SB 6440 -
By Committee on Health Care & Wellness
Strike everything after the enacting clause and insert the following:
"Sec. 1 RCW 48.05.070 and 1947 c 79 s .05.07 are each amended to
read as follows:
To apply for an original certificate of authority an insurer shall:
(1) File with the commissioner its request therefor showing:
(a) Its name, home office location, type of insurer, organization
date, and state or country of its domicile.
(b) The kinds of insurance it proposes to transact.
(c) Additional information as the commissioner may reasonably
require.
(2) File with the commissioner:
(a) A copy of its charter as amended, certified, if a foreign or
alien insurer, by the proper public officer of the state or country of
domicile.
(b) A copy of its bylaws, certified by its proper officer.
(c) A statement of its financial condition, management, and affairs
on a form satisfactory to or furnished by the commissioner.
(d) If a foreign or alien insurer, or a domestic reciprocal
insurer, an appointment of the commissioner as its attorney to receive
service of legal process.
(e) If an alien insurer, a copy of the appointment and authority of
its United States manager, certified by its proper officer.
(f) If a foreign or alien insurer, a certificate from the proper
public official of its state or country of domicile showing that it is
duly organized and is authorized to transact the kinds of insurance
proposed to be transacted.
(g) If a domestic reciprocal insurer, the declaration required by
RCW 48.10.090 of this code.
(h) Other documents or stipulations as the commissioner may
reasonably require to evidence compliance with the provisions of this
code.
(3) A foreign insurer is not required to comply with subsection
(2)(a), (b), (c), (e), or (g) of this section if it is a qualifying
reciprocal plan. A qualifying reciprocal plan is a foreign insurer
that:
(a) Is authorized in a state that is a member of the consortium
authorized in section 5 of this act;
(b) Proposes to sell in Washington only a health benefit plan that:
(i) Has benefits substantially equivalent to the essential health
benefits designated in Washington under P.L. 111-148 of 2010, as
amended;
(ii) Has been approved by a state with which the commissioner has
a reciprocity agreement; and
(iii) Is not a health savings account or qualified high deductible
health plan; and
(c) Has and maintains total adjusted capital that is greater than
three times its authorized control level risk-based capital.
(4) Deposit with the commissioner the fees required by this code to
be paid for filing the accompanying documents, and for the certificate
of authority, if granted.
Sec. 2 RCW 48.21.047 and 2010 c 292 s 8 are each amended to read
as follows:
(1) An insurer may not offer any health benefit plan to any small
employer without complying with RCW 48.21.045(3).
(2) Employers purchasing health plans provided through associations
or through member-governed groups formed specifically for the purpose
of purchasing health care are not small employers and the plans are not
subject to RCW 48.21.045(3).
(3) A qualifying reciprocal plan as defined in RCW 48.05.070(3) is
not subject to RCW 48.21.045.
(4) For purposes of this section, "health benefit plan," "health
plan," and "small employer" mean the same as defined in RCW 48.43.005.
(((4))) (5) For purposes of this section, "census date" has the
same meaning as defined in RCW 48.44.010.
NEW SECTION. Sec. 3 A new section is added to chapter 48.21 RCW
to read as follows:
(1) Each qualifying reciprocal plan issued or renewed pursuant to
RCW 48.05.070, 48.21.047, and sections 3 through 6 of this act must
contain the following declaration in bold face type at the beginning of
the document:
"The benefits in this policy do not include each of the benefits
required by the state of Washington. (Name of state) initially
approved this policy for sale, and the benefit requirements of that
state are reflected in the policy. The rates applied to calculate
premium were not approved by the state of Washington, but by (Name of
State). Those requirements may be different from the requirements for
policies approved by Washington. Please consult your insurance agent
or insurer to determine which health benefits are covered under the
policy."
(2) Each insurer and producer offering a qualifying reciprocal plan
pursuant to RCW 48.05.070, 48.21.047, and sections 3 through 6 of this
act must provide applicants with a written side-by-side comparison of
health benefits under the plan, including differences in definition of
each benefit between Washington law and the law of the approving state,
whether the benefit is required under Washington law, and the
difference in the premium rate due to the difference in state laws.
(3) An insurer offering qualifying reciprocal plans under RCW
48.05.070, 48.21.047, and sections 3 through 6 of this act must offer
the plan through producers who comply with the requirements of chapter
48.17 RCW. Electronic marketing and sales of out-of-state policies are
permitted if a producer is available in Washington with whom the
applicant can discuss the qualifying plan.
NEW SECTION. Sec. 4 A new section is added to chapter 48.21 RCW
to read as follows:
(1) A health benefit plan offered by a foreign insurer authorized
under RCW 48.05.070(3) is not required to include health benefit
mandates required under this title that are not included in the
qualifying reciprocal plan as defined in RCW 48.05.070(3).
(2) A qualifying reciprocal plan must be filed with the
commissioner for approval pursuant to RCW 48.18.100. The commissioner
must approve the plan for use in this state if the plan meets the
requirements in RCW 48.05.070(3), and must disapprove it if it does
not. The commissioner may, but is not required to, accept the
determination of a member consortium state as to whether or not the
qualifying reciprocal plan is substantially equivalent to the essential
health benefits in Washington.
