BILL REQ. #: S-4343.1
| State of Washington | 60th Legislature | 2008 Regular Session |
Read first time 01/18/08. Referred to Committee on Health & Long-Term Care.
AN ACT Relating to reforming the health care system in Washington state; amending RCW 41.05.021, 48.43.012, 48.43.015, 48.43.025, and 48.43.035; reenacting and amending RCW 41.05.021, 48.43.005, and 48.43.018; adding new sections to chapter 48.43 RCW; adding a new chapter to Title 41 RCW; creating new sections; repealing RCW 48.01.260, 48.20.025, 48.20.028, 48.20.029, 48.21.045, 48.21.047, 48.43.038, 48.43.041, 48.44.017, 48.44.021, 48.44.022, 48.44.023, 48.44.024, 48.46.062, 48.46.063, 48.46.064, 48.46.066, 48.46.068, 70.47A.010, 70.47A.020, 70.47A.030, 70.47A.040, 70.47A.050, 70.47A.060, 70.47A.070, 70.47A.080, 70.47A.090, 70.47A.100, 70.47A.110, and 70.47A.900; providing effective dates; and providing an expiration date.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:
NEW SECTION. Sec. 101
(1) The people of Washington have expressed strong concerns about
health care costs and access to needed health services. Even if
currently insured, they are not confident that they will continue to
have health insurance coverage in the future and feel that they are
getting less, but spending more.
(2) Many employers, especially small employers, struggle with the
cost of providing employer-sponsored health insurance coverage to their
employees, while others are unable to offer employer-sponsored health
insurance due to its high cost. In addition, small employers continue
to invest a significant amount of their time in the health insurance
business as they are the lone gateway to group coverage for their
employees. This is time better served meeting their customers' needs
and fulfilling the many demands and challenges of our ever-changing
marketplace. Even after much research has been done by the employer to
secure a health benefit plan that works for everyone, it is, too often,
that some individuals are forced into a choice of health care coverage
they would have never made on their own, if given that chance.
(3) Six hundred thousand Washingtonians are uninsured.
Three-quarters work or have a working family member; two-thirds are low
income; and one-half are young adults. Many are low-wage workers who
are not offered, or eligible for, employer-sponsored coverage. Others
struggle with the burden of paying their share of the costs of
employer-sponsored health insurance, while still others turn down their
employer's offer of coverage due to its costs.
(4) Lack of portability remains a constant problem as thousands of
Washington residents go uninsured every year simply because they are
temporarily between jobs or their new job does not offer an affordable
option for them. In addition, two-income earner families are punished
by the system as they are forced to choose one employer's health
insurance plan over another without a chance to collect premium
contributions from both.
(5) Access to health insurance and other health care spending has
resulted in improved health for many Washingtonians. Yet, we are not
receiving as much value as we should for each health care dollar spent
in Washington state. By failing to sufficiently focus our efforts on
prevention and management of chronic diseases, such as diabetes,
asthma, and heart disease, too many Washingtonians suffer from
complications of their illnesses. By failing to make health insurance
coverage affordable for low-wage workers and self-employed people,
health problems that could be treated in a doctor's office are treated
in the emergency room or hospital. By failing to focus on the most
effective ways to maintain our health and treat disease, Washingtonians
have not made lifestyle changes proven to improve health, nor do they
receive the most effective care.
(6) There are very few incentives for young adults, nineteen
through thirty years old, to purchase their own health coverage.
Young, healthy adults are often quoted rates that are incongruent with
their level of risk and do not make financial sense when they look at
the cost benefit ratio. By failing to offer the right incentives for
this population to enroll in a health insurance plan, we have created
layers of problems such as increased uncompensated care and less
preventative care being sought.
NEW SECTION. Sec. 102
(1) Health insurance coverage is more affordable for employers,
employees, self-employed people, and other individuals;
(2) The process of choosing and purchasing health insurance
coverage is well-informed, clearer, and simpler;
(3) Prevention, chronic care management, wellness, and improved
quality of care are a fundamental part of our health care system;
(4) Administrative costs at every level are reduced;
(5) As a result of these changes, more people in Washington state
have access to affordable health insurance coverage and health outcomes
in Washington state are improved; and
(6) More insurance coverage choices are available to all health
consumers.
NEW SECTION. Sec. 201 The definitions in this section apply
throughout this chapter unless the context clearly requires otherwise.
(1) "Basic health plan" means the program administered under
chapter 70.47 RCW.
(2) "Carrier" means a carrier as defined in RCW 48.43.005.
(3) "Commissioner" means the insurance commissioner established
under RCW 48.02.010.
(4) "Eligible individual" means an individual who is eligible to
participate in the exchange by reason of meeting one or more of the
following qualifications:
(a) The individual is a Washington resident, meaning that the
individual is, and continues to be, residing on a permanent and
full-time basis in a place of permanent habitation in Washington that
remains the person's principal residence and from which the person is
absent only for temporary or transitory purposes. A person who is a
full-time student attending an institution outside of Washington may
maintain his or her Washington residency;
(b) The individual is not a Washington resident but is employed, at
least twenty hours a week on a regular basis, at a Washington location
by a bona fide employer, and the individual's employer does not offer
a group health insurance plan, or the individual is not eligible to
participate in any group health insurance plan offered by the
individual's employer;
(c) The individual, whether a resident or not, is enrolled in, or
eligible to enroll in, a participating employer plan;
(d) The individual is self-employed in Washington, and if a
nonresident self-employed individual, the individual's principal place
of business is in Washington;
(e) The individual is a full-time student attending an institution
of higher education located in Washington;
(f) The individual, whether a resident or not, is a dependent of
another individual who is an eligible individual;
(g) The individual is eligible for benefits under section 210 of
the federal trade act of 2002, at 26 U.S.C. Sec. 35(c).
(5) "Eligible employer" means any individual, partnership,
association, corporation, business trust, or person or group of persons
employing one or more persons, and filing payroll tax information on
each person.
(6) "Executive director" means an individual appointed by a vote of
the exchange board to serve as the secretary of administration and
finance for the exchange board.
(7) "Exchange" means the Washington state health insurance exchange
established in section 204 of this act.
(8) "Exchange board" and "board" means the board of the Washington
state health insurance exchange established in section 205 of this act.
(9) "Health plan" or "health benefit plan" means a health plan or
health benefit plan as defined in RCW 48.43.005.
(10) "Participating individual" means a person who has been
determined by the exchange to be, and continues to be, an eligible
individual or an employee of a participating employer plan for purposes
of obtaining coverage through the exchange.
(11) "Participating employer plan" means a group health plan, as
defined in federal law, Sec. 706 of ERISA (29 U.S.C. Sec. 1186), that
is sponsored by an employer and for which the plan sponsor has entered
into an agreement with the exchange, in accordance with the provisions
of section 208 of this act, for the exchange to offer and administer
health insurance benefits for enrollees in the plan.
(12) "Preexisting condition" means a preexisting condition as
defined in RCW 48.43.005.
(13) "Premium assistance payment" means a payment made to carriers
by the exchange as provided in section 209 of this act.
Sec. 202 RCW 41.05.021 and 2007 c 274 s 1 are each amended to
read as follows:
(((1))) The Washington state health care authority is created
within the executive branch. The authority shall have an administrator
appointed by the governor, with the consent of the senate. The
administrator shall serve at the pleasure of the governor. The
administrator may employ up to seven staff members, who shall be exempt
from chapter 41.06 RCW, and any additional staff members as are
necessary to administer this chapter. The administrator may delegate
any power or duty vested in him or her by this chapter, including
authority to make final decisions and enter final orders in hearings
conducted under chapter 34.05 RCW. The primary duties of the authority
shall be to: Administer state employees' insurance benefits and
retired or disabled school employees' insurance benefits; administer
the basic health plan pursuant to chapter 70.47 RCW; study state-purchased health care programs in order to maximize cost containment in
these programs while ensuring access to quality health care; implement
state initiatives, joint purchasing strategies, and techniques for
efficient administration that have potential application to all state-purchased health services; and administer grants that further the
mission and goals of the authority. The authority's duties include,
but are not limited to, the following:
(((a))) (1) To administer health care benefit programs for
employees and retired or disabled school employees as specifically
authorized in RCW 41.05.065 and in accordance with the methods
described in RCW 41.05.075, 41.05.140, and other provisions of this
chapter;
(((b))) (2) To analyze state-purchased health care programs and to
explore options for cost containment and delivery alternatives for
those programs that are consistent with the purposes of those programs,
including, but not limited to:
(((i))) (a) Creation of economic incentives for the persons for
whom the state purchases health care to appropriately utilize and
purchase health care services, including the development of flexible
benefit plans to offset increases in individual financial
responsibility;
(((ii))) (b) Utilization of provider arrangements that encourage
cost containment, including but not limited to prepaid delivery
systems, utilization review, and prospective payment methods, and that
ensure access to quality care, including assuring reasonable access to
local providers, especially for employees residing in rural areas;
(((iii))) (c) Coordination of state agency efforts to purchase
drugs effectively as provided in RCW 70.14.050;
(((iv))) (d) Development of recommendations and methods for
purchasing medical equipment and supporting services on a volume
discount basis;
(((v))) (e) Development of data systems to obtain utilization data
from state-purchased health care programs in order to identify cost
centers, utilization patterns, provider and hospital practice patterns,
and procedure costs, utilizing the information obtained pursuant to RCW
41.05.031; and
(((vi))) (f) In collaboration with other state agencies that
administer state purchased health care programs, private health care
purchasers, health care facilities, providers, and carriers:
(((A))) (i) Use evidence-based medicine principles to develop
common performance measures and implement financial incentives in
contracts with insuring entities, health care facilities, and providers
that:
(((I))) (A) Reward improvements in health outcomes for individuals
with chronic diseases, increased utilization of appropriate preventive
health services, and reductions in medical errors; and
(((II))) (B) Increase, through appropriate incentives to insuring
entities, health care facilities, and providers, the adoption and use
of information technology that contributes to improved health outcomes,
better coordination of care, and decreased medical errors;
(((B))) (ii) Through state health purchasing, reimbursement, or
pilot strategies, promote and increase the adoption of health
information technology systems, including electronic medical records,
by hospitals as defined in RCW 70.41.020(4), integrated delivery
systems, and providers that:
(((I))) (A) Facilitate diagnosis or treatment;
(((II))) (B) Reduce unnecessary duplication of medical tests;
(((III))) (C) Promote efficient electronic physician order entry;
(((IV))) (D) Increase access to health information for consumers
and their providers; and
(((V))) (E) Improve health outcomes;
(((C))) (iii) Coordinate a strategy for the adoption of health
information technology systems using the final health information
technology report and recommendations developed under chapter 261, Laws
of 2005;
(((c))) (3) To analyze areas of public and private health care
interaction;
(((d))) (4) To provide information and technical and administrative
assistance to the board;
(((e))) (5) To review and approve or deny applications from
counties, municipalities, and other political subdivisions of the state
to provide state-sponsored insurance or self-insurance programs to
their employees in accordance with the provisions of RCW 41.04.205,
setting the premium contribution for approved groups as outlined in RCW
41.05.050;
(((f))) (6) To establish billing procedures and collect funds from
school districts in a way that minimizes the administrative burden on
districts;
(((g))) (7) To publish and distribute to nonparticipating school
districts and educational service districts by October 1st of each year
a description of health care benefit plans available through the
authority and the estimated cost if school districts and educational
service district employees were enrolled;
(((h))) (8) To facilitate and cooperate with the Washington state
health insurance exchange established in section 204 of this act as
follows:
(a) Establish, if the exchange board finds it necessary, a risk
adjustment mechanism for premiums paid to carriers;
(b) Establish and manage a system for determining eligibility for
premium assistance payments and remitting premium assistance payments
to the carriers in accordance with the health insurance exchange;
(9) To apply for, receive, and accept grants, gifts, and other
payments, including property and service, from any governmental or
other public or private entity or person, and make arrangements as to
the use of these receipts to implement initiatives and strategies
developed under this section;
(((i))) (10) To issue, distribute, and administer grants that
further the mission and goals of the authority; and
(((j))) (11) To adopt rules consistent with this chapter as
described in RCW 41.05.160.
