BILL REQ. #:  H-1124.1 

Read first time 02/06/13.   Referred to Committee on Health Care & Wellness.

     AN ACT Relating to health plans provided through associations or member-governed groups; amending RCW 48.21.047, 48.44.024, and 48.46.068; and creating a new section.

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

NEW SECTION.  Sec. 1   The legislature finds that the offering of affordable health care to Washington residents is a critical public policy objective. The legislature further finds that as the affordable care act is fully implemented, it is critical that quality health care coverage continue to be available to residents of the state. The legislature further finds that association health care plans are an important means of delivering quality and affordable health care coverage and that continuation of such plans will help mitigate the costs of implementing the affordable care act. Therefore, the legislature declares that association health care plans meeting certain standards should be continued as a means of providing health care as the affordable care act is implemented.

Sec. 2   RCW 48.21.047 and 2010 c 292 s 8 are each amended to read as follows:
     (1) An insurer may not offer any health benefit plan to any small employer without complying with RCW 48.21.045(3).
     (2) Employers purchasing health plans provided through associations or through member-governed groups formed specifically for the purpose of purchasing health care are not small employers and the plans are not subject to RCW 48.21.045(3).
     (3) For plan years beginning on or after January 1, 2014, health plans provided through associations or member-governed groups are deemed large group health benefit plans, if the association or member-governed group:
     (a) Operates solely within the borders of a single state and only includes member companies that have a registered Washington state unified business identifier;
     (b) Complies with all state and federal laws applicable to fully insured large group health plans;
     (c) Does not health underwrite individuals;
     (d) Does not bar any entity from association membership based on age, health status, or claims experience; and
     (e) Offers coverage to all association members, regardless of age, health status, or claims experience.
     (4) For purposes of this section, "health benefit plan," "health plan," and "small employer" mean the same as defined in RCW 48.43.005.
     (((4))) (5) For purposes of this section, "census date" has the same meaning as defined in RCW 48.44.010.

Sec. 3   RCW 48.44.024 and 2003 c 248 s 15 are each amended to read as follows:
     (1) A health care service contractor may not offer any health benefit plan to any small employer without complying with RCW 48.44.023(3).
     (2) Employers purchasing health plans provided through associations or through member-governed groups formed specifically for the purpose of purchasing health care are not small employers and the plans are not subject to RCW 48.44.023(3).
     (3) For plan years beginning on or after January 1, 2014, health plans provided through associations or member-governed groups are deemed large group health benefit plans, if the association or member-governed group:
     (a) Operates solely within the borders of a single state and only includes member companies that have a registered Washington state unified business identifier;
     (b) Complies with all state and federal laws applicable to fully insured large group health plans;
     (c) Does not health underwrite individuals;
     (d) Does not bar any entity from association membership based on age, health status, or claims experience; and
     (e) Offers coverage to all association members, regardless of age, health status, or claims experience.
     (4) For purposes of this section, "health benefit plan," "health plan," and "small employer" mean the same as defined in RCW 48.43.005.

Sec. 4   RCW 48.46.068 and 2003 c 248 s 16 are each amended to read as follows:
     (1) A health maintenance organization may not offer any health benefit plan to any small employer without complying with RCW 48.46.066(3).
     (2) Employers purchasing health plans provided through associations or through member-governed groups formed specifically for the purpose of purchasing health care are not small employers and are not subject to RCW 48.46.066(3).
     (3) For plan years beginning on or after January 1, 2014, health plans provided through associations or member-governed groups are deemed large group health benefit plans, if the association or member-governed group:
     (a) Operates solely within the borders of a single state and only includes member companies that have a registered Washington state unified business identifier;
     (b) Complies with all state and federal laws applicable to fully insured large group health plans;
     (c) Does not health underwrite individuals;
     (d) Does not bar any entity from association membership based on age, health status, or claims experience; and
     (e) Offers coverage to all association members, regardless of age, health status, or claims experience.
     (4) For purposes of this section, "health benefit plan," "health plan," and "small employer" mean the same as defined in RCW 48.43.005.