BILL REQ. #: S-3962.2
State of Washington | 62nd Legislature | 2012 Regular Session |
Read first time 01/23/12. Referred to Committee on Health & Long-Term Care.
AN ACT Relating to applying for health insurance coverage when an insurance carrier discontinues all individual health benefit plan coverage; amending RCW 48.43.018; and declaring an emergency.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:
Sec. 1 RCW 48.43.018 and 2010 c 277 s 1 are each amended to read
as follows:
(1) Except as provided in (a) through (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 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.
(h) If a person is seeking an individual health benefit plan
because his or her employer, or former employer, discontinues group
coverage due to the closure of the business, completion of the standard
health questionnaire shall not be a condition of coverage if: (i)
Application for coverage is made within ninety days of the employer
discontinuing group coverage due to closure of the business; 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 discontinuation
of group coverage, and the effective date of the individual coverage
applied for is the date the group coverage is discontinued, or within
ninety days thereafter.
(i) If a person is seeking an individual health benefit plan
because his or her health carrier is discontinuing all individual
health benefit plan coverage by July 1, 2012, completion of the
standard health questionnaire shall not be a condition of coverage if:
(i) Application for coverage is made within ninety days of the carrier
discontinuing individual health benefit plan coverage; and (ii) the
person had at least twenty-four months of individual health benefit
plan 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 individual health
benefit plan coverage if application is made no more than ninety days
prior to the date of discontinuation of individual health benefit plan
coverage, and the effective date of the individual coverage applied for
is the date the individual health benefit plan coverage is
discontinued, 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.
NEW SECTION. Sec. 2 This act is necessary for the immediate
preservation of the public peace, health, or safety, or support of the
state government and its existing public institutions, and takes effect
immediately.