(((2) On and after January 1, 1996, the public employees' benefits
board may implement strategies to promote managed competition among
employee health benefit plans. Strategies may include but are not
limited to:))
(a) Standardizing the benefit package;
(b) Soliciting competitive bids for the benefit package;
(c) Limiting the state's contribution to a percent of the lowest
priced qualified plan within a geographical area;
(d) Monitoring the impact of the approach under this subsection
with regards to: Efficiencies in health service delivery, cost shifts
to subscribers, access to and choice of managed care plans statewide,
and quality of health services. The health care authority shall also
advise on the value of administering a benchmark employer-managed plan
to promote competition among managed care plans.
Sec. 203 RCW 41.05.021 and 2007 c 274 s 1 and 2007 c 114 s 3 are
each reenacted and amended to read as follows:
(((1))) The Washington state health care authority is created
within the executive branch. The authority shall have an administrator
appointed by the governor, with the consent of the senate. The
administrator shall serve at the pleasure of the governor. The
administrator may employ up to seven staff members, who shall be exempt
from chapter 41.06 RCW, and any additional staff members as are
necessary to administer this chapter. The administrator may delegate
any power or duty vested in him or her by this chapter, including
authority to make final decisions and enter final orders in hearings
conducted under chapter 34.05 RCW. The primary duties of the authority
shall be to: Administer state employees' insurance benefits and
retired or disabled school employees' insurance benefits; administer
the basic health plan pursuant to chapter 70.47 RCW; study state-purchased health care programs in order to maximize cost containment in
these programs while ensuring access to quality health care; implement
state initiatives, joint purchasing strategies, and techniques for
efficient administration that have potential application to all state-purchased health services; and administer grants that further the
mission and goals of the authority. The authority's duties include,
but are not limited to, the following:
(((a))) (1) To administer health care benefit programs for
employees and retired or disabled school employees as specifically
authorized in RCW 41.05.065 and in accordance with the methods
described in RCW 41.05.075, 41.05.140, and other provisions of this
chapter;
(((b))) (2) To analyze state-purchased health care programs and to
explore options for cost containment and delivery alternatives for
those programs that are consistent with the purposes of those programs,
including, but not limited to:
(((i))) (a) Creation of economic incentives for the persons for
whom the state purchases health care to appropriately utilize and
purchase health care services, including the development of flexible
benefit plans to offset increases in individual financial
responsibility;
(((ii))) (b) Utilization of provider arrangements that encourage
cost containment, including but not limited to prepaid delivery
systems, utilization review, and prospective payment methods, and that
ensure access to quality care, including assuring reasonable access to
local providers, especially for employees residing in rural areas;
(((iii))) (c) Coordination of state agency efforts to purchase
drugs effectively as provided in RCW 70.14.050;
(((iv))) (d) Development of recommendations and methods for
purchasing medical equipment and supporting services on a volume
discount basis;
(((v))) (e) Development of data systems to obtain utilization data
from state-purchased health care programs in order to identify cost
centers, utilization patterns, provider and hospital practice patterns,
and procedure costs, utilizing the information obtained pursuant to RCW
41.05.031; and
(((vi))) (f) In collaboration with other state agencies that
administer state purchased health care programs, private health care
purchasers, health care facilities, providers, and carriers:
(((A))) (i) Use evidence-based medicine principles to develop
common performance measures and implement financial incentives in
contracts with insuring entities, health care facilities, and providers
that:
(((I))) (A) Reward improvements in health outcomes for individuals
with chronic diseases, increased utilization of appropriate preventive
health services, and reductions in medical errors; and
(((II))) (B) Increase, through appropriate incentives to insuring
entities, health care facilities, and providers, the adoption and use
of information technology that contributes to improved health outcomes,
better coordination of care, and decreased medical errors;
(((B))) (ii) Through state health purchasing, reimbursement, or
pilot strategies, promote and increase the adoption of health
information technology systems, including electronic medical records,
by hospitals as defined in RCW 70.41.020(4), integrated delivery
systems, and providers that:
(((I))) (A) Facilitate diagnosis or treatment;
(((II))) (B) Reduce unnecessary duplication of medical tests;
(((III))) (C) Promote efficient electronic physician order entry;
(((IV))) (D) Increase access to health information for consumers
and their providers; and
(((V))) (E) Improve health outcomes;
(((C))) (iii) Coordinate a strategy for the adoption of health
information technology systems using the final health information
technology report and recommendations developed under chapter 261, Laws
of 2005;
(((c))) (3) To analyze areas of public and private health care
interaction;
(((d))) (4) To provide information and technical and administrative
assistance to the board;
(((e))) (5) To review and approve or deny applications from
counties, municipalities, and other political subdivisions of the state
to provide state-sponsored insurance or self-insurance programs to
their employees in accordance with the provisions of RCW 41.04.205 and
(((g) of this)) subsection (7) of this section, setting the premium
contribution for approved groups as outlined in RCW 41.05.050;
(((f))) (6) To review and approve or deny the application when the
governing body of a tribal government applies to transfer their
employees to an insurance or self-insurance program administered under
this chapter. In the event of an employee transfer pursuant to this
subsection (((1)(f))) (6), members of the governing body are eligible
to be included in such a transfer if the members are authorized by the
tribal government to participate in the insurance program being
transferred from and subject to payment by the members of all costs of
insurance for the members. The authority shall: (((i))) (a) Establish
the conditions for participation; (((ii))) (b) have the sole right to
reject the application; and (((iii))) (c) set the premium contribution
for approved groups as outlined in RCW 41.05.050. Approval of the
application by the authority transfers the employees and dependents
involved to the insurance, self-insurance, or health care program
approved by the authority;
(((g))) (7) To ensure the continued status of the employee
insurance or self-insurance programs administered under this chapter as
a governmental plan under section 3(32) of the employee retirement
income security act of 1974, as amended, the authority shall limit the
participation of employees of a county, municipal, school district,
educational service district, or other political subdivision, or a
tribal government, including providing for the participation of those
employees whose services are substantially all in the performance of
essential governmental functions, but not in the performance of
commercial activities;
(((h))) (8) To establish billing procedures and collect funds from
school districts in a way that minimizes the administrative burden on
districts;
(((i))) (9) To publish and distribute to nonparticipating school
districts and educational service districts by October 1st of each year
a description of health care benefit plans available through the
authority and the estimated cost if school districts and educational
service district employees were enrolled;
(((j))) (10) To facilitate and cooperate with the Washington state
health insurance exchange established in section 204 of this act as
follows:
(a) Establish, if the exchange board finds it necessary, a risk
adjustment mechanism for premiums paid to carriers;
(b) Establish and manage a system for determining eligibility for
premium assistance payments and remitting premium assistance payments
to the carriers in accordance with the health insurance exchange;
(11) To apply for, receive, and accept grants, gifts, and other
payments, including property and service, from any governmental or
other public or private entity or person, and make arrangements as to
the use of these receipts to implement initiatives and strategies
developed under this section;
(((k))) (12) To issue, distribute, and administer grants that
further the mission and goals of the authority; and
(((l))) (13) To adopt rules consistent with this chapter as
described in RCW 41.05.160.
(((2) On and after January 1, 1996, the public employees' benefits
board may implement strategies to promote managed competition among
employee health benefit plans. Strategies may include but are not
limited to:))
(a) Standardizing the benefit package;
(b) Soliciting competitive bids for the benefit package;
(c) Limiting the state's contribution to a percent of the lowest
priced qualified plan within a geographical area;
(d) Monitoring the impact of the approach under this subsection
with regards to: Efficiencies in health service delivery, cost shifts
to subscribers, access to and choice of managed care plans statewide,
and quality of health services. The health care authority shall also
advise on the value of administering a benchmark employer-managed plan
to promote competition among managed care plans.
