Washington State

House of Representatives

Office of Program Research

BILL

ANALYSIS

Health Care & Wellness Committee

HB 2061

This analysis was prepared by non-partisan legislative staff for the use of legislative members in their deliberations. This analysis is not a part of the legislation nor does it constitute a statement of legislative intent.

Brief Summary of Bill

Requires health carriers that offer a bronze level health benefit plan in the individual or small group market outside the Health Benefit Exchange (Exchange) to also offer silver and gold level plans in the same market.
Requires only non-grandfathered individual and small group plans offered outside the Exchange to conform with the actuarial values of bronze, silver, gold, and platinum.

Background:

The federal Patient Protection and Affordable Care Act as amended by the Health Care and Education Reconciliation Act of 2010 (ACA) specifies four categories of health plans to be offered through the Health Benefit Exchange (Exchange) and in the individual and small group markets outside the Exchange. The categories are based on the actuarial value of the plans (i.e., the percentage of the costs the plan is expected to pay):

platinum: 90 percent of the actuarial value of the benefits under the plan;
gold: 80 percent of the actuarial value of the benefits under the plan;
silver: 70 percent of the actuarial value of the benefits under the plan; and
bronze: 60 percent of the actuarial value of the benefits under the plan.

For plan or policy years beginning January 1, 2014, a carrier must offer individual or small group health benefit plans at the silver and gold level in any market outside the Exchange in which it offers a bronze level plan. All health plans outside the Exchange, other than catastrophic plans, must conform to the platinum, gold, silver, and bronze value tiers specified in the ACA.

Certain group health plans and individual health plans that were created before the ACA became effective are "grandfathered" and do not have to meet all the requirements of the ACA.

Summary of Bill:

For plan or policy years beginning January 1, 2014, a carrier that offers a bronze level health benefit plan in the individual market must also offer silver and gold level plans in the individual market, and a carrier that offers a bronze level health benefit plan in the small group market must also offer silver and gold level plans in the small group market.

Only non-grandfathered individual and small group plans offered outside the Exchange, other than catastrophic plans, must conform to the platinum, gold, silver, and bronze value tiers specified in the ACA.