(1) An issuer must not offer or issue a health plan to small groups through an association or member-governed group as a large group plan unless the collective number of eligible employees of all member employers is more than fifty, and the member-governed group or association health plan meets the requirements of WAC 284-43-8110
for a Pathway 1 Association Health Plan, or WAC 284-43-8120
for a governmental plan.
(2) For plans offered to association or member-governed groups that do not meet the requirements of subsection (1) of this section, the following specific requirements apply:
(a) An issuer must treat grandfathered plans issued under those purchasing arrangements as a closed pool, and file a single case closed pool rate filing. For purposes of this section, a single case closed pool rate filing means a rate filing which includes the rates and the rate filing information only for the issuer's closed pool enrollees.
(b) For each single case closed pool rate filing, an issuer must file a certification from an officer of the issuer attesting that:
(i) The employer members covered by the filing joined the association prior to or on March 23, 2010;
(ii) The issuer can establish with documentation in its files that none of the conditions triggering termination of grandfathered status set forth in WAC 284-43-0250
or in 45 C.F.R. 2590.715-1251(g) have occurred for any plan members.
(3) For each grandfathered plan issued to an association or member governed group under subsection (2) of this section, the issuer must include the following items in its rate filing:
(a) Plan number;
(b) Identification number assigned to each employer member, including employer members of less than two;
(c) Initial contract or certificate date;
(d) Number of employees for each employer member, pursuant to RCW 48.43.005
(e) Number of enrolled employees for each employer member for the prior calendar year;
(f) Current and proposed rate schedule for each employer member; and
(g) Description of the rating methodology and rate change for each employer member.
(4) WAC 284-43-6540
applies for a single case rate closed pool under this section.
[Statutory Authority: RCW 48.02.060
. WSR 19-22-032, amended and recodified as § 284-43-8140, filed 10/30/19, effective 11/30/19. Statutory Authority: RCW 48.02.060
. WSR 16-14-106 (Matter No. R 2016-11), § 284-43-0330, filed 7/6/16, effective 8/6/16. WSR 16-01-081, recodified as § 284-43-0330, filed 12/14/15, effective 12/14/15. Statutory Authority: RCW 48.02.060
, and 45 C.F.R. 150.101(2). WSR 14-01-039 (Matter No. R 2013-13), § 284-170-958, filed 12/11/13, effective 1/11/14.]