NEW SECTION. Sec. 204 (1) There is hereby established by the
state of Washington the Washington state health insurance exchange as
a body corporate and an independent instrumentality of the state of
Washington, created to serve public purposes provided for in this act,
but with legal existence separate from that of the state of Washington.
(2) The exchange is hereby recognized as a not-for-profit
corporation in accordance with the provisions of Title 24 RCW, and
shall seek recognition of the same status by the United States in
accordance with the provisions of the United States internal revenue
code, 26 U.S.C. Sec. 501(c).
(3) The limited purpose of the exchange is to facilitate the
availability, portability, choice, and adoption of private health
insurance plans to eligible individuals and groups, as provided in this
chapter.
(4) The exchange shall be administered by the executive director
and governed by the Washington state health insurance exchange board
established in section 205 of this act.
(5) The board shall appoint an executive director to serve as the
secretary of administration and finance for the exchange and shall
grant him or her the following powers and duties:
(a) Plan, direct, coordinate, and execute administrative functions
in conformity with the policies and directives of the board;
(b) Employ professional and clerical staff as necessary;
(c) Report to the board on all operations under his or her control
and supervision;
(d) Prepare an annual budget and manage the administrative expenses
of the exchange; and
(e) Undertake any other activities necessary to implement the
powers and duties set forth in this chapter.
NEW SECTION. Sec. 205 (1) The Washington state health insurance
exchange board is hereby established. The function of the board is to
develop and approve rules necessary for operation of the Washington
state health insurance exchange.
(2) The exchange board shall be composed of thirteen voting members
initially appointed by the governor as follows:
(a) A health economist;
(b) One representative of small businesses;
(c) One employee health plan benefits specialist;
(d) One representative of health care consumers;
(e) A physician licensed in good standing under chapter 18.57 RCW;
(f) A health insurance broker licensed in good standing under
chapter 48.17 RCW;
(g) A representative of organized labor;
(h) A representative of business associations;
(i) A representative from the association of Washington health care
plans;
(j) The assistant secretary of the department of social and health
services, health recovery services administration, ex officio;
(k) The insurance commissioner, ex officio;
(l) The administrator of the health care authority, ex officio; and
(m) The executive director, ex officio.
(3) The governor shall appoint the initial members of the board to
staggered terms not to exceed four years. Members appointed or elected
thereafter shall serve two-year terms. Members of the board shall be
compensated in accordance with RCW 43.03.250 and shall be reimbursed
for their travel expenses while on official business in accordance with
RCW 43.03.050 and 43.03.060. The board shall prescribe rules for the
conduct of its business. The executive director shall serve as chair
of the board. Meetings of the board shall be at the call of the chair.
(4) The board may establish technical advisory committees or seek
the advice of technical experts when necessary to execute the powers
and duties included in section 206 of this act.
(5) Upon the end of each corresponding term of service for such
positions as are to be prescribed, the board shall provide rules and
guidelines, such as they are necessary, for the nomination and
selection of industry representatives by their peers for the following
seven board positions:
(a) One representative of small businesses;
(b) One employee health plan specialist;
(c) One representative of health care consumers;
(d) A physician licensed in good standing under chapter 18.57 RCW;
(e) A health insurance broker licensed in good standing under
chapter 48.17 RCW;
(f) A representative of organized labor; and
(g) A representative of trade associations.
NEW SECTION. Sec. 206 The exchange board has the following
duties and powers:
(1) Establish procedures for the enrollment of eligible individuals
and groups, including:
(a) Publicizing the existence of the exchange and disseminating
information on eligibility requirements and enrollment procedures for
the exchange;
(b) Establishing procedures to determine each applicant's
eligibility for purchasing insurance offered by the exchange, including
a standard application form for eligible individuals and groups seeking
to purchase health insurance through the exchange, as well as persons
seeking a premium assistance payment. The application shall include
information necessary to determine an applicant's eligibility, previous
health insurance coverage history, and payment method;
(c) Establishing rules related to minimum participation of
employees in groups seeking to purchase health insurance through the
exchange;
(d) Preparing and distributing certificate of eligibility forms and
application forms to insurance brokers and the general public; and
(e) Establishing and administering procedures for the election of
coverage by participating individuals 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. The procedures
shall include preparing and distributing to participating individuals:
(i) Descriptions of the coverage, benefits, limitations,
copayments, and premiums for all participating plans; and
(ii) Forms and instructions for electing coverage and arranging
payment for coverage;
(2) Establish and manage a system of collecting and transmitting to
the applicable carriers all premium payments or contributions made by
or on behalf of participating individuals, including developing
mechanisms to receive and process automatic payroll deductions for
participating individuals enrolled in employer plans;
(3) Establish a plan for operating a health insurance service
center to provide eligible individuals and employers with information
on the exchange and manage exchange enrollment, and for publicizing the
existence of the exchange and the exchange's eligibility requirements
and enrollment procedures;
(4) Establish other procedures for operations of the exchange,
including but not limited to procedures to:
(a) Seek and receive any grant funding from the federal government,
departments or agencies of the state, and private foundations;
(b) Contract with professional service firms as may be necessary in
the board's judgment, and to fix their compensation;
(c) Contract with companies which provide third-party
administrative and billing services for insurance products;
(d) Charge and equitably apportion among participating institutions
its administrative costs and expenses incurred in the exercise of the
powers and duties granted by this chapter;
(e) Adopt bylaws for the regulation of its affairs and the conduct
of its business;
(f) Sue and be sued in its own name, plead, and be impleaded;
(g) Establish lines of credit, and establish one or more cash and
investment accounts to receive payments for services rendered and
appropriations from the state, and for all other business activity
granted by this chapter except to the extent otherwise limited by any
applicable provision of the employee retirement income security act of
1974; and
(h) Enter into interdepartmental agreements with the office of the
insurance commissioner, department of social and health services,
health care authority, and any other state agencies the board deems
necessary to implement this chapter; and
(5) Begin offering access to health benefit plans under this act on
September 1, 2009.
NEW SECTION. Sec. 207
NEW SECTION. Sec. 208
(2) Any employer seeking to be the sponsor of a participating
employer plan shall, as a condition of participation in the exchange,
enter into a binding agreement with the exchange that includes the
following conditions:
(a) The sponsoring employer designates the exchange to be the
plan's administrator for the employer's group health plan, and the
exchange agrees to undertake the obligations required of a plan
administrator under federal law;
(b) Any individual eligible to participate in the exchange by
reason of his or her eligibility for coverage under the employer's
participating employer plan, regardless of whether any such individual
would otherwise qualify as an eligible individual if not enrolled in
the participating employer plan, may elect coverage under any health
plan offered through the exchange, and neither the employer nor the
exchange shall limit such individual's choice of coverage from among
all the health plans offered;
(c) The employer agrees that, for the term of the agreement, the
employer will not offer to individuals eligible to participate in the
exchange by reason of their eligibility for coverage under the
employer's participating employer plan any separate or competing health
plan, regardless of whether any such individuals would otherwise
qualify as eligible individuals if not enrolled in the participating
employer plan;
(d) The employer reserves the right to offer benefits supplemental
to the benefits offered through the exchange, but any supplemental
benefits offered by the employer shall constitute a separate plan or
plans under federal law, for which the executive director shall not be
the plan administrator and for which neither the executive director nor
the exchange shall be responsible in any manner;
(e) The employer reserves the right to determine the criteria for
eligibility and enrollment in the participating employer plan and the
terms and amounts of the employer's contributions to that plan, so long
as for the term of the agreement with the exchange the employer agrees
not to alter or amend any criteria or contribution amounts at any time
other than during an annual period designated by the exchange for
participating employer plans to make such changes in conjunction with
the exchange's annual open enrollment period;
(f) The employer agrees to make available to the exchange any of
the employer's documents, records, or information, including copies of
the employer's federal and state tax and wage reports, that the
executive director reasonably determines are necessary for the exchange
to verify:
(i) That the employer is in compliance with the terms of its
agreement with the exchange governing the employer's sponsorship of a
participating employer plan;
(ii) That the participating employer plan is in compliance with
applicable laws relating to employee welfare benefit plans,
particularly those relating to nondiscrimination in coverage; and
(iii) The eligibility, under the terms of the employer's plan, of
those individuals enrolled in the participating employer plan;
(g) The employer agrees to also sponsor a "cafeteria plan" as
permitted under federal law, 26 U.S.C. Sec. 125, for all employees
eligible for coverage under the employer's participating employer plan.
(3) Beginning January 1, 2010, the state of Washington shall enter
into an agreement with the exchange to be the sponsor of a
participating employer plan on behalf of all individuals eligible for
health insurance benefits paid in whole or in part by the state of
Washington by reason of current or past employment by the state, or by
reason of being a dependent of such an individual, except for any
individuals who are eligible only for benefits consisting solely of
coverage of expected benefits.
NEW SECTION. Sec. 209
(2) Beginning January 1, 2010, the administrator of the health care
authority shall accept applications for premium assistance from
eligible individuals and employees of participating employer plans who
have family income up to two hundred percent of the federal poverty
level, as determined annually by the federal department of health and
human services, on behalf of themselves, their spouses, and their
dependent children.
(3) The health care authority shall design and implement a schedule
of premium assistance payments that is based upon gross family income,
giving appropriate consideration to family size and the ages of all
family members. The benchmark plan for purposes of designing the
premium assistance payment schedule shall be in conformity with the
average quality of benefits covered in the top three subscribed plans
in the individual insurance market as of January 1, 2008. After
January 1, 2010, the benchmark plan for purposes of the premium
assistance payment schedule shall be adjusted in conformity with the
top three subscribed plans in the exchange.