(3) Other than as provided in this section, RCW 48.18.110 may not
be grounds for disapproval of a qualifying reciprocal plan.
(4) To the extent consistent with federal law, the requirements of
chapter 48.43 RCW do not apply to a qualifying reciprocal plan.
NEW SECTION. Sec. 5 A new section is added to chapter 48.21 RCW
to read as follows:
(1) Beginning July 1, 2013, the commissioner is authorized to
contract with other states to establish and operate a consortium
governing the sale to small groups of a qualifying reciprocal plan, as
defined in RCW 48.05.070(3), by insurers admitted to one of the states
in the consortium.
(2) By January 1, 2013, the commissioner must report to the
legislature which states have been identified, and include a plan for
seeking a reciprocity agreement with at least one state. The
commissioner may not enter into such an agreement until the
commissioner has identified a minimum of five states whose regulatory
requirements for the offer and issue of health benefit plans meets or
exceeds those of Washington in the areas of network adequacy, consumer
protection, marketing requirements, and claims adjudication and
processing. The reciprocity consortium may commence with an agreement
with just one of the states.
(3) A state may not join the consortium if it authorizes two or
more carriers domiciled in Washington that offer health benefit plans,
unless five or more other states have joined the consortium.
(4) The commissioner may enter into separate reciprocity
agreements, or one uniform agreement. Any reciprocity agreement must
establish rules for the management of consumer questions and complaints
related to health benefit plans approved by one member state but sold
in another. The commissioner may adopt rules to implement consortium
rules as necessary to comply with the consortium agreement.
(5) Reciprocity consortium states must agree to provide the
commissioner with a list of approved health benefit plans that meet the
standard under RCW 48.05.070, 48.21.047, and sections 3 through 6 of
this act, and their premium rate schedules as they are approved. If a
health benefit plan is disapproved or otherwise removed from the market
pursuant to regulatory action or order, a reciprocity consortium state
must notify the commissioner of this action.
(6) The reciprocity consortium agreement must establish a mechanism
for payment of premium tax pursuant to chapter 48.14 RCW, payment of
regulatory surcharge pursuant to RCW 48.02.190, and collection of any
reinsurance or risk adjustment assessments that would otherwise be
applicable but for the domicile of the selling insurer.
(7) Insurers must inform the consortium states in writing of their
intent to offer a qualifying reciprocal policy as set forth in RCW
48.05.070(3) in consortium states not less than sixty days prior to the
first date of offer. Reciprocity consortium member states may
establish their own requirements for notification and offer.
(8) The commissioner must report to the legislature by December 1st
of each year after the effective date of this section on the
reciprocity consortium's formation, membership, the number of health
benefit plans offered in Washington through the consortium, effect on
the marketplace in Washington, including the health benefits exchange,
and must recommend whether continuing reciprocity sales serves the
public health and welfare.
NEW SECTION. Sec. 6 A new section is added to chapter 43.71 RCW
to read as follows:
A qualifying reciprocal plan offered by a foreign insurer
authorized under RCW 48.05.070(3) may be certified as a qualified
health plan through the exchange only if it, and its issuer, meet the
requirements of the exchange for certification as a qualified health
plan.
NEW SECTION. Sec. 7 Sections 1 through 6 of this act are
declared null and void if Title I of P.L. 111-148 of 2010, as amended,
is individually or as a whole found unconstitutional, or otherwise
repealed."
Correct the title.
EFFECT: Changes the date after which the Insurance Commissioner
(Commissioner) must allow reciprocal policies in Washington via a
consortium from January 2014 to July 1, 2013.
Provides a definition for "qualified reciprocal plans" that may be
sold through the consortium. Requires such plans to have benefits
substantially equivalent to Washington's essential health benefits
designated under federal law. Requires qualified reciprocal plans to
make certain disclosures to consumers, including a declaration and a
side-by-side comparison of the health benefits in the plan. Requires
qualified reciprocal plans to be sold by insurance producers
(agents/brokers), but allows electronic marketing and sales as long as
a producer is available in Washington with whom the applicant can
discuss the plan.
Exempts qualified reciprocal plans from application requirements,
rate review requirements, and other insurance regulations (including
benefit mandates) to the extent that such an exemption does not
conflict with federal law.
Prohibits the Commissioner from entering into an agreement with
another state to sell qualified reciprocal plans in Washington until at
least five states have been identified that meet or exceed Washington
standards (instead of National Association of Insurance Commissioners
standards) in network adequacy, consumer protection, market
requirements, and claims adjudication and processing. By January 1,
2013, requires the Commissioner to report to the Legislature which
states have been identified and a plan for seeking a reciprocity
agreement with at least one state.
Allows states that authorize two or more carriers domiciled in
Washington to join the consortium once five or more states are members
of the consortium. Allows qualified reciprocal plans to be sold
through the Exchange if they meet the standards for Exchange
certification for qualified health plans. Specifies operating
standards for the consortium.
Declares the act null and void if the federal Patient Protection
and Affordable Care Act is repealed or found unconstitutional.