HB 2117 -
By Representative Ericksen
SCOPE AND OBJECT 03/05/2009
On page 3, line 22, after "services;" strike "and" and insert
"((and))"
On page 3, line 23, after "(vi)" insert "Who is not between the
ages of nineteen and thirty-four and does not qualify for health plans
for young adults as provided in RCW 48.43.041, 48.44.022, 48.46.064, or
48.20.029; and
(vii)"
On page 3, line 27, strike "(vi)" and insert "(((vi))) (vii)"
On page 3, line 35, strike "(vi)" and insert "(((vi))) (vii)"
On page 14, after line 35, insert the following:
"Sec. 6 RCW 48.43.041 and 2000 c 79 s 26 are each amended to read
as follows:
(1) All individual health benefit plans, other than catastrophic
health plans, ((offered or renewed on or after October 1, 2000)) and
plans for young adults described in subsection (3) of this section,
shall include benefits described in this section. Nothing in this
section shall be construed to require a carrier to offer an individual
health benefit plan.
(a) Maternity services that include, with no enrollee cost-sharing
requirements beyond those generally applicable cost-sharing
requirements: Diagnosis of pregnancy; prenatal care; delivery; care
for complications of pregnancy; physician services; hospital services;
operating or other special procedure rooms; radiology and laboratory
services; appropriate medications; anesthesia; and services required
under RCW 48.43.115; and
(b) Prescription drug benefits with at least a two thousand dollar
benefit payable by the carrier annually.
(2) If a carrier offers a health benefit plan that is not a
catastrophic health plan to groups, and it chooses to offer a health
benefit plan to individuals, it must offer at least one health benefit
plan to individuals that is not a catastrophic health plan.
(3) Carriers may design and offer a separate health plan targeted
at young adults between nineteen and thirty-four years old. The plan
may include the benefits required under subsections (1) and (2) of this
section. The health plan designed for young adults is exempt from the
requirements of RCW 48.43.045(1), 48.43.515(5), 48.44.327, 48.20.392,
48.46.277, 48.43.043, 48.20.580, 48.21.241, 48.44.341, and 48.46.291.
Carriers that choose to exclude maternity services from a young adult
plan offered under this section must allow enrollees who become
pregnant to transfer to another health benefit plan with similar cost-sharing provisions that provides coverage for maternity services, once
pregnancy is confirmed by a licensed provider. Carriers shall allow
the transfer to occur without applying a preexisting condition waiting
period or other limitation or penalty including, but not limited to,
satisfying a new deductible or stop-loss requirement.
Sec. 7 RCW 48.44.022 and 2006 c 100 s 3 are each amended to read
as follows:
(1) Except for health benefit plans covered under RCW 48.44.021,
premium rates for health benefit plans for individuals shall be subject
to the following provisions:
(a) The health care service contractor shall develop its rates
based on an adjusted community rate and may only vary the adjusted
community rate for:
(i) Geographic area;
(ii) Family size;
(iii) Age;
(iv) Tenure discounts; and
(v) Wellness activities.
(b) The adjustment for age in (a)(iii) of this subsection may not
use age brackets smaller than five-year increments which shall begin
with age twenty and end with age sixty-five. Individuals under the age
of twenty shall be treated as those age twenty.
(c) The health care service contractor shall be permitted to
develop separate rates for individuals age sixty-five or older for
coverage for which medicare is the primary payer and coverage for which
medicare is not the primary payer. Both rates shall be subject to the
requirements of this subsection.
(d) Except as provided in subsection (2) of this section, the
permitted rates for any age group shall be no more than four hundred
twenty-five percent of the lowest rate for all age groups on January 1,
1996, four hundred percent on January 1, 1997, and three hundred
seventy-five percent on January 1, 2000, and thereafter.
(e) A discount for wellness activities shall be permitted to
reflect actuarially justified differences in utilization or cost
attributed to such programs.
(f) The rate charged for a health benefit plan offered under this
section may not be adjusted more frequently than annually except that
the premium may be changed to reflect:
(i) Changes to the family composition;
(ii) Changes to the health benefit plan requested by the
individual; or
(iii) Changes in government requirements affecting the health
benefit plan.
(g) For the purposes of this section, a health benefit plan that
contains a restricted network provision shall not be considered similar
coverage to a health benefit plan that does not contain such a
provision, provided that the restrictions of benefits to network
providers result in substantial differences in claims costs. This
subsection does not restrict or enhance the portability of benefits as
provided in RCW 48.43.015.
(h) A tenure discount for continuous enrollment in the health plan
of two years or more may be offered, not to exceed ten percent.
(2) Adjusted community rates established under this section shall
pool the medical experience of all individuals purchasing coverage,
except individuals purchasing coverage under RCW 48.44.021, and shall
not be required to be pooled with the medical experience of health
benefit plans offered to small employers under RCW 48.44.023. Carriers
may treat young adults and products developed specifically for them
consistent with RCW 48.43.041(3) as a single-banded experience pool for
purposes of establishing rates. The rates established for this age
group are not subject to subsection (1)(d) of this section.
(3) As used in this section and RCW 48.44.023 "health benefit
plan," "small employer," "adjusted community rates," and "wellness
activities" mean the same as defined in RCW 48.43.005.
Sec. 8 RCW 48.46.064 and 2006 c 100 s 5 are each amended to read
as follows:
(1) Except for health benefit plans covered under RCW 48.46.063,
premium rates for health benefit plans for individuals shall be subject
to the following provisions:
(a) The health maintenance organization shall develop its rates
based on an adjusted community rate and may only vary the adjusted
community rate for:
(i) Geographic area;
(ii) Family size;
(iii) Age;
(iv) Tenure discounts; and
(v) Wellness activities.
