WSR 19-01-054
PERMANENT RULES
HEALTH CARE AUTHORITY
(Employees and Retirees Benefits Division)
[Admin #2018-02—Filed December 14, 2018, 9:18 a.m., effective January 14, 2019]
Effective Date of Rule: Thirty-one days after filing.
Purpose: Making technical amendments to:
| |
| • | Change references from medicare supplement coverage to medicare supplemental coverage. |
| • | Revise several definitions in WAC 182-13-020. |
| • | Align eligibility in WAC 182-13-030 with RCW 41.05.197. |
| • | Clarify state residents can apply for medicare supplemental coverage thirty days before they are enrolled in Parts A and B of medicare. |
| • | Allow residents to apply within sixty-three days instead of sixty days for coverage after becoming a new resident. |
| • | Include guaranteed issue periods by cross-referencing RCW 48.66.045 and 48.66.055. |
Citation of Rules Affected by this Order: Amending WAC 182-13-010, 182-13-020, 182-13-030, and 182-13-040.
Adopted under notice filed as WSR 18-22-032 on October 29, 2018.
Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.
Number of Sections Adopted at the Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.
Number of Sections Adopted on the Agency's own Initiative: New 0, Amended 0, Repealed 0.
Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 4, Repealed 0.
Number of Sections Adopted using Negotiated Rule Making: New 0, Amended 0, Repealed 0; Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 0, Amended 4, Repealed 0.
Date Adopted: December 14, 2018.
Wendy Barcus
Rules Coordinator
AMENDATORY SECTION(Amending WSR 95-07-011, filed 3/3/95, effective 4/3/95)
WAC 182-13-010Purpose.
The purpose of this chapter is to establish criteria for state residents for participation in medicare ((supplement))supplemental coverage available through the HCA.
AMENDATORY SECTION(Amending WSR 95-07-011, filed 3/3/95, effective 4/3/95)
WAC 182-13-020Definitions.
Unless otherwise specifically provided, the definitions contained in this section apply throughout this chapter.
(1) "HCA" means the Washington state health care authority.
(2) "Health plan," or "plan" means any individual or group: Policy, agreement, or other contract providing coverage for medical, surgical, hospital, or emergency care services, whether issued, or issued for delivery, in Washington or any other state. "Health Plan" or "plan" also includes
any group health plan that is maintained by any state and governed by the Public Health Services Act in 42 U.S.C. Chapter 6A, self-insured coverage governed by the federal Employee Retirement Income Security Act
of 1974, coverage through the
Washington state health
insurance ((
Access Act))
pool as described in chapter
48.41 RCW, ((
coverage through the Basic Health Plan as described in chapter 70.47 RCW, and)) coverage through the medicaid program as described in Title
74 RCW
, and coverage through the Washington state health benefit exchange as described in chapter 43.71 RCW. "Health plan" or "plan" does not mean or include: Hospital confinement indemnity coverage as described in WAC 284-50-345; disability income protection coverage as described in WAC 284-50-355; accident only coverage as described in WAC 284-50-360; specified disease and specified accident coverage as described in WAC 284-50-365; limited benefit health insurance coverage as described in WAC 284-50-370; long-term care benefits as described in chapter
48.84 RCW; or limited health care coverage ((
such as dental only, vision only, or chiropractic only))
(e.g., dental only).
(3) "Lapse in coverage" means a period of time greater than ((ninety))sixty-three continuous days without coverage by a health plan.
(4) "Resident" means a person who demonstrates that ((he/she lives))they live in the state of Washington ((at the time of application for, and issuance of coverage))by providing evidence of residency.
AMENDATORY SECTION(Amending WSR 95-07-011, filed 3/3/95, effective 4/3/95)
WAC 182-13-030Eligibility.
((Residents are))A resident is eligible to apply for medicare ((supplement))supplemental coverage ((arranged by))available through the HCA ((when they are))provided the resident is:
(1) ((Eligible for))Enrolled in Parts A and B of medicare((,)); and
(2) ((
Actually enrolled in both Parts A and B of medicare not later than the effective date of medicare supplement coverage.))
Not eligible to purchase coverage as a retired or disabled employee under RCW 41.05.195.AMENDATORY SECTION(Amending WSR 95-07-011, filed 3/3/95, effective 4/3/95)
WAC 182-13-040Application for medicare ((supplement))supplemental coverage.
Residents meeting eligibility requirements may apply for medicare ((supplement))supplemental coverage ((arranged by))available through the HCA:
(1) ((During the initial open enrollment period of January 1 through June 30, 1995, or))No earlier than thirty days before they are enrolled in both Parts A and B of medicare;
(2) Within ((sixty))sixty-three days after becoming a resident((, or
(3) In the thirty day period before the resident becomes eligible for medicare, or
(4) Within sixty days of retirement, or
(5)))of Washington state;
(3) During any open enrollment period established by federal or state law((, or
(6)));
(4) During any open enrollment period established by the HCA subsequent to the initial open enrollment period provided that the applicant is replacing a health plan with no lapse in coverage; or
(5) When replacing coverage as described in RCW 48.66.045 or when enrolling during a guaranteed issue period as described in RCW 48.66.055.