5261-S AMS PARL NEED 808
SSB 5261 - S AMD 16
By Senator Parlette
ADOPTED 1/25/2008
On page 5, beginning on line 29, after "(c)" strike everything down through and including line 2 on page 6, and insert the following:
""Declination rate" for an insurer means the percentage of the total number of applicants for individual health benefit plans received by that insurer in the aggregate in the applicable year which are not accepted for enrollment by that insurer based on the results of the standard health questionnaire administered pursuant to RCW 48.43.018(2)(a).
(((c) ))(d)"Earned premiums" means premiums, as defined in RCW 48.43.005, plus any rate credits or recoupments less any refunds, for the applicable period, whether received before, during, or after the applicable period.
(e)(((d) ))"Incurred claims expense" means claims paid during the applicable period plus any increase, or less any decrease, in the claims reserves.
(f)(((e) ))"Loss ratio" means incurred claims expense as a percentage of earned premiums.
(g)(((f) ))"Reserves" means: (i) Active life reserves; and (ii) additional reserves whether for a specific liability purpose or not."
On page 6, line 21, after "standard" strike everything through "section." on line 22 and insert, "((established in subsection (7) of this section.)) of seventy four percent, minus the premium tax rate applicable to the insurer's individual health benefit plans under RCW 48.14.020."
On page 6, line 28, after "loss ratio" insert "and its actual declination rate"
On page 7, line 29, after "((seventy-four ))" strike "seventy-seven percent" and insert "((percent)) the percentage set forth in the following schedule that correlates to the health care service contractor's actual declination rate in the preceding year,"
On page 7, line 31, after "48.14.020." insert the following:
Actual Declination Rate |
Loss Ratio |
Under Six Percent (6%) |
Seventy Four Percent (74%) |
Six Percent (6%) or more (but less than Seven Percent) |
Seventy Five Percent (75%) |
Seven Percent (7%) or more (but less than Eight Percent) |
Seventy Six Percent (76%) |
Eight Percent (8%) or more |
Seventy Seven Percent (77%) |
On page 8, line 11 after "(c)" insert the following:
""Declination rate" for an insurer means the percentage of the total number of applicants for individual health benefit plans received by that insurer in the aggregate in the applicable year which are not accepted for enrollment by that insurer based on the results of the standard health questionnaire administered pursuant to RCW 48.43.018(2)(a).
(d)(((c) ))"
On page 8, line 15, strike "(d)" and insert "(((d)))(e)"
On page 8, line 18, strike "(e)" and insert "(((e) ))(f)"
On page 8, line 20 strike "(f) and insert "(((f)))(g)"
On page 9, on line 4, strike everything through "section." on line 5 and insert "((established in subsection (7) of this section.)) of seventy four percent, minus the premium tax rate applicable to the insurer's individual health benefit plans under RCW 48.14.020."
On page 9, line 11, after "loss ratio" insert "and its actual declination rate"
On page 10, line 14, after "((seventy-four))" strike "seventy-seven percent" and insert, "((percent)) the percentage set forth in the following schedule that correlates to the health care service contractor's actual declination rate in the preceding year,"
On page 10, line 16, after "RCW 48.14.0201." insert the following:
Actual Declination Rate |
Loss Ratio |
Under Six Percent (6%) |
Seventy Four Percent (74%) |
Six Percent (6%) or more (but less than Seven Percent) |
Seventy Five Percent (75%) |
Seven Percent (7%) or more (but less than Eight Percent) |
Seventy Six Percent (76%) |
Eight Percent (8%) or more |
Seventy Seven Percent (77%) |
On page 10, line 33, after "(c)" insert the following:
""Declination rate" for an insurer means the percentage of the total number of applicants for individual health benefit plans received by that insurer in the aggregate in the applicable year which are not accepted for enrollment by that insurer based on the results of the standard health questionnaire administered pursuant to RCW 48.43.018(2)(a).
(d)"
On page 11, line 1, strike "(d)" and insert "(((d)))(e)"
On page 11, line 4, strike "(e)" and insert "(((e) ))(f)"
On page 11, line 6, strike "(f)" and insert (((f)))(g)"
On page 11, line 28 after "standard" strike everything through "section." on line 29 and insert "((established in subsection (7) of this section.))of seventy four percent, minus the premium tax rate applicable to the insurer's individual health benefit plans under RCW 48.14.020."
On page 11, line 35 after "loss ratio" insert "and its actual declination rate"
On page 13, line 2 after "((seventy-four))" strike "seventy-seven" and insert "((percent ))the percentage set forth in the following schedule that correlates to the health maintenance organization's actual declination rate in the preceding year,"
On page 13, line 4 after "RCW 48.14.0201." insert the following:
Actual Declination Rate |
Loss Ratio |
Under Six Percent (6%) |
Seventy Four Percent (74%) |
Six Percent (6%) or more (but less than Seven Percent) |
Seventy Five Percent (75%) |
Seven Percent (7%) or more (but less than Eight Percent) |
Seventy Six Percent (76%) |
Eight Percent (8%) or more |
Seventy Seven Percent (77%) |
EFFECT: Retains the commissioner's authority established in the substitute bill, inserts a sliding-scale loss-ratio requirement that is tied to the declination rate (or rate of people each plan denies coverage for).