1714-S AMH CODY KNUT 065
SHB 1714 - H AMD 380
By Representative Cody
NOT CONSIDERED 4/26/2009
Strike everything after the enacting clause and insert the following:
"NEW SECTION. Sec.1. A new section is added to chapter 48.43 RCW to read as follows:
(1) The 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 data needed to complete the report is not readily available, the commissioner may require carriers to submit the following aggregated data related to small group and association health plans for each calendar year 2000 through 2008, by March 1, 2010:
(a) The number of persons residing in Washington state who receive health benefit coverage through the small group health plans and association health plans underwritten or administered by the carrier, 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 the small group health plan and association health plan blocks of business underwritten or administered by the carrier, 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 for each year;
(c) The calendar year-end enrollment of the small group health plan and association health plan blocks 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;
(c) For the association health plan block of business underwritten or administered by the carrier, the percentage of health plan enrollees for each year 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;
(d) The annual calendar year earned premium and incurred claims, for each year reported, for the small group health plan block of business and the association health plan block of business underwritten or administered by the carrier;
(e) For the association health plan block of business underwritten or administered by the carrier, 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, for each year reported.
(2) In fulfilling the requirements of subsection 1 of this section:
(a) Carriers are not required to provide individually identifiable information that identifies specific small group plans or association health plans, or allows for the identification of specific association health plans; and
(b) Carriers who underwrite or administer an association health plan that makes up at least sixty percent of its association health plan covered lives in the state of Washington on the effective date of this act 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.
(3) The commissioner shall 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.
(4) For the purposes of this section, the terms "association health plan" and "association plan" shall include all member-governed group health plans and multiple employer welfare arrangements.
(5) 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.
(6) The report shall be submitted to the legislature no later than July 1, 2010.
Sec. 2. RCW 42.56.400 is hereby 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
all viators regulated 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); and
(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; and
(14) Documents, materials, or information obtained by
the insurance commissioner under RCW 48.37.140; and
(15) 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, 2010, rather than ongoing annual reports.
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