FINAL BILL REPORT

SB 6834

                              C 187 L 90

BYSenators Sellar, Conner, West, McDonald and Bauer

Establishing a basic health care plan for small business employees.

Senate Committee on Financial Institutions & Insurance and Committee on Ways & Means

House Committe on Health Care

SYNOPSIS AS ENACTED

BACKGROUND:

Health insurance policies issued in the state of Washington are required to cover treatment by specified health care providers and certain types of treatment.  These requirements appear in the statute that regulates disability insurance policies, health care maintenance agreements and health care service contracts.  These mandated benefits must be included in the majority of policies issued by any insurance company, health maintenance organization or health care service contractor.

It has been suggested that because of the numerous mandates that are contained in state law, it is difficult for small businesses to purchase insurance for their employees.  As a result, many people working for small business are left without medical insurance coverage.  It has also been suggested that if a basic health insurance product were available, more small businesses would be able to afford insurance for their employees.

SUMMARY:

A basic group disability policy, health care service contract or health maintenance agreement may be offered to employers of fewer than 25 employees.  The basic contract, policy or agreement must provide coverage for hospital expenses and services rendered by a licensed physician or doctor of osteopathic medicine.  The basic policy, contract or agreement is not subject to any of the statutes mandating coverage for specified practitioners or procedures.  The requirements that a child be covered from birth and after the age of eligibility when the child is incapacitated remain.  The requirement that adopted children be covered also applies to the basic health program.

An insurer may offer and a purchaser may seek benefits in excess of the basic program that is authorized.  The Insurance Commissioner must approve all forms, policies and contracts.  Rates for any basic plan must be reasonable in relationship to the benefits included in the plan.

The Insurance Commissioner is required to collect data from insurers, health care service contractors and health maintenance organizations relating to the basic programs sold.  The data collected must include the number of groups purchasing coverage, the number of insured persons, subscribers, members and their dependents, and the rate and rate increases of the coverage.  The Insurance Commissioner is required to provide by November 1, 1992 a written summary of the data to the Governor, appropriate legislative committees and other interested parties.

The basic group health plan authorized may not supplant an existing policy.  The right of employees to collectively bargain for insurance benefits in excess of the basic program authorized is not restricted.

VOTES ON FINAL PASSAGE:

     Senate   43    6

     House 97  0

EFFECTIVE:June 7, 1990