BILL REQ. #: S-4552.2
State of Washington | 60th Legislature | 2008 Regular Session |
Read first time 01/23/08. Referred to Committee on Health & Long-Term Care.
AN ACT Relating to the Washington state health insurance pool; amending RCW 48.41.100; and creating a new section.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:
Sec. 1 RCW 48.41.100 and 2007 c 259 s 30 are each amended to read
as follows:
(1) The following persons who are residents of this state are
eligible for pool coverage:
(a) Any person who provides evidence of a carrier's decision not to
accept him or her for enrollment in an individual health benefit plan
as defined in RCW 48.43.005 based upon, and within ninety days of the
receipt of, the results of the standard health questionnaire designated
by the board and administered by health carriers under RCW 48.43.018;
(b) Any person who continues to be eligible for pool coverage based
upon the results of the standard health questionnaire designated by the
board and administered by the pool administrator pursuant to subsection
(3) of this section;
(c) Any person who resides in a county of the state where no
carrier or insurer eligible under chapter 48.15 RCW offers to the
public an individual health benefit plan other than a catastrophic
health plan as defined in RCW 48.43.005 at the time of application to
the pool, and who makes direct application to the pool; and
(d) Any medicare eligible person upon providing evidence of
rejection for medical reasons, a requirement of restrictive riders, an
up-rated premium, or a preexisting conditions limitation on a medicare
supplemental insurance policy under chapter 48.66 RCW, the effect of
which is to substantially reduce coverage from that received by a
person considered a standard risk by at least one member within six
months of the date of application.
(2) The following persons are not eligible for coverage by the
pool:
(a) Any person having terminated coverage in the pool unless (i)
twelve months have lapsed since termination, or (ii) that person can
show continuous other coverage which has been involuntarily terminated
for any reason other than nonpayment of premiums. However, these
exclusions do not apply to eligible individuals 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));
(b) Any person on whose behalf the pool has paid out two million
dollars in benefits;
(c) Inmates of public institutions and persons ((whose benefits are
duplicated under public programs)) eligible for medical assistance as
defined in RCW 74.09.010. However, these exclusions do not apply to
eligible individuals 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));
(d) Any person who resides in a county of the state where any
carrier or insurer regulated under chapter 48.15 RCW offers to the
public an individual health benefit plan other than a catastrophic
health plan as defined in RCW 48.43.005 at the time of application to
the pool and who does not qualify for pool coverage based upon the
results of the standard health questionnaire, or pursuant to subsection
(1)(d) of this section.
(3) When a carrier or insurer regulated under chapter 48.15 RCW
begins to offer an individual health benefit plan in a county where no
carrier had been offering an individual health benefit plan:
(a) If the health benefit plan offered is other than a catastrophic
health plan as defined in RCW 48.43.005, any person enrolled in a pool
plan pursuant to subsection (1)(c) of this section in that county shall
no longer be eligible for coverage under that plan pursuant to
subsection (1)(c) of this section, but may continue to be eligible for
pool coverage based upon the results of the standard health
questionnaire designated by the board and administered by the pool
administrator. The pool administrator shall offer to administer the
questionnaire to each person no longer eligible for coverage under
subsection (1)(c) of this section within thirty days of determining
that he or she is no longer eligible;
(b) Losing eligibility for pool coverage under this subsection (3)
does not affect a person's eligibility for pool coverage under
subsection (1)(a), (b), or (d) of this section; and
(c) The pool administrator shall provide written notice to any
person who is no longer eligible for coverage under a pool plan under
this subsection (3) within thirty days of the administrator's
determination that the person is no longer eligible. The notice shall:
(i) Indicate that coverage under the plan will cease ninety days from
the date that the notice is dated; (ii) describe any other coverage
options, either in or outside of the pool, available to the person;
(iii) describe the procedures for the administration of the standard
health questionnaire to determine the person's continued eligibility
for coverage under subsection (1)(b) of this section; and (iv) describe
the enrollment process for the available options outside of the pool.
(4) The board shall ensure that an independent analysis of the
eligibility standards for the pool coverage is conducted, including
examining the eight percent eligibility threshold, eligibility for
medicaid enrollees and other publicly sponsored enrollees, and the
impacts on the pool and the state budget. The board shall report the
findings to the legislature by December 1, 2007.
NEW SECTION. Sec. 2 The Washington state health insurance pool
relies upon enrollee premiums and assessments paid by health insurance
carriers for financing, and the number of enrollees supporting the
assessment payments has declined as more employers and associations
have chosen to self-insure their health care benefits. The office of
the insurance commissioner is directed to convene a task force to
recommend the best options for equitable, stable, and broad-based
funding sources for the Washington state health insurance pool.
Participants should include, at a minimum, representatives from
insurance carriers, the pool, and the office of financial management.
The task force recommendations shall be delivered to the legislature by
December 1, 2008.