SHB 2404 -
By Senator Jacobsen
On page 6, after line 33 of the amendment, insert the following:
"Sec. 7 RCW 48.41.030 and 2004 c 260 s 25 are each amended to
read as follows:
The definitions in this section apply throughout this chapter
unless the context clearly requires otherwise.
(1) "Accounting year" means a twelve-month period determined by the
board for purposes of record-keeping and accounting. The first
accounting year may be more or less than twelve months and, from time
to time in subsequent years, the board may order an accounting year of
other than twelve months as may be required for orderly management and
accounting of the pool.
(2) "Administrator" means the entity chosen by the board to
administer the pool under RCW 48.41.080.
(3) "Board" means the board of directors of the pool.
(4) "Commissioner" means the insurance commissioner.
(5) "Covered person" means any individual resident of this state
who is eligible to receive benefits from any member, or other health
plan.
(6) "Health care facility" has the same meaning as in RCW
70.38.025.
(7) "Health care provider" means any physician, facility, or health
care professional, who is licensed in Washington state and entitled to
reimbursement for health care services.
(8) "Health care services" means services for the purpose of
preventing, alleviating, curing, or healing human illness or injury.
(9) "Health carrier" or "carrier" has the same meaning as in RCW
48.43.005.
(10) "Health coverage" means any group or individual disability
insurance policy, health care service contract, and health maintenance
agreement, except those contracts entered into for the provision of
health care services pursuant to Title XVIII of the Social Security
Act, 42 U.S.C. Sec. 1395 et seq. The term does not include short-term
care, long-term care, dental, vision, accident, fixed indemnity,
disability income contracts, limited benefit or credit insurance,
coverage issued as a supplement to liability insurance, insurance
arising out of the worker's compensation or similar law, automobile
medical payment insurance, or insurance under which benefits are
payable with or without regard to fault and which is statutorily
required to be contained in any liability insurance policy or
equivalent self-insurance.
(11) "Health plan" means any arrangement by which persons,
including dependents or spouses, covered or making application to be
covered under this pool, have access to hospital and medical benefits
or reimbursement including any group or individual disability insurance
policy; health care service contract; health maintenance agreement;
uninsured arrangements of group or group-type contracts including
employer self-insured, cost-plus, or other benefit methodologies not
involving insurance or not governed by Title 48 RCW; coverage under
group-type contracts which are not available to the general public and
can be obtained only because of connection with a particular
organization or group; and coverage by medicare or other governmental
benefits. This term includes coverage through "health coverage" as
defined under this section, and specifically excludes those types of
programs excluded under the definition of "health coverage" in
subsection (10) of this section.
(12) "Medical assistance" means coverage under Title XIX of the
federal Social Security Act (42 U.S.C., Sec. 1396 et seq.) and chapter
74.09 RCW.
(13) "Medicare" means coverage under Title XVIII of the Social
Security Act, (42 U.S.C. Sec. 1395 et seq., as amended).
(14) "Member" means any commercial insurer which provides
disability insurance or stop loss insurance, any health care service
contractor, any health maintenance organization licensed under Title 48
RCW, any retainer health care practices authorized under this act, and
any self-funded multiple employer welfare arrangement as defined in RCW
48.125.010. "Member" also means the Washington state health care
authority as issuer of the state uniform medical plan. "Member" shall
also mean, as soon as authorized by federal law, employers and other
entities, including a self-funding entity and employee welfare benefit
plans that provide health plan benefits in this state on or after May
18, 1987. "Member" does not include any insurer, health care service
contractor, or health maintenance organization whose products are
exclusively dental products or those products excluded from the
definition of "health coverage" set forth in subsection (10) of this
section.
(15) "Network provider" means a health care provider who has
contracted in writing with the pool administrator or a health carrier
contracting with the pool administrator to offer pool coverage to
accept payment from and to look solely to the pool or health carrier
according to the terms of the pool health plans.
(16) "Plan of operation" means the pool, including articles, by-laws, and operating rules, adopted by the board pursuant to RCW
48.41.050.
(17) "Point of service plan" means a benefit plan offered by the
pool under which a covered person may elect to receive covered services
from network providers, or nonnetwork providers at a reduced rate of
benefits.
(18) "Pool" means the Washington state health insurance pool as
created in RCW 48.41.040."
Renumber the remaining sections consecutively and correct any internal references accordingly.
SHB 2404 -
By Senator
On page 8, line 2 of the title amendment, after "48.44.010" insert "and 48.41.030"
EFFECT: Retainer health care practices must contribute to the Washington State Health Insurance Pool (WSHIP).