WSR 13-03-138




[ Insurance Commissioner Matter No. R 2012-17 -- Filed January 23, 2013, 9:52 a.m. ]

     Supplemental Notice to WSR 13-03-041.

     Preproposal statement of inquiry was filed as WSR 12-12-064.

     Title of Rule and Other Identifying Information: Essential health benefits designation, supplementation and establishment of scope and limitation requirements.

     Hearing Location(s): Training Room, T-120, 5000 Capitol Way South, Tumwater, WA, on March 12, 2013, at 10:00 a.m.

     Date of Intended Adoption: March 13, 2013.

     Submit Written Comments to: Meg L. Jones, P.O. Box 40258, Olympia, WA 98504, e-mail, fax (360) 586-3109, by March 11, 2013.

     Assistance for Persons with Disabilities: Contact Lorie Villaflores by March 10, 2013, TTY (360) 586-0241 or (360) 725-7087.

     Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: The proposed rules will establish new sections in chapter 284-43 WAC (health benefits), explaining the requirements associated with carrier inclusion of the essential health benefits (EHB) package in nongrandfathered individual and small group plans for plans with coverage beginning January 1, 2014. Under federal law, plans must be substantially equal to the "EHB-benchmark plan." The proposed rules identify the specific supplementation of benefits for pediatric oral and vision services with federally-designated benchmark plans for those benefits, and the scope, limitation and definition of covered benefits that comprise the EHB-benchmark plan.

     Reasons Supporting Proposal: RCW 48.43.715 directs the commissioner to designate by rule the small group plan with the largest enrollment as the benchmark plan for purposes of defining the essential health benefits package for nongrandfathered individual and small group health benefit plans issued on or after January 1, 2014. The same legislation requires supplementation, and adjustment or establishment of scope and limitation requirements by the commissioner in order to ensure meaningful benefits and prevent bias based on health selection. Carriers require specific guidance in order to prepare plan filings for the commissioner's review, and have sufficient time to satisfy plan replacement and health benefit exchange participation requirements.

     Statutory Authority for Adoption: RCW 48.02.060, 48.21.241, 48.21.320, 48.44.460, 48.44.341, 48.46.291, 48.46.530, and 48.43.715.

     Statute Being Implemented: RCW 48.43.715.

     Rule is necessary because of federal law, P.L. 111-148, section 1302 (2010).

     Name of Proponent: Office of the insurance commissioner, governmental.

     Name of Agency Personnel Responsible for Drafting: Meg Jones, P.O. Box 40258, Olympia, WA 98504, (360) 725-7170; Implementation: Beth Berendt, P.O. Box 40258, Olympia, WA 98504, (360) 725-7117; and Enforcement: Carol Sureau, P.O. Box 40258, Olympia, WA 98504, (360) 725-7050.

     No small business economic impact statement has been prepared under chapter 19.85 RCW. The entities that must comply with the proposed rule are not small businesses, pursuant to chapter 19.85 RCW.

     A cost-benefit analysis is required under RCW 34.05.328. A preliminary cost-benefit analysis may be obtained by contacting Meg Jones, P.O. Box 40258, Olympia, WA 98504, phone (360) 725-7170, fax (360) 586-3109, e-mail

January 23, 2013

Mike Kreidler

Insurance Commissioner

     Reviser's note: The material contained in this filing exceeded the page-count limitations of WAC 1-21-040 for appearance in this issue of the Register. It will appear in the 13-04 issue of the Register.