5406-S.E AMH HCW KNUT 071
ESSB 5406 - H COMM AMD
By Committee on Health Care & Wellness
Strike everything after the enacting clause and insert the following:
"Sec. 1. RCW 48.43.018 and 2007 c 80 s 13 and 2007 c 259 s 37 are each reenacted and amended to read as follows:
(1) Except as provided in (a) through (((d))) (g)
of this subsection, a health carrier may require any person applying for an
individual health benefit plan and the health care authority shall require any
person applying for nonsubsidized enrollment in the basic health plan to
complete the standard health questionnaire designated under chapter 48.41 RCW.
(a) If a person is seeking an individual health benefit plan or enrollment in the basic health plan as a nonsubsidized enrollee due to his or her change of residence from one geographic area in Washington state to another geographic area in Washington state where his or her current health plan is not offered, completion of the standard health questionnaire shall not be a condition of coverage if application for coverage is made within ninety days of relocation.
(b) If a person is seeking an individual health benefit plan or enrollment in the basic health plan as a nonsubsidized enrollee:
(i) Because a health care provider with whom he or she has an established care relationship and from whom he or she has received treatment within the past twelve months is no longer part of the carrier's provider network under his or her existing Washington individual health benefit plan; and
(ii) His or her health care provider is part of another carrier's or a basic health plan managed care system's provider network; and
(iii) Application for a health benefit plan under that carrier's provider network individual coverage or for basic health plan nonsubsidized enrollment is made within ninety days of his or her provider leaving the previous carrier's provider network; then completion of the standard health questionnaire shall not be a condition of coverage.
(c) If a person is seeking an individual health benefit plan or enrollment in the basic health plan as a nonsubsidized enrollee due to his or her having exhausted continuation coverage provided under 29 U.S.C. Sec. 1161 et seq., completion of the standard health questionnaire shall not be a condition of coverage if application for coverage is made within ninety days of exhaustion of continuation coverage. A health carrier or the health care authority as administrator of basic health plan nonsubsidized coverage shall accept an application without a standard health questionnaire from a person currently covered by such continuation coverage if application is made within ninety days prior to the date the continuation coverage would be exhausted and the effective date of the individual coverage applied for is the date the continuation coverage would be exhausted, or within ninety days thereafter.
(d) ((If a person is seeking an individual health
benefit plan or enrollment in the basic health plan as a nonsubsidized enrollee
following disenrollment from a health plan that is exempt from continuation
coverage provided under 29 U.S.C. Sec. 1161 et seq., completion of the standard
health questionnaire shall not be a condition of coverage if: (i) The person
had at least twenty-four months of continuous group coverage including church
plans immediately prior to disenrollment; (ii) application is made no more than
ninety days prior to the date of disenrollment; and (iii) the effective date of
the individual coverage applied for is the date of disenrollment, or within
ninety days thereafter.
(f))) If a person is seeking an individual health benefit plan or
enrollment in the basic health plan as a nonsubsidized enrollee due to a change
in employment status that would qualify him or her to purchase continuation
coverage provided under 29 U.S.C. Sec. 1161 et seq., but the person's employer
is exempt under federal law from the requirement to offer such coverage,
completion of the standard health questionnaire shall not be a condition of
coverage if: (i) Application for coverage is made within ninety days of a
qualifying event as defined in 29 U.S.C. Sec. 1163; and (ii) the person had at
least twenty-four months of continuous group coverage immediately prior to the
qualifying event. A health carrier shall accept an application without
a standard health questionnaire from a person with at least twenty-four months
of continuous group coverage if application is made no more than ninety days
prior to the date of a qualifying event and the effective date of the
individual coverage applied for is the date of the qualifying event, or within
ninety days thereafter.
