BILL REQ. #:  H-4287.1 

Read first time 01/15/08.   Referred to Committee on Health Care & Wellness.

     AN ACT Relating to association health plans; and adding a new section to chapter 48.43 RCW.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:

NEW SECTION.  Sec. 1   A new section is added to chapter 48.43 RCW to read as follows:
     (1) The commissioner shall require carriers to report such data as the commissioner may determine are necessary for the evaluation of:
     (a) The impact of the sale of association health plans on the overall health care marketplace of this state; and
     (b) The impact of association health plans that use claims data or health factors in setting rates for small groups that are included in an association plan.
     (2) The data may include, but need not be limited to, the following:
     (a) The number of persons residing in Washington who receive health benefit coverage through each association health plan underwritten or administered by the carrier, and whether the association plan uses claims data or health factors in setting rates for small groups included in the plan;
     (b) Demographic information regarding the persons covered in association health plans and in small group plans;
     (c) The average claims experience of persons covered by the carrier's association health plans and by its small group plans;
     (d) Eligibility requirements, underwriting criteria, and coverage standards, including but not limited to association membership requirements, health questions (if any) asked or used for the purpose of considering eligibility or cost of coverage, and a description of any other standard for eligibility or qualification for enrollment or coverage;
     (e) The methodology used by the carrier to determine the cost of coverage for each association health plan; and
     (f) Such other data as the commissioner may reasonably require.
     (3) The commissioner may adopt rules necessary to implement this section, including but not limited to the format and timing of data reporting, and defining the years for which data must be provided.
     (4)(a) Data, information, and documents provided by the carrier pursuant to this section are exempt from public inspection and copying under chapters 42.17 and 42.56 RCW to the extent that they contain actuarial formula, statistics, and assumptions submitted in support of setting rates for the association plans.
     (b) The commissioner is authorized to use documents, materials, or other information obtained pursuant to this section in the furtherance of any regulatory activities, reports to the legislature, or legal actions brought as a part of the commissioner's official duties.
     (5) The commissioner shall submit a report based upon the information obtained pursuant to this section to the appropriate committees of the senate and house of representatives by January 1, 2009.