chapter 71.05 or 71.24 RCW, kidney disease treatment centers licensed under chapter 70.41 RCW, ambulatory diagnostic, treatment, or surgical facilities licensed under chapter 70.41 RCW, drug and alcohol treatment facilities licensed under chapter 70.96A RCW, and home health agencies licensed under chapter 70.127 RCW, and includes such facilities if owned and operated by a political subdivision or instrumentality of the state and such other facilities as required by federal law and implementing regulations.
(((6)))
(8) "Health care provider" or "provider" means:
(a) A person regulated under Title 18 or chapter 70.127 RCW, to practice health or health-related services or otherwise practicing health care services in this state consistent with state law; or
(b) An employee or agent of a person described in (a) of this subsection, acting in the course and scope of his or her employment.
(((7)))
(9) "Health care service" means that service offered or
provided by health care facilities and health care providers relating to the
prevention, cure, or treatment of illness, injury, or disease.
(((8)))
(10) "Health carrier" or "carrier" means a
disability insurer regulated under chapter 48.20 or 48.21 RCW, a health care
service contractor as defined in RCW 48.44.010, or a health maintenance
organization as defined in RCW 48.46.020.
(((9)))
(11) "Health plan" or "health benefit plan" means
any policy, contract, or agreement offered by a health carrier to provide,
arrange, reimburse, or pay for health care service except the following:
(a) Long-term care insurance governed by chapter 48.84 RCW;
(b) Medicare supplemental health insurance governed by chapter 48.66 RCW;
(c) Limited health care service offered by limited health care service contractors in accordance with RCW 48.44.035;
(d) Disability income;
(e) Coverage incidental to a property/casualty liability insurance policy such as automobile personal injury protection coverage and homeowner guest medical;
(f) Workers' compensation coverage;
(g) Accident only coverage;
(h) Specified disease and hospital confinement indemnity when marketed solely as a supplement to a health plan;
(i) Employer-sponsored self-funded health plans; and
(j) Dental only and vision only coverage.
(((10)))
(12) "Basic health plan services" means that schedule of
covered health services, including the description of how those benefits are to
be administered, that are required to be delivered to an enrollee under the
basic health plan, as revised from time to time.
(((11)))
(13) "Preexisting condition" means any medical condition,
illness, or injury that existed any time prior to the effective date of
coverage.
(((12)))
(14) "Premium" means all sums charged, received, or deposited
by a health carrier as consideration for a health plan or the continuance of a
health plan. Any assessment or any "membership," "policy,"
"contract," "service," or similar fee or charge made by a health
carrier in consideration for a health plan is deemed part of the premium.
"Premium" shall not include amounts paid as enrollee point-of-service
cost-sharing.
(((13)))
(15) "Small employer" means any person, firm, corporation,
partnership, association, political subdivision except school districts, or
self-employed individual that is actively engaged in business that, on at least
fifty percent of its working days during the preceding calendar quarter,
employed no more than fifty eligible employees, with a normal work week of
thirty or more hours, the majority of whom were employed within this state, and
is not formed primarily for purposes of buying health insurance and in which a
bona fide employer-employee relationship exists. In determining the number of
eligible employees, companies that are affiliated companies, or that are
eligible to file a combined tax return for purposes of taxation by this state,
shall be considered an employer. Subsequent to the issuance of a health plan
to a small employer and for the purpose of determining eligibility, the size of
a small employer shall be determined annually. Except as otherwise
specifically provided, a small employer shall continue to be considered a small
employer until the plan anniversary following the date the small employer no
longer meets the requirements of this definition. The term "small
employer" includes a self-employed individual or sole proprietor. The
term "small employer" also includes a self-employed individual or
sole proprietor who derives at least seventy-five percent of his or her income
from a trade or business through which the individual or sole proprietor has
attempted to earn taxable income and for which he or she has filed the
appropriate internal revenue service form 1040, schedule C or F, for the
previous taxable year.
(((14)))
(16) "Wellness activity" means an explicit program of an
activity consistent with department of health guidelines, such as, smoking
cessation, injury and accident prevention, reduction of alcohol misuse,
appropriate weight reduction, exercise, automobile and motorcycle safety, blood
cholesterol reduction, and nutrition education for the purpose of improving
enrollee health status and reducing health service costs.
(((15)))
(17) "Basic health plan" means the plan described under
chapter 70.47 RCW, as revised from time to time.
NEW SECTION. Sec. 2. A new section is added to chapter 48.43 RCW to read as follows:
(1) A health carrier may not deny or cancel health plan coverage, or vary the premiums, terms, or conditions for health plan coverage, for an individual or a family member of an individual:
(a) On the basis of genetic information; or
(b) Because the individual or family member of an individual has requested or received genetic services.
(2)(a) A health carrier may not request or require an individual to whom the carrier provides health plan coverage, or an individual who desires the carrier to provide health plan coverage, to disclose to the carrier genetic information about the individual or family member of the individual.
(b) A health carrier may not disclose genetic information about an individual without the prior written authorization of the individual or legal representative of the individual. Authorization is required for each disclosure and must include an identification of the person to whom the disclosure is to be made.
(3) The insurance commissioner shall enforce the requirements established under subsections (1) and (2) of this section.
(4) A person may bring a civil action:
(a) To enjoin any act or practice that violates subsection (1) or (2) of this section;
(b) To obtain other appropriate equitable relief: (i) To redress such violations; or (ii) to enforce subsection (1) or (2) of this section; or
(c) To obtain other legal relief, including monetary damages.
(5) The insurance commissioner may adopt rules necessary or appropriate to carry out this section.
(6) Nothing in this section is to be construed as requiring a health plan to provide benefits to a particular participant or beneficiary.
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