For the purposes of mitigating inequity in the health insurance market, unless waived by the commissioner pursuant to RCW 48.43.725
and subsection (3) of this section, the commissioner must assess a fee on any health carrier offering a health plan or student health plan that excludes, under state or federal law, any benefit mandated or required by Title 48
RCW or rules adopted by the commissioner. Such health carrier must:
(1) Notify each enrollee in writing of the following:
(a) Which benefits the health plan or student health plan does not cover; and
(b) Alternate ways in which the enrollees may access excluded benefits in a timely manner.
(2) As part of its form filing:
(a) Provide a sample notification to enrollees as required in subsection (1) of this section;
(b) Include in the benefit description alternate ways enrollees may access excluded benefits in a timely manner; and
(c) Describe how enrollees have prompt access to the information required under subsection (1) of this section.
(3) As part of its rate filing:
(a) Include a cover letter and as a separate supporting document, a description of excluded benefits and the specific state or federal law permitting the benefit exclusion;
(b) Submit the health carrier's supporting documentation for calculating the amount of estimated fee, per member per month and in total. The estimated fee in total must be the actuarial equivalent of costs attributed to the provision and administration of the excluded benefit for members in the rating group or rating pool. The carrier must include a certification by a member of the American Academy of Actuaries that the estimated fee in total is the actuarial equivalent of costs attributed to the provision and administration of the excluded benefit; and
(c) If a health carrier intends to request the commissioner's approval to waive the fee calculated in this subsection, the health carrier must submit:
(i) A separate document requesting a fee waiver;
(ii) A description of any excluded mandated or required benefit and the specific state or federal law permitting the benefit exclusion; and
(iii) A detailed description of alternative access provided by the carrier to any excluded mandated or required benefit. The description should include sufficient information for the commissioner to determine whether a carrier excluding a mandated or required benefit has provided enrollees alternative access to such benefit. In making a fee-waiver determination, the commissioner may take into account timely access, cost, ease of use, and provider access.
The commissioner may request from the carrier additional information or documents necessary to evaluate the fee-waiver request.
(4) The commissioner's determination whether to grant the fee waiver requested by the carrier will be part of the rate filing records.
(5) If a fee waiver is not requested or granted based upon a request in the rate filing, fees calculated and assessed by the commissioner under RCW 48.43.725
(2) and subsection (3) of this section, must be paid by the health carrier to the OIC within sixty days after the rate filing is approved.