BILL REQ. #:  S-4216.2 

Read first time 01/16/08.   Referred to Committee on Health & Long-Term Care.

     AN ACT Relating to the collection and analysis of data concerning association health plans; adding a new section to chapter 48.43 RCW; and creating a new section.

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 health 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 health 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 carriers shall electronically submit the information described in subsections (1) and (2) of this section in a format and according to instructions prescribed by the commissioner.
     (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 health plans. The data, information, and documents may be provided in their entirety for analysis as required in section 2 of this act.
     (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) For purposes of this section, "association health plan" means a health plan purchased through an association or through a member-governed group formed specifically for the purpose of purchasing health care.

NEW SECTION.  Sec. 2   By December 15, 2008, and one year thereafter, the joint legislative audit and review committee shall obtain data as described in section 1 of this act, from the office of the insurance commissioner, and report to the legislature on association health plans and any impact they may have on the small group insurance market in Washington state, including:
     (1) Enrollment, affordability, premiums charged, and selection trends in the association plans market;
     (2) Changes in enrollment, affordability, premiums charged, and financial viability of small group plans;
     (3) Any shifts of covered populations between small group and association plans;
     (4) Any adverse selection into either small group or association plans; and
     (5) Other measures of emerging trends in the small group and association plan health insurance markets.