The premium assistance schedule shall be applied to eligible
individuals, and to the employee premium obligation remaining after
employer premium contributions for employees of participating employer
plans, so that employees benefit financially from their employers'
contribution to the cost of their coverage through the exchange. Any
surcharge included in the premium under section 212 of this act shall
be included when determining the appropriate level of premium
assistance payments.
(4) A financial sponsor may, with the prior approval of the
executive director, pay the premium or any other amount on behalf of an
eligible individual or employee of a participating employer plan, by
arrangement with the individual or employee and through a mechanism
acceptable to the executive director. The executive director shall
establish a mechanism for receiving premium payments from the United
States internal revenue service for eligible individuals who are
eligible for benefits under section 210 of the federal trade act of
2002, at 26 U.S.C. Sec. 35(c).
(5) The exchange shall remit the premium assistance in an amount
determined under subsection (3) of this section to the carrier offering
the health plan in which the eligible individual or employee of a
participating employer plan has chosen to enroll. If, however, such
individual or employee has chosen to enroll in a high deductible health
plan, any difference between the amount of premium assistance that the
individual or employee would receive and the applicable premium rate
for the high deductible health plan shall be deposited into a health
savings account for the benefit of that individual or employee.
(6) As of January 1, 2010, all basic health plan enrollees under
chapter 70.47 RCW shall transition to the premium assistance program.
The health care authority shall provide information and assistance
necessary to allow enrollees to successfully transition to the premium
assistance program, including assistance with enrolling in the exchange
and choosing a health plan during the 2009 open enrollment period.
NEW SECTION. Sec. 210
NEW SECTION. Sec. 211
(2) In cases where a membership organization enrolls in the
exchange its eligible members, or the eligible members of its member
entities, the plan chosen by each individual shall pay the organization
a fee equal to the commission specified in subsection (1) of this
section. Nothing in this section shall be deemed either to require a
membership organization that enrolls persons in the exchange to be
licensed by Washington as an insurance broker, or to permit such an
organization to provide any other services requiring licensure as an
insurance broker without first obtaining such license.
NEW SECTION. Sec. 212
(2) Each carrier participating in the exchange shall be required to
furnish such reasonable reports as the board determines necessary to
enable the executive director to carry out his or her duties under this
chapter.
NEW SECTION. Sec. 213
NEW SECTION. Sec. 214
(1) The operation and administration of the exchange, including
surveys and reports of health benefit plans available to participating
individuals and on the experience of the plans. The experience on the
plans shall include data on enrollees in the exchange, the operation
and administration of the exchange premium assistance program,
expenses, claims statistics, complaints data, how the exchange met its
goals, and other information deemed pertinent by the exchange; and
(2) Any significant observations regarding utilization and adoption
of the exchange.
NEW SECTION. Sec. 215
(1) The impact of medicaid and state children's health insurance
program enrollees participating in the exchange, with respect to the
utilization of services and cost of health plans offered through the
exchange;
(2) Whether any distinction should be made between adult and child
enrollees;
(3) Opportunities to provide plan design flexibility through
medicaid state plan amendments;
(4) The need for a new section 1115 waiver from the federal
government for moving a sizable portion of the medicaid and state
children's health insurance program population into a defined
contribution model;
(5) A study of other states that have attempted similar reforms
involving a defined contribution model within their medicaid population
and whether any ideas should be incorporated to facilitate the move of
enrollees to the exchange;
(6) Whether any cost savings to the state would result from the
incorporation of medicaid and state children's health insurance program
enrollees to the exchange;
(7) The effect any such move would have on the premiums of current
exchange enrollees;
(8) The capacity of participating carriers in the exchange to
properly manage the care of medicaid and state children's health
insurance program enrollees;
(9) The impact of expanded choice and cost sharing on medicaid
enrollees;
(10) What specific categories of categorically needy medicaid and
state children's health insurance program enrollees, if any, should be
excluded from participation in the exchange; and
(11) If the board recommends participation of any medicaid eligible
citizens in the exchange, how the composition of the board should be
modified to reflect their participation.
NEW SECTION. Sec. 216
Sec. 301 RCW 48.43.005 and 2007 c 296 s 1 and 2007 c 259 s 32 are
each reenacted and amended to read as follows:
Unless otherwise specifically provided, the definitions in this
section apply throughout this chapter.
(1) "Adjusted community rate" means the rating method used to
establish the premium for health plans adjusted to reflect actuarially
demonstrated differences in utilization or cost attributable to
geographic region, age, family size, and use of wellness activities.
(2) "Basic health plan" means the plan described under chapter
70.47 RCW, as revised from time to time.
(3) "Basic health plan model plan" means a health plan as required
in RCW 70.47.060(2)(e).
(4) "Basic health plan services" means that schedule of covered
health services, including the description of how those benefits are to
be administered, that are required to be delivered to an enrollee under
the basic health plan, as revised from time to time.
(5) "Catastrophic health plan" means:
(a) In the case of a contract, agreement, or policy covering a
single enrollee, a health benefit plan requiring a calendar year
deductible of, at a minimum, one thousand seven hundred fifty dollars
and an annual out-of-pocket expense required to be paid under the plan
(other than for premiums) for covered benefits of at least three
thousand five hundred dollars, both amounts to be adjusted annually by
the insurance commissioner; and
(b) In the case of a contract, agreement, or policy covering more
than one enrollee, a health benefit plan requiring a calendar year
deductible of, at a minimum, three thousand five hundred dollars and an
annual out-of-pocket expense required to be paid under the plan (other
than for premiums) for covered benefits of at least six thousand
dollars, both amounts to be adjusted annually by the insurance
commissioner; or
(c) Any health benefit plan that provides benefits for hospital
inpatient and outpatient services, professional and prescription drugs
provided in conjunction with such hospital inpatient and outpatient
services, and excludes or substantially limits outpatient physician
services and those services usually provided in an office setting.
In July 2008, and in each July thereafter, the insurance
commissioner shall adjust the minimum deductible and out-of-pocket
expense required for a plan to qualify as a catastrophic plan to
reflect the percentage change in the consumer price index for medical
care for a preceding twelve months, as determined by the United States
department of labor. The adjusted amount shall apply on the following
January 1st.
(6) "Certification" means a determination by a review organization
that an admission, extension of stay, or other health care service or
procedure has been reviewed and, based on the information provided,
meets the clinical requirements for medical necessity, appropriateness,
level of care, or effectiveness under the auspices of the applicable
health benefit plan.
(7) "Concurrent review" means utilization review conducted during
a patient's hospital stay or course of treatment.
(8) "Covered person" or "enrollee" means a person covered by a
health plan including an enrollee, subscriber, policyholder,
beneficiary of a group plan, or individual covered by any other health
plan.
(9) "Creditable coverage" means continual coverage of the applicant
under any of the following health plans, with no lapse in coverage of
more than sixty-three days immediately prior to the date of
application:
(a) A group health plan;
(b) Health insurance coverage;
(c) Part A or Part B of Title XVIII of the social security act,
approved July 30, 1965 (79 Stat. 291; 42 U.S.C. Sec. 1395c et seq. or
1395j et seq., respectively);
(d) Title XIX of the social security act, approved July 30, 1965
(79 Stat. 343; 42 U.S.C. Sec. 1396 et seq.), other than coverage
consisting solely of benefits under section 1928;
(e) Chapter 55 of Title 10, United States Code (10 U.S.C. Sec. 1071
et seq.);
(f) A medical care program of the Indian health service or of a
tribal organization;
(g) A state health benefits risk pool;
(h) A health plan offered under Chapter 89 of Title 5, United
States Code (5 U.S.C. Sec. 8901 et seq.);
(i) The basic health plan as established in chapter 70.47 RCW;
(j) The health insurance pool as established in chapter 48.41 RCW;
(k) A health benefit plan under section 5(e) of the peace corps act
(22 U.S.C. Sec. 2504(e)); or
(l) Any other qualifying coverage required by the health insurance
portability and accountability act of 1996 (HIPAA, Title II), as it may
be amended, or regulations under that act.
(10) "Dependent" means, at a minimum, the enrollee's legal spouse
and unmarried dependent children who qualify for coverage under the
enrollee's health benefit plan.
(((10))) (11) "Eligible employee" means an employee who works on a
full-time basis with a normal work week of thirty or more hours. The
term includes a self-employed individual, including a sole proprietor,
a partner of a partnership, and may include an independent contractor,
if the self-employed individual, sole proprietor, partner, or
independent contractor is included as an employee under a health
benefit plan of a small employer, but does not work less than thirty
hours per week and derives at least seventy-five percent of his or her
income from a trade or business through which he or she has attempted
to earn taxable income and for which he or she has filed the
appropriate internal revenue service form. Persons covered under a
health benefit plan pursuant to the consolidated omnibus budget
reconciliation act of 1986 shall not be considered eligible employees
for purposes of minimum participation requirements of chapter 265, Laws
of 1995.
(((11))) (12) "Eligible individual" means an individual, including
a sole proprietor, who is a resident of Washington state. "Eligible
individual" includes any individual who is eligible for benefits under
section 210 of the federal trade act of 2002, at 26 U.S.C. Sec. 35(c).
(13) "Emergency medical condition" means the emergent and acute
onset of a symptom or symptoms, including severe pain, that would lead
a prudent layperson acting reasonably to believe that a health
condition exists that requires immediate medical attention, if failure
to provide medical attention would result in serious impairment to
bodily functions or serious dysfunction of a bodily organ or part, or
would place the person's health in serious jeopardy.
(((12))) (14) "Emergency services" means otherwise covered health
care services medically necessary to evaluate and treat an emergency
medical condition, provided in a hospital emergency department.
(((13))) (15) "Enrollee point-of-service cost-sharing" means
amounts paid to health carriers directly providing services, health
care providers, or health care facilities by enrollees and may include
copayments, coinsurance, or deductibles.
(((14))) (16) "Exchange" means the Washington state health
insurance exchange established in sections 204 through 206 of this act.
