2SHB 2537 -
By Senator Parlette
NOT ADOPTED 03/07/2008
On page 1, line 10 of the amendment, strike "established in RCW
70.47A.100" and insert "((established in RCW 70.47A.100))"
On page 1, line 13 of the amendment, strike "and"
On page 1, beginning on line 16 of the amendment, after "services"
strike all material through "or" on line 17, and insert "; and
(c) Is employed by a ((participating)) small employer ((or"
On page 1, line 22 of the amendment, after "48.43.005" insert "or any plan provided by a self-funded multiple employer welfare arrangement as defined in RCW 48.125.010 or by another benefit arrangement defined in the federal employee retirement income security act of 1974, as amended"
Beginning on page 1, line 23 of the amendment, after "(5)" strike
all material through "(6)" on page 2, line 4, and insert
"(("Participating small employer" means a small employer that employs
at least one eligible partnership participant and has entered into an
agreement with the partnership for the partnership to offer and
administer the small employer's group health benefit plan, as defined
in federal law, Sec. 706 of ERISA (29 U.S.C. Sec. 1167), for enrollees
in the plan.))"
(6)
Renumber the remaining subsections consecutively and correct any internal references accordingly.
On page 2, beginning on line 6 of the amendment, strike all
material through "employment." on line 11, and insert "(((7)
"Partnership participant" means an employee of a participating small
employer, or a former employee of a participating small employer who
chooses to continue receiving coverage through the partnership
following separation from employment.))"
Renumber the remaining subsections consecutively and correct any internal references accordingly.
On page 2, beginning on line 25 of the amendment, after "eligible"
strike "partnership participants" and insert "((partnership
participants)) employees"
Beginning on page 2, line 28 of the amendment, strike all material
through "(3)" on page 4, line 16, and insert the following:
"(2) ((Consistent with policies adopted by the board under section
59 of this act, the administrator shall, directly or by contract:))"
(a) Establish and administer procedures for enrolling small
employers in the partnership, including publicizing the existence of
the partnership and disseminating information on enrollment, and
establishing rules related to minimum participation of employees in
small groups purchasing health insurance through the partnership.
Opportunities to publicize the program for outreach and education of
small employers on the value of insurance shall explore the use of
online employer guides. As a condition of participating in the
partnership, a small employer must agree to establish a cafeteria plan
under section 125 of the federal internal revenue code that will enable
employees to use pretax dollars to pay their share of their health
benefit plan premium. The partnership shall provide technical
assistance to small employers for this purpose;
(b) Establish and administer procedures for health benefit plan
enrollment by employees of small employers during open enrollment
periods and outside of open enrollment periods upon the occurrence of
any qualifying event specified in the federal health insurance
portability and accountability act of 1996 or applicable state law.
Neither the employer nor the partnership shall limit an employee's
choice of coverage from among all the health benefit plans offered;
(c) Establish and manage a system for the partnership to be
designated as the sponsor or administrator of a participating small
employer health benefit plan and to undertake the obligations required
of a plan administrator under federal law;
(d) Establish and manage a system of collecting and transmitting to
the applicable carriers all premium payments or contributions made by
or on behalf of partnership participants, including employer
contributions, automatic payroll deductions for partnership
participants, premium subsidy payments, and contributions from
philanthropies;
(e) Establish and manage a system for determining eligibility for
and making premium subsidy payments under chapter 259, Laws of 2007;
(f) Establish a mechanism to apply a surcharge to all health
benefit plans, which shall be used only to pay for administrative and
operational expenses of the partnership. The surcharge must be applied
uniformly to all health benefit plans offered through the partnership
and must be included in the premium for each health benefit plan.
Surcharges may not be used to pay any premium assistance payments under
this chapter;
(g) Design a schedule of premium subsidies that is based upon gross
family income, giving appropriate consideration to family size and the
ages of all family members based on a benchmark health benefit plan
designated by the board. The amount of an eligible partnership
participant's premium subsidy shall be determined by applying a sliding
scale subsidy schedule with the percentage of premium similar to that
developed for subsidized basic health plan enrollees under RCW
70.47.060. The subsidy shall be applied to the employee's premium
obligation for his or her health benefit plan, so that employees
benefit financially from any employer contribution to the cost of their
coverage through the partnership.
(3)
On page 4, at the beginning of line 22 of the amendment, insert "(1)"
On page 4, line 23 of the amendment, after "eligible" strike
"partnership participants" and insert "((partnership participants))
employees"
On page 4, after line 25 of the amendment, insert the following:
"(2) Premium subsidy payments may be provided to eligible employees
if:
(a) The eligible employee is employed by a small employer;
(b) The actuarial value of the health benefit plan offered by the
small employer is at least substantially equivalent to that of the
basic health plan benefit offered under chapter 70.47 RCW. The office
of the insurance commissioner under Title 48 RCW shall certify those
small employer health benefit plans that are at least ninety percent
actuarially equivalent to the basic health plan benefit; and
(c) The small employer will pay at least forty percent of the
monthly premium cost for health benefit plan coverage of the eligible
employee.
(3) The amount of an eligible employee's premium subsidy shall be
determined by applying the sliding scale subsidy schedule similar to
the subsidy scale used for subsidized basic health plan enrollees under
RCW 70.47.060.
(4) After an eligible individual has enrolled in the program, the
program shall issue subsidies in an amount determined pursuant to
subsection (3) of this section to either the eligible employee or to
the carrier designated by the eligible employee.
(5) An eligible employee must agree to provide verification of
continued enrollment in his or her small employer's health benefit plan
on a semiannual basis or to notify the administrator whenever his or
her enrollment status changes, whichever is earlier. Verification or
notification may be made directly by the employee, or through his or
her employer or the carrier providing the small employer health benefit
plan. When necessary, the administrator has the authority to perform
retrospective audits on premium subsidy accounts. The administrator
may suspend or terminate an employee's participation in the program and
seek repayment of any subsidy amounts paid due to the omission or
misrepresentation of an applicant or enrolled employee. The
administrator shall adopt rules to define the appropriate application
of these sanctions and the processes to implement the sanctions
provided in this subsection, within available resources."
Beginning on page 4, line 34 of the amendment, strike all material through "void." on page 18, line 6, and insert the following:
"NEW SECTION. Sec. 5 The joint legislative audit and review
committee shall conduct a program and fiscal review of the small
employer health insurance partnership program and report their findings
and recommendation to the appropriate committees of the legislature no
later than December 1, 2010.
NEW SECTION. Sec. 6 The following acts or parts of acts are each
repealed:
(1) RCW 70.47A.100 (Health insurance partnership board) and 2007 c
260 s 4;
(2) RCW 70.47A.110 (Health insurance partnership board -- Duties) and
2007 c 260 s 5;
(3) 2007 c 260 s 10 (uncodified); and
(4) 2007 c 260 s 11 (uncodified)."
2SHB 2537 -
By Senator Parlette
NOT ADOPTED 03/07/2008
On page 18, beginning on line 9 of the title amendment, after "70.47A.040," strike the remainder of the title amendment and insert "and 70.47A.070; repealing RCW 70.47A.100 and 70.47A.110; repealing 2007 c 260 s 10 (uncodified); repealing 2007 c 260 s 11 (uncodified); and creating a new section."
EFFECT: Allows benefit plans offered by small employers including self-funded MEWAs and other ERISA plans; Employer benefit products must be certified by the OIC as meeting 90% equivalency with BH. Premium assistance will be developed on a similar scale used for the Basic Health program. Eliminates the HIP Board and the purchasing program. The HIP studies are eliminated. JLARC must conduct a review of the program by December 1, 2010.