WSR 13-24-110
[Insurance Commissioner Matter No. R 2013-28—Filed December 4, 2013, 7:35 a.m.]
Subject of Possible Rule Making: Substitution of essential health benefits in individual and small group health benefit plans.
Statutes Authorizing the Agency to Adopt Rules on this Subject: RCW 48.02.060 and 48.43.715.
Reasons Why Rules on this Subject may be Needed and What They Might Accomplish: When the essential health benefits were established by regulation in 2013, the commissioner included a requirement that issuers not substitute benefits that differ from a benefit or benefits in the benchmark plan within a category for the 2014 benefit year. Due to the complexity of the new rating and filing requirements, and because the United States Department of Health and Human Services' Center for Medicaid and Medicare Services is expected to alter both the templates for filing, and the filing instructions for the 2015 benefit year, extending the nonsubstitution requirement to the 2015 benefit year filings facilitates the review of plans for approval.
Other Federal and State Agencies that Regulate this Subject and the Process Coordinating the Rule with These Agencies: The United States Department of Health and Human Services provides states with flexibility to establish requirements such as nonsubstitution of benefits. Coordination is not necessary.
Process for Developing New Rule: Submit written comments by January 10, 2013 [2014], to Meg Jones,, fax (360) 586-3109.
Interested parties can participate in the decision to adopt the new rule and formulation of the proposed rule before publication by contacting Meg Jones, P.O. Box 40258, Olympia, WA 98504,, fax (360) 586-3109.
December 4, 2013
Mike Kreidler
Insurance Commissioner