(17) "Grievance" means a written complaint submitted by or on
behalf of a covered person regarding: (a) Denial of payment for
medical services or nonprovision of medical services included in the
covered person's health benefit plan, or (b) service delivery issues
other than denial of payment for medical services or nonprovision of
medical services, including dissatisfaction with medical care, waiting
time for medical services, provider or staff attitude or demeanor, or
dissatisfaction with service provided by the health carrier.
(((15))) (18) "Health care facility" or "facility" means hospices
licensed under chapter 70.127 RCW, hospitals licensed under chapter
70.41 RCW, rural health care facilities as defined in RCW 70.175.020,
psychiatric hospitals licensed under chapter 71.12 RCW, nursing homes
licensed under chapter 18.51 RCW, community mental health centers
licensed under chapter 71.05 or 71.24 RCW, kidney disease treatment
centers licensed under chapter 70.41 RCW, ambulatory diagnostic,
treatment, or surgical facilities licensed under chapter 70.41 RCW,
drug and alcohol treatment facilities licensed under chapter 70.96A
RCW, and home health agencies licensed under chapter 70.127 RCW, and
includes such facilities if owned and operated by a political
subdivision or instrumentality of the state and such other facilities
as required by federal law and implementing regulations.
(((16))) (19) "Health care provider" or "provider" means:
(a) A person regulated under Title 18 or chapter 70.127 RCW, to
practice health or health-related services or otherwise practicing
health care services in this state consistent with state law; or
(b) An employee or agent of a person described in (a) of this
subsection, acting in the course and scope of his or her employment.
(((17))) (20) "Health care service" means that service offered or
provided by health care facilities and health care providers relating
to the prevention, cure, or treatment of illness, injury, or disease.
(((18))) (21) "Health carrier" or "carrier" means a disability
insurer regulated under chapter 48.20 or 48.21 RCW, a health care
service contractor as defined in RCW 48.44.010, or a health maintenance
organization as defined in RCW 48.46.020.
(((19))) (22) "Health plan" or "health benefit plan" means any
policy, contract, or agreement offered by a health carrier to provide,
arrange, reimburse, or pay for health care services except the
following:
(a) Long-term care insurance governed by chapter 48.84 RCW;
(b) Medicare supplemental health insurance governed by chapter
48.66 RCW;
(c) Coverage supplemental to the coverage provided under chapter
55, Title 10, United States Code;
(d) Limited health care services offered by limited health care
service contractors in accordance with RCW 48.44.035;
(e) Disability income;
(f) Coverage incidental to a property/casualty liability insurance
policy such as automobile personal injury protection coverage and
homeowner guest medical;
(g) Workers' compensation coverage;
(h) Accident only coverage;
(i) Specified disease or illness-triggered fixed payment insurance,
hospital confinement fixed payment insurance, or other fixed payment
insurance offered as an independent, noncoordinated benefit;
(j) Employer-sponsored self-funded health plans;
(k) Dental only and vision only coverage; and
(l) Plans deemed by the insurance commissioner to have a short-term
limited purpose or duration, or to be a student-only plan that is
guaranteed renewable while the covered person is enrolled as a regular
full-time undergraduate or graduate student at an accredited higher
education institution, after a written request for such classification
by the carrier and subsequent written approval by the insurance
commissioner.
(((20))) (23) "Material modification" means a change in the
actuarial value of the health plan as modified of more than five
percent but less than fifteen percent.
(((21))) (24) "Participating individual" means a person who has
been determined by the exchange to be, and continues to be, an eligible
individual, an employee of a participating employer plan, or a member
of an association health plan for purposes of obtaining coverage
through the exchange. As used in this section, "association health
plan" includes health plans offered through associations, trusts, and
member-governed groups.
(25) "Participating employer plan" means a group health plan, as
defined in federal law, Sec. 706 of ERISA (29 U.S.C. Sec. 1186), that
is sponsored by an employer and for which the plan sponsor has entered
into an agreement with the exchange, in accordance with the provisions
of section 208 of this act, for the exchange to offer and administer
health insurance benefits for enrollees in the plan.
(26) "Preexisting condition" means any medical condition, illness,
or injury that existed any time prior to the effective date of
coverage.
(((22))) (27) "Premium" means all sums charged, received, or
deposited by a health carrier as consideration for a health plan or the
continuance of a health plan. Any assessment or any "membership,"
"policy," "contract," "service," or similar fee or charge made by a
health carrier in consideration for a health plan is deemed part of the
premium. "Premium" shall not include amounts paid as enrollee point-of-service cost-sharing.
(((23))) (28) "Review organization" means a disability insurer
regulated under chapter 48.20 or 48.21 RCW, health care service
contractor as defined in RCW 48.44.010, or health maintenance
organization as defined in RCW 48.46.020, and entities affiliated with,
under contract with, or acting on behalf of a health carrier to perform
a utilization review.
(((24))) (29) "Small employer" or "small group" means any person,
firm, corporation, partnership, association, political subdivision,
sole proprietor, or self-employed individual that is actively engaged
in business that, on at least fifty percent of its working days during
the preceding calendar quarter, employed at least two but no more than
fifty eligible employees, with a normal work week of thirty or more
hours, the majority of whom were employed within this state, and is not
formed primarily for purposes of buying health insurance and in which
a bona fide employer-employee relationship exists. In determining the
number of eligible employees, companies that are affiliated companies,
or that are eligible to file a combined tax return for purposes of
taxation by this state, shall be considered an employer. Subsequent to
the issuance of a health plan to a small employer and for the purpose
of determining eligibility, the size of a small employer shall be
determined annually. Except as otherwise specifically provided, a
small employer shall continue to be considered a small employer until
the plan anniversary following the date the small employer no longer
meets the requirements of this definition. A self-employed individual
or sole proprietor must derive at least seventy-five percent of his or
her income from a trade or business through which the individual or
sole proprietor has attempted to earn taxable income and for which he
or she has filed the appropriate internal revenue service form 1040,
schedule C or F, for the previous taxable year except for a self-
employed individual or sole proprietor in an agricultural trade or
business, who must derive at least fifty-one percent of his or her
income from the trade or business through which the individual or sole
proprietor has attempted to earn taxable income and for which he or she
has filed the appropriate internal revenue service form 1040, for the
previous taxable year. A self-employed individual or sole proprietor
who is covered as a group of one on the day prior to June 10, 2004,
shall also be considered a "small employer" to the extent that
individual or group of one is entitled to have his or her coverage
renewed as provided in RCW 48.43.035(6).
(((25))) (30) "Utilization review" means the prospective,
concurrent, or retrospective assessment of the necessity and
appropriateness of the allocation of health care resources and services
of a provider or facility, given or proposed to be given to an enrollee
or group of enrollees.
(((26))) (31) "Wellness activity" means an explicit program of an
activity consistent with department of health guidelines, such as,
smoking cessation, injury and accident prevention, reduction of alcohol
misuse, appropriate weight reduction, exercise, automobile and
motorcycle safety, blood cholesterol reduction, and nutrition education
for the purpose of improving enrollee health status and reducing health
service costs.
NEW SECTION. Sec. 302
(2) No health benefit plan may be offered through the exchange
unless the commissioner has first certified to the exchange that:
(a) The carrier seeking to offer the plan is an admitted carrier in
Washington state and is in good standing with the office of the
insurance commissioner;
(b) The plan meets the rating specifications under section 303 of
this act, the preexisting condition provisions under RCW 48.43.015 and
48.43.025, the issue and renewal provisions of RCW 48.43.035, and the
requirements of this section; and
(c) The plan and the carrier are in compliance with all other
applicable Washington state laws.
(3) No plan shall be certified that excludes from coverage any
individual otherwise determined by the exchange as meeting the
eligibility requirements for participating individuals.
(4) Each certification shall be valid for a uniform term of at
least one year, but may be made automatically renewable from term to
term in the absence of notice of either:
(a) Withdrawal by the commissioner; or
(b) Discontinuation of participation in the exchange by the
carrier.
(5) Certification of a plan may be withdrawn only after notice to
the carrier and opportunity for hearing. The commissioner may,
however, decline to renew the certification of any carrier at the end
of a certification term.
(6) Each plan certified by the commissioner as eligible to be
offered through the exchange shall contain a detailed description of
benefits offered including maximums, limitations, exclusions, and other
benefit limits.
(7) The exchange shall not decline or refuse to offer, or otherwise
restrict the offering to any participating individual, any plan that
has obtained, in a timely fashion in advance of the annual open season,
certification by the commissioner in accordance with the provisions of
this section.
(8) The exchange shall not impose on any participating plan or any
carrier or plan seeking to participate in the exchange any terms or
conditions, including any requirements or agreements with respect to
rates or benefits, beyond, or in addition to, those terms and
conditions established and imposed by the commissioner in certifying
plans under the provisions of this section.
(9) The commissioner shall establish and administer, rules and
procedures for certifying plans to participate in the exchange, in
accordance with the provisions of this section.
(10) Nothing in this section precludes an association or member-governed group from offering a commissioner-approved plan for purchase
by its members in the exchange such that:
(a) Member-governed and association plans are not permitted to
exclude other eligible exchange enrollees from obtaining coverage
through the plan; and
(b) Member-governed groups and associations may provide a secondary
level of membership for a nominal monthly fee that allows participation
in said plan by nonmembers.
NEW SECTION. Sec. 303
(1)(a) A carrier offering any health benefit plan through the
exchange may offer and actively market a health benefit plan featuring
a limited schedule of covered health care services. Nothing in this
subsection precludes a carrier from offering, or a consumer from
purchasing, other health benefit plans that may have more comprehensive
benefits than those included in the product offered under this
subsection. A carrier offering a health benefit plan under this
subsection shall clearly disclose all covered benefits to consumers in
a brochure filed with the insurance commissioner.
