BillTracker

Preserving access to individual market health care coverage throughout Washington state (Cody, Jinkins)

AN ACT Relating to preserving access to individual market health care coverage throughout Washington state; amending RCW 48.41.200 and 48.41.090; adding a new section to chapter 48.43 RCW; and creating a new section.

SUMMARY OF 1ST SUBSTITUTE BILL COMPARED TO ORIGINAL BILL
The substitute bill (1) removes the requirement that a health carrier offering a health plan to school employees offer a Silver qualified health plan (QHP) in counties where no health plans are offered on the Exchange; (2) requires instead a health carrier offering health plans to school employees to offer at least one Silver and one Gold QHP on the Exchange in any county in which the carrier offers a health plan to school employees beginning in plan year 2020; and (3) reduces a person's Washington State Health Insurance Pool premiums by a percentage based on his or her income, instead of basing the premium reduction on the average amount of federal premium subsidies available in the same geographic rating area.

EFFECT OF HOUSE STRIKER AMENDMENT
(1) Requires a health carrier to offer silver and gold qualified health plans in counties where it offers a health plan approved by either the School Employees' Benefits Board (SEBB) or the Public Employees' Benefits Board (PEBB), instead of only the SEBB. (2) Prohibits the rates for health plans approved by the PEBB or the SEBB from including the administrative costs or actuarial risks associated with a qualified health plan offered by the carrier and requires the Health Care Authority to perform annual actuarial reviews to ensure compliance with the prohibition. (3) Removes the premium reductions for enrollees in the Washington Health Insurance Pool in counties where there is no other individual market coverage available. (4) Requires, until December 31, 2019, a health carrier to allow an individual to purchase an individual market health plan outside of his or her county of residence under the following circumstances: (1) There are no individual market health plans available in the individual's county of residence and (2) the health plan is offered in the same geographic rating area as the individual's county of residence. (5) Requires, until December 31, 2019, the Health Benefit Exchange to allow an individual to purchase a qualified health plan being offered outside his or her county of residence under the same circumstances. (6) Requires, until December 31, 2019, the Insurance Commissioner to take into account the availability of telemedicine services and consider all reasonable requests to allow the delivery of services using all access points in neighboring counties when evaluating the adequacy of the provider networks of a health plan that has enrollees who do not reside in the county in which the health plan is offered if the carrier did not participate in the individual market in 2018 in that county. (7) Makes, until December 31, 2019, an individual eligible to purchase a health plan outside of his or her county of residence ineligible for coverage by the Washington State Health Insurance Pool (WSHIP). (8) Adds a severability clause.

SENATE COMMITTEE (Health & Long Term Care) STRIKER AMENDMENT
(1) Removes provisions allowing someone to purchase coverage in another county if there are no individual market plan options in their county and restores language allowing individuals to purchase WSHIP coverage at lower rates depending on their income. (2) Expires provisions allowing certain individuals to purchase WSHIP coverage at a lower rate, on December 31, 2019. (3) Permits any health carrier within an insurance holding company to offer a silver and gold plan on the Exchange if any health carrier in that same holding company offers a fully insured plan approved by PEBB or SEBB, as opposed to requiring the same carrier that offers the PEBB or SEBB approved option to offer options on the Exchange.

Hearing Date: Monday, February 19, 2018 -- 10:00 am

WA State Legislature Link:
http://app.leg.wa.gov/billsummary?BillNumber=2408&Year=2017    (opens a new browser tab)