WSR 97-04-074

PREPROPOSAL STATEMENT OF INQUIRY

INSURANCE COMMISSIONER'S OFFICE

[Matter No. R 97-01--Filed February 5, 1997, 9:25 a.m.]

Subject of Possible Rule Making: Possible amendment of WAC 284-51-050 - the allowable expense for coordination of benefits (COB) and the effect on benefits when an enrollee is eligible for health care benefits from two or more health benefit plans, at least one of which includes managed care provisions.

Statutes Authorizing the Agency to Adopt Rules on this Subject: RCW 48.02.060 and 48.21.200.

Reasons Why Rules on this Subject may be Needed and What They Might Accomplish: The current provisions of WAC 284-51-050 Allowable expense, do not take into account changes that have occurred in the health insurance products available to groups and individuals. The majority of health care benefit plans currently offered include managed care features with requirements for pretreatment authorization or referral by the carrier or a provider, and/or use of specified providers for specialty services. Such managed care provisions may preclude subscribers from realizing any benefits from a second health care plan for which premiums are paid with an expectation of coverage. Amending WAC 284-51-050 may increase consumer access to secondary plan benefits, clarify requirements for qualifying for these benefits, and decrease consumer complaints on the subject.

Other Federal and State Agencies that Regulate this Subject and the Process Coordinating the Rule with These Agencies: None.

Process for Developing New Rule: Agency study; and written comments are solicited. Send suggestions to Kacy Brandeberry, P.O. Box 40255, Olympia, WA 98504-0255, FAX (360) 586-3535, Internet inscomr@aol.com. Deadline for comments, March 14, 1997.

Interested parties can participate in the decision to adopt the new rule and formulation of the proposed rule before publication by contacting Kacy Brandeberry, P.O. Box 40255, Olympia, WA 98504-0255, phone (360) 664-3790, FAX (360) 586-3535, Internet inscomr@aol.com.

February 5, 1997

Deborah Senn

Insurance Commissioner

Legislature Code Reviser

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