(b) A health benefit plan offered under this subsection shall
provide coverage for hospital expenses and services rendered by a
physician licensed under chapter 18.57 or 18.71 RCW but is not subject
to the requirements of RCW 48.21.130, 48.21.140, 48.21.141, 48.21.142,
48.21.144, 48.21.146, 48.21.160 through 48.21.197, 48.21.200,
48.21.220, 48.21.225, 48.21.230, 48.21.235, 48.21.240, 48.21.244,
48.21.250, 48.21.300, 48.21.310, or 48.21.320.
(2) Nothing in this section prohibits a carrier from offering, or
a purchaser from seeking, health benefit plans with benefits in excess
of the health benefit plan offered under subsection (1) of this
section. All forms, policies, and contracts shall be submitted for
approval to the commissioner, and the rates of any plan offered under
this section shall be reasonable in relation to the benefits thereto.
(3) The carrier shall develop its rates based on an adjusted
community rate and may only vary the adjusted community rate for:
(a) Geographic area;
(b) Family size;
(c) Age; and
(d) Wellness activities.
(4) The adjustment for age in subsection (3)(c) of this section may
not use age brackets smaller than five-year increments, which shall
begin with age twenty and end with age sixty-five. Participating
individuals under the age of twenty shall be treated as those age
twenty.
(5) The carrier shall be permitted to develop separate rates for
individuals age sixty-five or older for coverage for which medicare is
the primary payer and coverage for which medicare is not the primary
payer. Both rates are subject to the requirements of this section.
(6) The permitted rates for any age group shall be no more than
four hundred twenty-five percent of the lowest rate for all age groups.
(7) A discount for wellness activities is encouraged to reflect
actuarially justified differences in utilization or cost attributed to
such programs.
(8) Rating factors shall produce premiums for identical eligible
individuals that differ only by the amounts attributable to plan
design, with the exception of discounts for health improvement
programs.
(9)(a) Except to the extent provided otherwise in (b) of this
subsection, adjusted community rates established under this section
shall pool the medical experience of all eligible individuals
purchasing coverage through the exchange. However, annual rate
adjustments for each health benefit plan offered through the exchange
may vary by up to plus or minus six percentage points from the overall
adjustment of a carrier's entire pool. In addition, high deductible
health plans with health savings accounts are allowed a variance of
plus four or minus eight percentage points from the overall adjustment
of a carrier's entire pool. Any such overall adjustment is to be
approved by the insurance commissioner, upon a showing by the carrier,
certified by a member of the American academy of actuaries that: (i)
The variation is a result of deductible leverage, benefit design, or
provider network characteristics; and (ii) for a rate renewal period,
the projected weighted average of all benefit plans will have a revenue
neutral effect on the carrier's exchange clients. Variations of
greater than six percentage points or minus eight percentage points for
high deductible health plans with health savings accounts, are subject
to review by the commissioner, and must be approved or denied within
sixty days of submittal. A variation that is not denied within sixty
days shall be deemed approved. The commissioner must provide to the
carrier a detailed actuarial justification for any denial within thirty
days of the denial.
(b) Carriers may treat persons under age thirty-five as a separate
experience pool for purposes of establishing rates for health plans
approved by the commissioner and available in the exchange. The rates
charged for this age group are not subject to subsection (6) of this
section.
Sec. 304 RCW 48.43.012 and 2001 c 196 s 6 are each amended to
read as follows:
(((1))) No carrier may reject an individual for ((an individual))
a health benefit plan through the exchange established in section 204
of this act based upon preexisting conditions of the individual except
as provided in RCW 48.43.018.
(((2) No carrier may deny, exclude, or otherwise limit coverage for
an individual's preexisting health conditions except as provided in
this section.))
(3) For an individual health benefit plan originally issued on or
after March 23, 2000, preexisting condition waiting periods imposed
upon a person enrolling in an individual health benefit plan shall be
no more than nine months for a preexisting condition for which medical
advice was given, for which a health care provider recommended or
provided treatment, or for which a prudent layperson would have sought
advice or treatment, within six months prior to the effective date of
the plan. No carrier may impose a preexisting condition waiting period
on an individual health benefit plan issued to an eligible individual
as defined in section 2741(b) of the federal health insurance
portability and accountability act of 1996 (42 U.S.C. 300gg-41(b)).
(4) Individual health benefit plan preexisting condition waiting
periods shall not apply to prenatal care services.
(5) No carrier may avoid the requirements of this section through
the creation of a new rate classification or the modification of an
existing rate classification. A new or changed rate classification
will be deemed an attempt to avoid the provisions of this section if
the new or changed classification would substantially discourage
applications for coverage from individuals who are higher than average
health risks. These provisions apply only to individuals who are
Washington residents.
Sec. 305 RCW 48.43.015 and 2004 c 192 s 5 are each amended to
read as follows:
(1) For a health benefit plan offered to a group or through the
exchange established in sections 204 through 206 of this act, every
health carrier shall reduce any preexisting condition exclusion,
limitation, or waiting period in the group health plan in accordance
with the provisions of section 2701 of the federal health insurance
portability and accountability act of 1996 (42 U.S.C. Sec. 300gg).
(2) For a health benefit plan offered to a group other than a small
group:
(a) If the individual applicant's immediately preceding health plan
coverage terminated during the period beginning ninety days and ending
sixty-four days before the date of application for the new plan and
such coverage was similar and continuous for at least three months,
then the carrier shall not impose a waiting period for coverage of
preexisting conditions under the new health plan.
(b) If the individual applicant's immediately preceding health plan
coverage terminated during the period beginning ninety days and ending
sixty-four days before the date of application for the new plan and
such coverage was similar and continuous for less than three months,
then the carrier shall credit the time covered under the immediately
preceding health plan toward any preexisting condition waiting period
under the new health plan.
(c) For the purposes of this subsection, a preceding health plan
includes an employer-provided self-funded health plan, the basic health
plan's offering to health coverage tax credit eligible enrollees as
established by chapter 192, Laws of 2004, and plans of the Washington
state health insurance pool.
(3) For a health benefit plan offered ((to a small group)) through
the exchange established in sections 204 through 206 of this act:
(a) If the individual applicant's immediately preceding health plan
coverage terminated during the period beginning ninety days and ending
sixty-four days before the date of application for the new plan and
such coverage was similar and continuous for at least nine months, then
the carrier shall not impose a waiting period for coverage of
preexisting conditions under the new health plan.
(b) If the individual applicant's immediately preceding health plan
coverage terminated during the period beginning ninety days and ending
sixty-four days before the date of application for the new plan and
such coverage was similar and continuous for less than nine months,
then the carrier shall credit the time covered under the immediately
preceding health plan toward any preexisting condition waiting period
under the new health plan.
(c) For the purpose of this subsection, a preceding health plan
includes an employer-provided self-funded health plan, the basic health
plan's offering to health coverage tax credit eligible enrollees as
established by chapter 192, Laws of 2004, and plans of the Washington
state health insurance pool.
(4) ((For a health benefit plan offered to an individual, other
than an individual to whom subsection (5) of this section applies,
every health carrier shall credit any preexisting condition waiting
period in that plan for a person who was enrolled at any time during
the sixty-three day period immediately preceding the date of
application for the new health plan in a group health benefit plan or
an individual health benefit plan, other than a catastrophic health
plan, and (a) the benefits under the previous plan provide equivalent
or greater overall benefit coverage than that provided in the health
benefit plan the individual seeks to purchase; or (b) the person is
seeking an individual health benefit plan due to his or her change of
residence from one geographic area in Washington state to another
geographic area in Washington state where his or her current health
plan is not offered, if application for coverage is made within ninety
days of relocation; or (c) the person is seeking an individual health
benefit plan: (i) Because a health care provider with whom he or she
has an established care relationship and from whom he or she has
received treatment within the past twelve months is no longer part of
the carrier's provider network under his or her existing Washington
individual health benefit plan; and (ii) his or her health care
provider is part of another carrier's provider network; and (iii)
application for a health benefit plan under that carrier's provider
network individual coverage is made within ninety days of his or her
provider leaving the previous carrier's provider network. The carrier
must credit the period of coverage the person was continuously covered
under the immediately preceding health plan toward the waiting period
of the new health plan. For the purposes of this subsection (4), a
preceding health plan includes an employer-provided self-funded health
plan, the basic health plan's offering to health coverage tax credit
eligible enrollees as established by chapter 192, Laws of 2004, and
plans of the Washington state health insurance pool.)) Subject to the provisions of subsections (1) through ((
(5) Every health carrier shall waive any preexisting condition
waiting period in its individual plans for a person who is an eligible
individual as defined in section 2741(b) of the federal health
insurance portability and accountability act of 1996 (42 U.S.C. Sec.
300gg-41(b)).
(6)(5)))
(3) of this section, nothing contained in this section requires a
health carrier to amend a health plan to provide new benefits in its
existing health plans. In addition, nothing in this section requires
a carrier to waive benefit limitations not related to an individual or
group's preexisting conditions or health history.
Sec. 306 RCW 48.43.018 and 2007 c 259 s 37 and 2007 c 80 s 13 are
each reenacted and amended to read as follows:
(1) Except as provided in (a) through (d) of this subsection, ((a
health carrier may)) the exchange established in section 204 of this
act shall require any person applying ((for)) as an individual, outside
of a plan permitted under federal law, 26 U.S.C. Sec. 125, for a health
benefit plan, and the health care authority shall require any person
applying for nonsubsidized enrollment in the basic health plan, to
complete the standard health questionnaire designated under chapter
48.41 RCW. The health questionnaire shall be kept by the exchange and
shall be provided upon the request of any carrier receiving an
application from an individual, separate from any employer plan, for
coverage, and without such individual providing proof of creditable
coverage lasting eighteen consecutive months or more.
(a) If a person is seeking ((an individual)) a health benefit plan
or enrollment in the basic health plan as a nonsubsidized enrollee due
to his or her change of residence from one geographic area in
Washington state to another geographic area in Washington state where
his or her current health plan is not offered, completion of the
standard health questionnaire shall not be a condition of coverage if
application for coverage is made within ninety days of relocation.