(b) The adjustment for age in (a)(iii) of this subsection may not
use age brackets smaller than five-year increments which shall begin
with age twenty and end with age sixty-five. Individuals under the age
of twenty shall be treated as those age twenty.
(c) The health maintenance organization shall be permitted to
develop separate rates for individuals age sixty-five or older for
coverage for which medicare is the primary payer and coverage for which
medicare is not the primary payer. Both rates shall be subject to the
requirements of this subsection.
(d) Except as provided in subsection (2) of this section, the
permitted rates for any age group shall be no more than four hundred
twenty-five percent of the lowest rate for all age groups on January 1,
1996, four hundred percent on January 1, 1997, and three hundred
seventy-five percent on January 1, 2000, and thereafter.
(e) A discount for wellness activities shall be permitted to
reflect actuarially justified differences in utilization or cost
attributed to such programs.
(f) The rate charged for a health benefit plan offered under this
section may not be adjusted more frequently than annually except that
the premium may be changed to reflect:
(i) Changes to the family composition;
(ii) Changes to the health benefit plan requested by the
individual; or
(iii) Changes in government requirements affecting the health
benefit plan.
(g) For the purposes of this section, a health benefit plan that
contains a restricted network provision shall not be considered similar
coverage to a health benefit plan that does not contain such a
provision, provided that the restrictions of benefits to network
providers result in substantial differences in claims costs. This
subsection does not restrict or enhance the portability of benefits as
provided in RCW 48.43.015.
(h) A tenure discount for continuous enrollment in the health plan
of two years or more may be offered, not to exceed ten percent.
(2) Adjusted community rates established under this section shall
pool the medical experience of all individuals purchasing coverage,
except individuals purchasing coverage under RCW 48.46.063, and shall
not be required to be pooled with the medical experience of health
benefit plans offered to small employers under RCW 48.46.066. Carriers
may treat young adults and products developed specifically for them
consistent with RCW 48.43.041(3) as a single-banded experience pool for
purposes of establishing rates. The rates established for this age
group are not subject to subsection (1)(d) of this section.
(3) As used in this section and RCW 48.46.066, "health benefit
plan," "adjusted community rate," "small employer," and "wellness
activities" mean the same as defined in RCW 48.43.005.
Sec. 9 RCW 48.20.029 and 2006 c 100 s 2 are each amended to read
as follows:
(1) Premiums for health benefit plans for individuals who purchase
the plan as a member of a purchasing pool:
(a) Consisting of five hundred or more individuals affiliated with
a particular industry;
(b) To whom care management services are provided as a benefit of
pool membership; and
(c) Which allows contributions from more than one employer to be
used towards the purchase of an individual's health benefit plan;
shall be calculated using the adjusted community rating method that
spreads financial risk across the entire purchasing pool of which the
individual is a member. All such rates shall conform to the following:
(i) The insurer shall develop its rates based on an adjusted
community rate and may only vary the adjusted community rate for:
(A) Geographic area;
(B) Family size;
(C) Age;
(D) Tenure discounts; and
(E) Wellness activities.
(ii) The adjustment for age in (c)(i)(C) of this subsection may not
use age brackets smaller than five-year increments which shall begin
with age twenty and end with age sixty-five. Individuals under the age
of twenty shall be treated as those age twenty.
(iii) The insurer shall be permitted to develop separate rates for
individuals age sixty-five or older for coverage for which medicare is
the primary payer, and coverage for which medicare is not the primary
payer. Both rates are subject to the requirements of this subsection.
(iv) Except as provided in subsection (2) of this section, the
permitted rates for any age group shall be no more than four hundred
twenty-five percent of the lowest rate for all age groups on January 1,
1996, four hundred percent on January 1, 1997, and three hundred
seventy-five percent on January 1, 2000, and thereafter.
(v) A discount for wellness activities shall be permitted to
reflect actuarially justified differences in utilization or cost
attributed to such programs not to exceed twenty percent.
(vi) The rate charged for a health benefit plan offered under this
section may not be adjusted more frequently than annually except that
the premium may be changed to reflect:
(A) Changes to the family composition;
(B) Changes to the health benefit plan requested by the individual;
or
(C) Changes in government requirements affecting the health benefit
plan.
(vii) For the purposes of this section, a health benefit plan that
contains a restricted network provision shall not be considered similar
coverage to a health benefit plan that does not contain such a
provision, provided that the restrictions of benefits to network
providers result in substantial differences in claims costs. This
subsection does not restrict or enhance the portability of benefits as
provided in RCW 48.43.015.
(viii) A tenure discount for continuous enrollment in the health
plan of two years or more may be offered, not to exceed ten percent.
(2) Adjusted community rates established under this section shall
not be required to be pooled with the medical experience of health
benefit plans offered to small employers under RCW 48.21.045. Carriers
may treat young adults and products developed specifically for them
consistent with RCW 48.43.041(3) as a single-banded experience pool for
purposes of establishing rates. The rates established for this age
group are not subject to subsection (1)(c)(iv) of this section.
(3) As used in this section, "health benefit plan," "adjusted
community rates," and "wellness activities" mean the same as defined in
RCW 48.43.005.
NEW SECTION. Sec. 10 A new section is added to chapter 48.43 RCW
to read as follows:
The office of the insurance commissioner shall make available
educational and outreach materials targeted to young adults age
nineteen to thirty-four years old, as funding becomes available.
Education and outreach efforts shall focus on educating young consumers
on the importance and value of health insurance, including educational
materials, public service messages, and other outreach activities. The
commissioner is authorized to fund these activities with grants,
donations, in-kind contributions, or other funding that may be
available."
Correct the title.
EFFECT: Limits eligibility for the basic health plan to individuals over the age of thirty-four who no longer qualify for a young adult health insurance health plan for individuals between the ages of nineteen and thirty-five.