(e) If a person is seeking an individual health benefit plan,
completion of the standard health questionnaire shall not be a condition of
coverage if: (i) The person had at least twenty-four months of continuous
basic health plan coverage under chapter 70.47 RCW immediately prior to
disenrollment; and (ii) application for coverage is made within ninety days of
disenrollment from the basic health plan. A health carrier shall accept an
application without a standard health questionnaire from a person with at least
twenty-four months of continuous basic health plan coverage if application is
made no more than ninety days prior to the date of disenrollment and the
effective date of the individual coverage applied for is the date of
disenrollment, or within ninety days thereafter.
(f) If a person is seeking an individual health benefit
plan due to a change in employment status that would qualify him or her to
purchase continuation coverage provided under 29 U.S.C. Sec. 1161 et seq.,
completion of the standard health questionnaire is not a condition of coverage
if: (i) Application for coverage is made within ninety days of a qualifying
event as defined in 29 U.S.C. Sec. 1163; and (ii) the person had at least twenty-four
months of continuous group coverage immediately prior to the qualifying event.
A health carrier shall accept an application without a standard health
questionnaire from a person with at least twenty-four months of continuous
group coverage if application is made no more than ninety days prior to the
date of a qualifying event and the effective date of the individual coverage
applied for is the date of the qualifying event, or within ninety days
thereafter.
(g) If a person is seeking an individual health benefit plan due to
their terminating continuation coverage under 29 U.S.C. Sec. 1161 et seq.,
completion of the standard health questionnaire shall not be a condition of
coverage if: (i) Application for coverage is made within ninety days of terminating
the continuation coverage; and (ii) the person had at least twenty-four months
of continuous group coverage immediately prior to the termination. A health
carrier shall accept an application without a standard health questionnaire
from a person with at least twenty-four months of continuous group coverage if
application is made no more than ninety days prior to the date of termination
of the continuation coverage and the effective date of the individual coverage
applied for is the date the continuation coverage is terminated, or within
ninety days thereafter.
(2) If, based upon the results of the standard health questionnaire, the person qualifies for coverage under the Washington state health insurance pool, the following shall apply:
(a) The carrier may decide not to accept the person's application for enrollment in its individual health benefit plan and the health care authority, as administrator of basic health plan nonsubsidized coverage, shall not accept the person's application for enrollment as a nonsubsidized enrollee; and
(b) Within fifteen business days of receipt of a completed application, the carrier or the health care authority as administrator of basic health plan nonsubsidized coverage shall provide written notice of the decision not to accept the person's application for enrollment to both the person and the administrator of the Washington state health insurance pool. The notice to the person shall state that the person is eligible for health insurance provided by the Washington state health insurance pool, and shall include information about the Washington state health insurance pool and an application for such coverage. If the carrier or the health care authority as administrator of basic health plan nonsubsidized coverage does not provide or postmark such notice within fifteen business days, the application is deemed approved.
(3) If the person applying for an individual health benefit plan: (a) Does not qualify for coverage under the Washington state health insurance pool based upon the results of the standard health questionnaire; (b) does qualify for coverage under the Washington state health insurance pool based upon the results of the standard health questionnaire and the carrier elects to accept the person for enrollment; or (c) is not required to complete the standard health questionnaire designated under this chapter under subsection (1)(a) or (b) of this section, the carrier or the health care authority as administrator of basic health plan nonsubsidized coverage, whichever entity administered the standard health questionnaire, shall accept the person for enrollment if he or she resides within the carrier's or the basic health plan's service area and provide or assure the provision of all covered services regardless of age, sex, family structure, ethnicity, race, health condition, geographic location, employment status, socioeconomic status, other condition or situation, or the provisions of RCW 49.60.174(2). The commissioner may grant a temporary exemption from this subsection if, upon application by a health carrier, the commissioner finds that the clinical, financial, or administrative capacity to serve existing enrollees will be impaired if a health carrier is required to continue enrollment of additional eligible individuals."
EFFECT: Removes language that allows individuals to avoid taking the Standard Health Questionnaire retroactively to September 1, 2008. Deletes the emergency clause.
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