(b) If a person is seeking ((an individual)) a health benefit plan
or enrollment in the basic health plan as a nonsubsidized enrollee:
(i) Because a health care provider with whom he or she has an
established care relationship and from whom he or she has received
treatment within the past twelve months is no longer part of the
carrier's provider network under his or her existing Washington
((individual)) health benefit plan; and
(ii) His or her health care provider is part of another carrier's
or a basic health plan managed care system's provider network; and
(iii) Application for a health benefit plan under that carrier's
provider network ((individual)) coverage or for basic health plan
nonsubsidized enrollment is made within ninety days of his or her
provider leaving the previous carrier's provider network; then
completion of the standard health questionnaire shall not be a
condition of coverage.
(c) If a person is seeking ((an individual)) a health benefit plan
or enrollment in the basic health plan as a nonsubsidized enrollee due
to his or her having exhausted continuation coverage provided under 29
U.S.C. Sec. 1161 et seq., completion of the standard health
questionnaire shall not be a condition of coverage if application for
coverage is made within ninety days of exhaustion of continuation
coverage. A health carrier or the health care authority as
administrator of basic health plan nonsubsidized coverage shall accept
an application without a standard health questionnaire from a person
currently covered by such continuation coverage if application is made
within ninety days prior to the date the continuation coverage would be
exhausted and the effective date of the individual coverage applied for
is the date the continuation coverage would be exhausted, or within
ninety days thereafter.
(d) If a person is seeking ((an individual)) a health benefit plan
or enrollment in the basic health plan as a nonsubsidized enrollee
following disenrollment from a health plan that is exempt from
continuation coverage provided under 29 U.S.C. Sec. 1161 et seq.,
completion of the standard health questionnaire shall not be a
condition of coverage if: (i) The person had at least twenty-four
months of continuous group coverage including church plans immediately
prior to disenrollment; (ii) application is made no more than ninety
days prior to the date of disenrollment; and (iii) the effective date
of the individual coverage applied for is the date of disenrollment, or
within ninety days thereafter.
(((f))) (e) If a person is seeking ((an individual)) a health
benefit plan, completion of the standard health questionnaire shall not
be a condition of coverage if: (i) The person had at least twenty-four
months of continuous basic health plan coverage under chapter 70.47 RCW
immediately prior to disenrollment; and (ii) application for coverage
is made within ninety days of disenrollment from the basic health plan.
A health carrier shall accept an application without a standard health
questionnaire from a person with at least twenty-four months of
continuous basic health plan coverage if application is made no more
than ninety days prior to the date of disenrollment and the effective
date of the individual coverage applied for is the date of
disenrollment, or within ninety days thereafter.
(2) If, based upon the results of the standard health
questionnaire, the person qualifies for coverage under the Washington
state health insurance pool, the following shall apply:
(a) The carrier may decide not to accept the person's application
for enrollment in its ((individual)) health benefit plan and the health
care authority, as administrator of basic health plan nonsubsidized
coverage, shall not accept the person's application for enrollment as
a nonsubsidized enrollee; and
(b) Within fifteen business days of receipt of a completed
application, the carrier or the health care authority as administrator
of basic health plan nonsubsidized coverage shall provide written
notice of the decision not to accept the person's application for
enrollment to both the person and the administrator of the Washington
state health insurance pool. The notice to the person shall state that
the person is eligible for health insurance provided by the Washington
state health insurance pool, and shall include information about the
Washington state health insurance pool and an application for such
coverage. If the carrier or the health care authority as administrator
of basic health plan nonsubsidized coverage does not provide or
postmark such notice within fifteen business days, the application is
deemed approved.
(3) If the person applying for ((an individual)) a health benefit
plan: (a) Does not qualify for coverage under the Washington state
health insurance pool based upon the results of the standard health
questionnaire; (b) does qualify for coverage under the Washington state
health insurance pool based upon the results of the standard health
questionnaire and the carrier elects to accept the person for
enrollment; or (c) is not required to complete the standard health
questionnaire designated under this chapter under subsection (1)(a) or
(b) of this section, the carrier or the health care authority as
administrator of basic health plan nonsubsidized coverage, whichever
entity administered the standard health questionnaire, shall accept the
person for enrollment if he or she resides within the carrier's or the
basic health plan's service area and provide or assure the provision of
all covered services regardless of age, sex, family structure,
ethnicity, race, health condition, geographic location, employment
status, socioeconomic status, other condition or situation, or the
provisions of RCW 49.60.174(2). The commissioner may grant a temporary
exemption from this subsection if, upon application by a health
carrier, the commissioner finds that the clinical, financial, or
administrative capacity to serve existing enrollees will be impaired if
a health carrier is required to continue enrollment of additional
eligible individuals.
Sec. 307 RCW 48.43.025 and 2001 c 196 s 9 are each amended to
read as follows:
(1) For group health benefit plans for groups other than small
groups, no carrier may reject an individual for health plan coverage
based upon preexisting conditions of the individual and no carrier may
deny, exclude, or otherwise limit coverage for an individual's
preexisting health conditions; except that a carrier may impose a
three-month benefit waiting period for preexisting conditions for which
medical advice was given, or for which a health care provider
recommended or provided treatment within three months before the
effective date of coverage. Any preexisting condition waiting period
or limitation relating to pregnancy as a preexisting condition shall be
imposed only to the extent allowed in the federal health insurance
portability and accountability act of 1996.
(2) For group health benefit plans ((for small groups)) offered
through the exchange established in sections 204 through 206 of this
act, no carrier may reject an individual for health plan coverage based
upon preexisting conditions of the individual and no carrier may deny,
exclude, or otherwise limit coverage for an individual's preexisting
health conditions. Except that a carrier may impose a nine-month
benefit waiting period for preexisting conditions for which medical
advice was given, or for which a health care provider recommended or
provided treatment within six months before the effective date of
coverage. Any preexisting condition waiting period or limitation
relating to pregnancy as a preexisting condition shall be imposed only
to the extent allowed in the federal health insurance portability and
accountability act of 1996.
(3) No carrier may avoid the requirements of this section through
the creation of a new rate classification or the modification of an
existing rate classification. A new or changed rate classification
will be deemed an attempt to avoid the provisions of this section if
the new or changed classification would substantially discourage
applications for coverage from individuals or groups who are higher
than average health risks. These provisions apply only to individuals
who are Washington residents.
Sec. 308 RCW 48.43.035 and 2004 c 244 s 4 are each amended to
read as follows:
For group health benefit plans and for health benefit plans offered
through the exchange established in sections 204 through 206 of this
act, the following shall apply:
(1) Except as provided in RCW 48.43.018, all health carriers shall
accept for enrollment any state resident within the group to whom the
plan is offered and within the carrier's service area and provide or
assure the provision of all covered services regardless of age, sex,
family structure, ethnicity, race, health condition, geographic
location, employment status, socioeconomic status, other condition or
situation, or the provisions of RCW 49.60.174(2). The insurance
commissioner may grant a temporary exemption from this subsection, if,
upon application by a health carrier the commissioner finds that the
clinical, financial, or administrative capacity to serve existing
enrollees will be impaired if a health carrier is required to continue
enrollment of additional eligible individuals.
(2) Except as provided in subsection (5) of this section, all
health plans shall contain or incorporate by endorsement a guarantee of
the continuity of coverage of the plan. For the purposes of this
section, a plan is "renewed" when it is continued beyond the earliest
date upon which, at the carrier's sole option, the plan could have been
terminated for other than nonpayment of premium. The carrier may
consider the group's anniversary date as the renewal date for purposes
of complying with the provisions of this section.
(3) The guarantee of continuity of coverage required in health
plans shall not prevent a carrier from canceling or nonrenewing a
health plan for:
(a) Nonpayment of premium;
(b) Violation of published policies of the carrier approved by the
insurance commissioner;
(c) Covered persons entitled to become eligible for medicare
benefits by reason of age who fail to apply for a medicare supplement
plan or medicare cost, risk, or other plan offered by the carrier
pursuant to federal laws and regulations;
(d) Covered persons who fail to pay any deductible or copayment
amount owed to the carrier and not the provider of health care
services;
(e) Covered persons committing fraudulent acts as to the carrier;
(f) Covered persons who materially breach the health plan; or
(g) Change or implementation of federal or state laws that no
longer permit the continued offering of such coverage.
(4) The provisions of this section do not apply in the following
cases:
(a) A carrier has zero enrollment on a product;
(b) A carrier replaces a product and the replacement product is
provided to all covered persons within that class or line of business,
includes all of the services covered under the replaced product, and
does not significantly limit access to the kind of services covered
under the replaced product. The health plan may also allow
unrestricted conversion to a fully comparable product;
(c) No sooner than January 1, 2005, a carrier discontinues offering
a particular type of health benefit plan offered for groups of up to
two hundred if: (i) The carrier provides notice to each group of the
discontinuation at least ninety days prior to the date of the
discontinuation; (ii) the carrier offers to each group provided
coverage of this type the option to enroll, with regard to small
employer groups, in any other small employer group plan, or with regard
to groups of up to two hundred, in any other applicable group plan,
currently being offered by the carrier in the applicable group market;
and (iii) in exercising the option to discontinue coverage of this type
and in offering the option of coverage under (c)(ii) of this
subsection, the carrier acts uniformly without regard to any health
status-related factor of enrolled individuals or individuals who may
become eligible for this coverage;
(d) A carrier discontinues offering all health coverage in the
small group market or for groups of up to two hundred, or both markets,
in the state and discontinues coverage under all existing group health
benefit plans in the applicable market involved if: (i) The carrier
provides notice to the commissioner of its intent to discontinue
offering all such coverage in the state and its intent to discontinue
coverage under all such existing health benefit plans at least one
hundred eighty days prior to the date of the discontinuation of
coverage under all such existing health benefit plans; and (ii) the
carrier provides notice to each covered group of the intent to
discontinue the existing health benefit plan at least one hundred
eighty days prior to the date of discontinuation. In the case of
discontinuation under this subsection, the carrier may not issue any
group health coverage in this state in the applicable group market
involved for a five-year period beginning on the date of the
discontinuation of the last health benefit plan not so renewed. This
subsection (4) does not require a carrier to provide notice to the
commissioner of its intent to discontinue offering a health benefit
plan to new applicants when the carrier does not discontinue coverage
of existing enrollees under that health benefit plan; or
(e) A carrier is withdrawing from a service area or from a segment
of its service area because the carrier has demonstrated to the
insurance commissioner that the carrier's clinical, financial, or
administrative capacity to serve enrollees would be exceeded.
