WSR 16-22-098
[Insurance Commissioner Matter No. R 2016-21—Filed November 2, 2016, 11:50 a.m.]
Original Notice.
Preproposal statement of inquiry was filed as WSR 16-16-091.
Title of Rule and Other Identifying Information: Special enrollment rule: Expanded health benefit exchange request.
Hearing Location(s): Office of the Insurance Commissioner (OIC), 5000 Capitol Boulevard, Tumwater, WA 98504, on December 8, 2016, at 9:00 a.m.
Date of Intended Adoption: December 9, 2016.
Submit Written Comments to: Bianca Stoner, P.O. Box 40260, Olympia, WA 98504, e-mail, fax (360) 586-3109, by December 8, 2016.
Assistance for Persons with Disabilities: Contact Lorie Villaflores by December 7, 2016, TTY (360) 586-0241 or (360) 725-7087.
Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: Under this rule change, OIC will remove the word "twentieth" and replace it with the word "fifteenth" in WAC 284-43-1140 (2)(a).
Reasons Supporting Proposal: In May 2016, OIC filed Rule 2016-13 to change the deadline for consumers to apply for health plans sold on the Washington health benefit exchange (exchange) using special enrollment rights. The exchange asked OIC to make this change, because although 45 C.F.R. 155.420 allows a special enrollment deadline as early as the fifteenth, the existing state regulation (WAC 284-43-1140) does not permit a deadline earlier than the twentieth.
After learning that the exchange hoped to make this change, some issuers asked OIC to let them make the same change. In response to that request, OIC withdrew the CR-101 for Rule 2016-13 and issued the CR-101 for Rule 2016-21.
This change will give both the exchange and issuers the option of using a special enrollment deadline as early as the fifteenth for coverage that starts the first day of the next month.
Statutory Authority for Adoption: RCW 48.02.060, 48.18.120(2), 48.20.450, 48.44.050, and 48.46.200.
Statute Being Implemented: Chapter 48.43 RCW.
Rule is not necessitated by federal law, federal or state court decision.
Name of Proponent: Mike Kreidler, insurance commissioner, governmental.
Name of Agency Personnel Responsible for Drafting: Bianca Stoner, P.O. Box 40260, Olympia, WA 98504-0260, (360) 725-7041; Implementation: Molly Nollette, P.O. Box 40255, Olympia, WA 98504-0255, (360) 725-7117; and Enforcement: AnnaLisa Gellermann, P.O. Box 40255, Olympia, WA 98504-0255, (360) 725-7050.
No small business economic impact statement has been prepared under chapter 19.85 RCW. The entities that need to comply with the proposed rules do not qualify as small businesses under the definition of small business in RCW 19.85.020(3). In addition, this proposed rule making allows insurers to make a change in their special enrollment period but does not require them to do so.
A cost-benefit analysis is required under RCW 34.05.328. A preliminary cost-benefit analysis may be obtained by contacting Bianca Stoner, P.O. Box 40260, Olympia, WA 98504, phone (360) 725-7041, fax (360) 586-3109, e-mail
November 2, 2016
Mike Kreidler
Insurance Commissioner
AMENDATORY SECTION (Amending WSR 16-14-106, filed 7/6/16, effective 8/6/16)
WAC 284-43-1140 Duration, notice requirements and effective dates of coverage for individual market special enrollment periods.
(1) Special enrollment periods must not be shorter than sixty days from the date of the qualifying event.
(2) The effective date of coverage for those enrolling in an individual health plan through a special enrollment period is the first date of the next month after the premium is received by the issuer, unless one of the following exceptions applies:
(a) For those enrolling after the ((twentieth)) fifteenth of the month, the issuer must begin coverage not later than the first date of the second month after the application is received. Issuers may establish an earlier effective date at their discretion;
(b) For special enrollment of newborn, adopted or placed for adoption children, the date of birth, date of adoption or date of placement for adoption, as applicable, becomes the first effective date of coverage. The same requirement applies to foster children or children placed for foster care on qualified health plans;
(c) For special enrollment based on marriage or the beginning of a domestic partnership, and for special enrollment based on loss of minimum essential coverage, coverage must begin on the first day of the next month.
(3) For individual plans offered either on or off the health benefit exchange, an issuer must include detailed information about special enrollment options and rights in its health plan documents provided pursuant to WAC 284-43-5130, and in the policy, contract or certificate of coverage provided to an employer, plan sponsor or enrollee. The notice must be substantially similar to the model notice provided by the U.S. Department of Health and Human Services.