SHB 1714 -
By Representative Cody
ADOPTED 02/10/2010
Strike everything after the enacting clause and insert the following:
"NEW SECTION. Sec. 1 (1) The insurance commissioner shall
prepare and submit a report to the legislature related to the
performance of the small group health plan market and the association
health plan market. To the extent that the data needed to complete the
report are not readily available, the commissioner may require carriers
to submit aggregated data for the small group health plans and
association health plans underwritten or administered by the carrier,
for each calendar year 2005 through 2008. Data submitted shall not
identify specific small group plans or association health plans, and
the report shall not identify specific small group or association
health plans or present data in a manner that allows identification of
specific plans. Carriers who underwrite or administer an association
health plan that covers fewer than ten thousand lives in any year
reported may, at their own expense, contract with a third party to
aggregate and report the information required under this section with
that of other carriers who qualify for this option. The data must be
reported separately for the carrier's small group health plan block of
business and association health plan block of business, and must
include the following information:
(a) The number of persons residing in Washington state who receive
health benefit coverage through each block of business, including the
number of persons enrolled in the plans on the first day and last day
of each year, the number of persons enrolled in the plans during each
year, and the number of persons who terminated enrollment in the plans
during each year;
(b) The calendar year-end enrollment of each block of business, by
age group using five-year increments beginning with age twenty and
ending with age sixty-five, and the average age of persons covered in
each block of business;
(c) The calendar year-end enrollment of each block of business by
employer size for each year, reporting by groups of two to five, six to
ten, eleven to twenty-five, twenty-six to fifty, fifty-one to one
hundred, and more than one hundred;
(d) The annual calendar year earned premium and incurred claims for
each block of business;
(e) For the association health plan block of business, the number
of association health plans that limit eligibility for health plan
coverage to employer groups of a minimum size, or that limit
eligibility for health plan coverage to a subset of the industries that
the association sponsoring the health plan was established to serve,
and the percentage of health plan enrollees for whom each of the
following elements is used in setting health plan rates:
(i) Claims experience;
(ii) Employer group size; or
(iii) Health status factors.
(2) In fulfilling the requirements of subsection (1) of this
section the commissioner may adopt rules necessary to implement the
data submission administrative process under this section, including
the format, timing of data reporting, data standards, instructions,
definitions, and data sources.
(3) For the purposes of this subsection, the terms "association
health plan" and "association plan" shall include all member-governed
group health plans and multiple employer welfare arrangements and any
other arrangement to which two or more public or private employers, of
which at least two are small employers, contribute to provide health
care for their employees.
(4) Data, information, and documents provided by a carrier pursuant
to this section are exempt from public inspection and copying under RCW
48.02.120 and chapters 42.17 and 42.56 RCW.
(5) The report shall be submitted to the legislature no later than
July 1, 2011.
(6) This section expires June 30, 2011.
Sec. 2 RCW 42.56.400 and 2009 c 104 s 23 are each amended to read
as follows:
The following information relating to insurance and financial
institutions is exempt from disclosure under this chapter:
(1) Records maintained by the board of industrial insurance appeals
that are related to appeals of crime victims' compensation claims filed
with the board under RCW 7.68.110;
(2) Information obtained and exempted or withheld from public
inspection by the health care authority under RCW 41.05.026, whether
retained by the authority, transferred to another state purchased
health care program by the authority, or transferred by the authority
to a technical review committee created to facilitate the development,
acquisition, or implementation of state purchased health care under
chapter 41.05 RCW;
(3) The names and individual identification data of either all
owners or all insureds, or both, received by the insurance commissioner
under chapter 48.102 RCW;
(4) Information provided under RCW 48.30A.045 through 48.30A.060;
(5) Information provided under RCW 48.05.510 through 48.05.535,
48.43.200 through 48.43.225, 48.44.530 through 48.44.555, and 48.46.600
through 48.46.625;
(6) Examination reports and information obtained by the department
of financial institutions from banks under RCW 30.04.075, from savings
banks under RCW 32.04.220, from savings and loan associations under RCW
33.04.110, from credit unions under RCW 31.12.565, from check cashers
and sellers under RCW 31.45.030(3), and from securities brokers and
investment advisers under RCW 21.20.100, all of which is confidential
and privileged information;
(7) Information provided to the insurance commissioner under RCW
48.110.040(3);
(8) Documents, materials, or information obtained by the insurance
commissioner under RCW 48.02.065, all of which are confidential and
privileged;
(9) Confidential proprietary and trade secret information provided
to the commissioner under RCW 48.31C.020 through 48.31C.050 and
48.31C.070;
(10) Data filed under RCW 48.140.020, 48.140.030, 48.140.050, and
7.70.140 that, alone or in combination with any other data, may reveal
the identity of a claimant, health care provider, health care facility,
insuring entity, or self-insurer involved in a particular claim or a
collection of claims. For the purposes of this subsection:
(a) "Claimant" has the same meaning as in RCW 48.140.010(2).
(b) "Health care facility" has the same meaning as in RCW
48.140.010(6).
(c) "Health care provider" has the same meaning as in RCW
48.140.010(7).
(d) "Insuring entity" has the same meaning as in RCW 48.140.010(8).
(e) "Self-insurer" has the same meaning as in RCW 48.140.010(11);
(11) Documents, materials, or information obtained by the insurance
commissioner under RCW 48.135.060;
(12) Documents, materials, or information obtained by the insurance
commissioner under RCW 48.37.060;
(13) Confidential and privileged documents obtained or produced by
the insurance commissioner and identified in RCW 48.37.080;
(14) Documents, materials, or information obtained by the insurance
commissioner under RCW 48.37.140;
(15) Documents, materials, or information obtained by the insurance
commissioner under RCW 48.17.595; ((and))
(16) Documents, materials, or information obtained by the insurance
commissioner under RCW 48.102.051(1) and 48.102.140 (3) and (7)(a)(ii);
and
(17) Data, information, and documents provided by a carrier
pursuant to section 1 of this act."
Correct the title.
EFFECT: The report will include the annual calendar year earned premium and incurred claims for both the small group and association health plan blocks of business administered by the carrier. Carriers are provided flexibility in providing or contracting for the provision of the information required in the report. Multiple employer welfare arrangements are included in the reporting requirements. Information submitted to the Insurance Commissioner by carriers is exempt from public disclosure. The definitions of "incurred claims" and "loss ratio" are deleted as these terms are already defined in statute. There will be a one-time report submitted to the Insurance Commissioner by July 1, 2011, rather than ongoing annual reports. The study period is changed from 2000-2008 to 2005-2008. The Insurance Commissioner is authorized to adopt rules to complete the reporting requirement.