(5) The provisions of this section do not apply to health plans
deemed by the insurance commissioner to be unique or limited or have a
short-term purpose, after a written request for such classification by
the carrier and subsequent written approval by the insurance
commissioner.
(6) Notwithstanding any other provision of this section, the
guarantee of continuity of coverage applies to a group of one only if:
(a) The carrier continues to offer any other small employer group plan
in which the group of one was eligible to enroll on the day prior to
June 10, 2004; and (b) the person continues to qualify as a group of
one under the criteria in place on the day prior to June 10, 2004.
NEW SECTION. Sec. 309
(2) A carrier shall not issue or renew a small group health benefit
plan, including a plan offered through an association or
member-governed group whether or not formed specifically for the
purpose of purchasing health care, other than through the exchange
established in section 204 of this act, after January 1, 2010.
NEW SECTION. Sec. 310
NEW SECTION. Sec. 401
(a) The employee's election to, in lieu of insurance coverage, take
full personal responsibility for any and all health care-related
expenses incurred while without coverage, including but not limited to:
Preventative, emergency, and major medical services;
(b) The employee's forfeiture of any and all rights to any
consideration or compensation in lieu of their employers financial
contribution for health care;
(c) The employee's election to apply, or not apply, for coverage
through the exchange; and
(d) The employee's election to be considered, or not to be
considered, for any publicly financed health insurance program or
premium subsidy program administered by Washington.
(2) Each form shall be signed by the individual to whom it
pertains.
(3) Each self-employed individual in Washington shall annually file
the same form with the commissioner.
(4) The secretary of the department of social and health services
shall annually file the same form with the commissioner on behalf of
all individuals receiving medical assistance benefits through a state-funded program, excepting such individuals as who are also covered by
Part A or Part B of Title XVIII of the social security act (79 Stat.
291; 42 U.S.C. Sec. 1395c et seq. or 1395j et seq., respectively).
(5) For purposes of this section, "health insurance coverage" does
not include any coverage consisting solely of one or more excepted
benefits.
(6) The commissioner shall prepare and distribute such forms.
NEW SECTION. Sec. 501
(a) Carriers already pay for half of all high-risk claims through
assessments that go toward the health insurance pool;
(b) Consumers are asked to share in that responsibility with higher
premium costs; and
(c) Because they are the most directly affected by any high-risk
transfer system, carriers are best suited to develop and come to
agreement with the commissioner on a model that would effectively
balance risk among carriers but not artificially shift costs to
average-risk consumers or the state.
(2) On a date no later than September 1, 2008, the insurance
commissioner shall convene a high-risk transfer pool task force
consisting of representatives from each insurance carrier licensed to
sell health benefit plans in Washington state as of January 1, 2008.
(3) A series of meetings shall be held among all task force members
at a location to be determined by the commissioner. The following
parameters apply:
(a) Discussion shall be limited to risk transfer solutions that
minimize or exclude any state subsidy and preserve the affordability of
insurance products for all state residents; and
(b) Such discussion shall examine the potential for leveraging
additional federal funds for lower-income pool participants.
(4) In direct consultation with the commissioner, the task force
members shall develop a risk transfer proposal that will best serve the
exchange, its carriers, and its enrollees for transferring high-risk
claims evenly among carriers.
(5) The task force shall consider active and proposed models from
other states that function to spread high risk in the most equitable
manner possible.
(6) The task force shall complete its work on a date no later than
January 1, 2009, and shall publish a final report for public
consumption.
(7) The final report shall be submitted to the house of
representatives and senate health care committees for expedient
consideration and further action.
NEW SECTION. Sec. 601 (1) Sections 102, 201, and 204 through 216
of this act constitute a new chapter in Title
(2) Sections 302, 303, 309, 310, and 401 of this act are each added
to chapter 48.43 RCW.
NEW SECTION. Sec. 602 Part headings and captions used in this
act are not any part of the law.
NEW SECTION. Sec. 603 The following acts or parts of acts are
each repealed, effective January 1, 2010:
(1) RCW 48.01.260 (Health benefit plans -- Carriers -- Clarification)
and 2000 c 79 s 40;
(2) RCW 48.20.025 (Schedule of rates for individual health benefit
plans -- Loss ratio -- Remittance of premiums -- Definitions) and 2003 c 248
s 8, 2001 c 196 s 1, & 2000 c 79 s 3;
(3) RCW 48.20.028 (Calculation of premiums -- Adjusted community
rating method -- Definitions) and 2006 c 100 s 1, 2000 c 79 s 4, 1997 c
231 s 207, & 1995 c 265 s 13;
(4) RCW 48.20.029 (Calculation of premiums -- Members of a purchasing
pool--Adjusted community rating method--Definitions) and 2006 c 100 s
2;
(5) RCW 48.21.045 (Health plan benefits for small employers--Coverage -- Exemption from statutory requirements -- Premium rates--Requirements for providing coverage for small employers -- Definitions)
and 2007 c 260 s 7, 2004 c 244 s 1, 1995 c 265 s 14, & 1990 c 187 s 2;
(6) RCW 48.21.047 (Requirements for plans offered to small
employers -- Definitions) and 2005 c 223 s 11 & 1995 c 265 s 22;
(7) RCW 48.43.038 (Individual health plans -- Guarantee of continuity
of coverage--Exceptions) and 2000 c 79 s 25;
(8) RCW 48.43.041 (Individual health benefit plans -- Mandatory
benefits) and 2000 c 79 s 26;
(9) RCW 48.44.017 (Schedule of rates for individual contracts -- Loss
ratio -- Remittance of premiums -- Definitions) and 2001 c 196 s 11 & 2000
c 79 s 29;
(10) RCW 48.44.021 (Calculation of premiums -- Members of a
purchasing pool -- Adjusted community rating method -- Definitions) and
2006 c 100 s 4;
(11) RCW 48.44.022 (Calculation of premiums -- Adjusted community
rate -- Definitions) and 2006 c 100 s 3, 2004 c 244 s 6, 2000 c 79 s 30,
1997 c 231 s 208, & 1995 c 265 s 15;
(12) RCW 48.44.023 (Health plan benefits for small employers--Coverage -- Exemption from statutory requirements -- Premium rates--Requirements for providing coverage for small employers) and 2007 c 260
s 8, 2004 c 244 s 7, 1995 c 265 s 16, & 1990 c 187 s 3;
(13) RCW 48.44.024 (Requirements for plans offered to small
employers -- Definitions) and 2003 c 248 s 15 & 1995 c 265 s 23;
(14) RCW 48.46.062 (Schedule of rates for individual agreements--Loss ratio -- Remittance of premiums -- Definitions) and 2001 c 196 s 12 &
2000 c 79 s 32;
(15) RCW 48.46.063 (Calculation of premiums--Members of a
purchasing pool -- Adjusted community rating method -- Definitions) and
2006 c 100 s 6;
(16) RCW 48.46.064 (Calculation of premiums -- Adjusted community
rate -- Definitions) and 2006 c 100 s 5, 2004 c 244 s 8, 2000 c 79 s 33,
1997 c 231 s 209, & 1995 c 265 s 17;
(17) RCW 48.46.066 (Health plan benefits for small employers--Coverage -- Exemption from statutory requirements -- Premium rates--Requirements for providing coverage for small employers) and 2007 c 260
s 9, 2004 c 244 s 9, 1995 c 265 s 18, & 1990 c 187 s 4;
(18) RCW 48.46.068 (Requirements for plans offered to small
employers -- Definitions) and 2003 c 248 s 16 & 1995 c 265 s 24;
(19) RCW 70.47A.010 (Finding -- Intent) and 2007 c 260 s 1 & 2006 c
255 s 1;
(20) RCW 70.47A.020 (Definitions) and 2007 c 260 s 2 & 2006 c 255
s 2;
(21) RCW 70.47A.030 (Health insurance partnership established--Administrator duties) and 2007 c 259 s 58 & 2006 c 255 s 3;
(22) RCW 70.47A.040 (Applications for premium subsidies) and 2007
c 260 s 6 & 2006 c 255 s 4;
(23) RCW 70.47A.050 (Enrollment to remain within appropriation) and
2007 c 260 s 12 & 2006 c 255 s 5;
(24) RCW 70.47A.060 (Rules) and 2007 c 260 s 13 & 2006 c 255 s 6;
(25) RCW 70.47A.070 (Reports) and 2006 c 255 s 7;
(26) RCW 70.47A.080 (Health insurance partnership account) and 2007
c 260 s 14 & 2006 c 255 s 8;
(27) RCW 70.47A.090 (State children's health insurance program--Federal waiver request) and 2006 c 255 s 9;
(28) RCW 70.47A.100 (Health insurance partnership board) and 2007
c 260 s 4;
(29) RCW 70.47A.110 (Health insurance partnership board -- Duties)
and 2007 c 260 s 5; and
(30) RCW 70.47A.900 (Captions not law -- 2006 c 255) and 2006 c 255
s 11.
NEW SECTION. Sec. 604 Sections 304 through 308 of this act take
effect January 1, 2010.
NEW SECTION. Sec. 605 Section 202 of this act expires January 1,
2009.
NEW SECTION. Sec. 606 Section 203 of this act takes effect
January 1, 2009.