WSR 11-01-138




[ Insurance Commissioner Matter No. R 2010-16 -- Filed December 21, 2010, 2:00 p.m. ]

Subject of Possible Rule Making: Guaranteed issue enrollment of persons under age nineteen.

Statutes Authorizing the Agency to Adopt Rules on this Subject: RCW 48.02.060, 48.18.120(2), 48.20.450, 48.44.050, 48.46.200.

Reasons Why Rules on this Subject may be Needed and What They Might Accomplish: Effective for policy years and plan years beginning after September 23, 2010, interim final federal regulation requires health carriers and insurers that are not grandfathered to enroll persons up to age nineteen without applying a preexisting condition exclusion or waiting period or other limitations on benefits due to a preexisting condition. Federal law does not establish a uniform open enrollment period, but leaves management of such a market regulation to the states.

Due to the risk of adverse selection posed by parents or others waiting to enroll persons up to age nineteen until they have a medical condition requiring treatment, and then disenrolling when treatment is concluded, the commissioner enacted an emergency rule responding to a health carrier petition asking for open enrollment periods as the sole time frame for enrollment for this enrollee population. That rule established open enrollment during 2010 for policy years beginning in 2011. The rule expires January 27, 2011. Under this rule making, the commissioner will consider rules that would provide guidance to carriers, and those who seek insurance for persons under age nineteen regarding how the new federal law will be implemented in Washington's market.

Other Federal and State Agencies that Regulate this Subject and the Process Coordinating the Rule with These Agencies: United States Department of Health and Human Services (USDHHS) administers the federal law that prompted the commissioner to propose rules in this area. This rule making is related to implementation of the requirements in Pub. L. 111-148 and the interim final regulations issued June 28, 2010, found at Vol. 75 F.R. 37187-37241, and codified in 45 C.F.R. Parts 144, 146 and 147. States are required to ensure that their state law does not interfere with the application of the federal law.

Process for Developing New Rule: Working with carriers, the Washington State Health Insurance Pool, the Pre-existing Condition Insurance Pool and the USDHHS to devise rules implementing guaranteed issue coverage for persons under age nineteen.

Interested parties can participate in the decision to adopt the new rule and formulation of the proposed rule before publication by contacting Meg L. Jones, P.O. Box 40258, Olympia, WA 98504-0258, e-mail, phone (360) 725-7170, fax (360) 586-3109.

December 21, 2010

Mike Kreidler

Insurance Commissioner

Washington State Code Reviser's Office