Washington 2019-2020 Regular Session Status: Passed Senate 12 D cosponsors

SB 5805 — Making state law consistent with selected federal consumer protections in the patient protection and affordable care act.

Last action — By resolution, reintroduced and retained in present status.

  1. ✓
    Introduced
  2. ✓
    In Committee
  3. 3
    Passed Senate
  4. 4
    Passed House
  5. 5
    To Executive
  6. 6
    Enacted

This bill died with 2019-2020 Regular Session. It reached “Passed Senate” and never advanced before the session ended, so it can no longer move — a new version would have to be reintroduced in the current session.

This bill is no longer active — its legislative session has ended, so there is no live prognosis. It would have to be reintroduced in the current session to move again.

Bill Text

What changed in the latest version

1 added · 1 removed

Plain-language change summary

The revised version of Bill SB 5805 makes several critical updates to align Washington state health insurance laws with federal protections under the Affordable Care Act. Key changes include prohibiting health carriers from denying coverage based on preexisting conditions and ensuring that essential health benefits cannot have annual or lifetime dollar limits. These changes are important as they enhance consumer protections, ensuring that individuals can access necessary health services without facing unfair financial burdens or coverage denials due to their health status.

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S-1852.2SUBSTITUTE SENATE BILL 5805State of Washington66th Legislature2019 Regular SessionBySenate Health & Long Term Care (originally sponsored by Senators Cleveland, Wellman, Randall, Billig, Nguyen, Pedersen, Saldaña, Carlyle, Kuderer, Wilson, C., Conway, Darneille, Hasegawa, Takko, Keiser, Frockt, Hunt, Mullet, Rolfes, McCoy, Salomon, Van De Wege, Das, Liias, Hobbs, Palumbo, and Dhingra)READ FIRST TIME 02/21/19.AN ACT Relating to making state law consistent with selected federal consumer protections in the patient protection and affordable care act;
S-1205.1SENATE BILL 5805State of Washington66th Legislature2019 Regular SessionBySenators Cleveland, Wellman, Randall, Billig, Nguyen, Pedersen, Saldaña, Carlyle, Kuderer, Wilson, C., Conway, Darneille, Hasegawa, Takko, Keiser, Frockt, Hunt, Mullet, Rolfes, McCoy, Salomon, Van De Wege, Das, Liias, Hobbs, Palumbo, and DhingraAN ACT Relating to making state law consistent with selected federal consumer protections in the patient protection and affordable care act;
amending RCW 48.43.005, 48.43.012, 48.21.270, 48.44.380, 48.46.460, 48.43.715, and 48.43.0122;
amending RCW 48.43.005, 48.20.028, 48.21.045, 48.44.022, 48.44.023, 48.46.064, 48.46.066, 48.43.012, 48.21.270, 48.44.380, 48.46.460, 48.43.715, and 48.43.0122;
adding a new section to chapter 43.71 RCW;
repealing RCW 48.43.015, 48.43.017, 48.43.018, 48.43.025, 48.20.025, 48.44.017, and 48.46.062;
repealing RCW 48.43.015, 48.43.017, 48.43.018, and 48.43.025;
(a) Have been employed by the same small employer or small group for at least twelve months prior to application for small group coverage, and (b) verify that he or she derived at least seventy-five percent of his or her income from a trade or business through which the individual or sole proprietor has attempted to earn taxable income and for which he or she has filed the appropriate internal revenue service form 1040, schedule C or F, for the previous taxable year, except a self-employed individual or sole proprietor in an agricultural trade or business, must have derived at least fifty-one percent of his or her income from the trade or business through which the individual or sole proprietor has attempted to earn taxable income and for which he or she has filed the appropriate internal revenue service form 1040, for the previous taxable year.(34) "Special enrollment" means a defined period of time of not less than thirty-one days, triggered by a specific qualifying event experienced by the applicant, during which applicants may enroll in the carrier's individual health benefit plan without being subject to health screening or otherwise required to provide evidence of insurability as a condition for enrollment.(35) "Standard health questionnaire" means the standard health questionnaire designated under chapter 48.41 RCW.(36) "Utilization review" means the prospective, concurrent, or retrospective assessment of the necessity and appropriateness of the allocation of health care resources and services of a provider or facility, given or proposed to be given to an enrollee or group of enrollees.(37) "Wellness activity" means an explicit program of an activity consistent with department of health guidelines, such as, smoking cessation, injury and accident prevention, reduction of alcohol misuse, appropriate weight reduction, exercise, automobile and motorcycle safety, blood cholesterol reduction, and nutrition education for the purpose of improving enrollee health status and reducing health service costs.(38) "Essential health benefit categories" means:(a) Ambulatory patient services;(b) Emergency services;(c) Hospitalization;(d) Maternity and newborn care;(e) Mental health and substance use disorder services, including behavioral health treatment;(f) Prescription drugs;(g) Rehabilitative and habilitative services and devices;(h) Laboratory services;(i) Preventive and wellness services and chronic disease management;
(a) Have been employed by the same small employer or small group for at least twelve months prior to application for small group coverage, and (b) verify that he or she derived at least seventy-five percent of his or her income from a trade or business through which the individual or sole proprietor has attempted to earn taxable income and for which he or she has filed the appropriate internal revenue service form 1040, schedule C or F, for the previous taxable year, except a self-employed individual or sole proprietor in an agricultural trade or business, must have derived at least fifty-one percent of his or her income from the trade or business through which the individual or sole proprietor has attempted to earn taxable income and for which he or she has filed the appropriate internal revenue service form 1040, for the previous taxable year.(34) "Special enrollment" means a defined period of time of not less than thirty-one days, triggered by a specific qualifying event experienced by the applicant, during which applicants may enroll in the carrier's individual health benefit plan without being subject to health screening or otherwise required to provide evidence of insurability as a condition for enrollment.(35) "Standard health questionnaire" means the standard health questionnaire designated under chapter 48.41 RCW.(36) "Utilization review" means the prospective, concurrent, or retrospective assessment of the necessity and appropriateness of the allocation of health care resources and services of a provider or facility, given or proposed to be given to an enrollee or group of enrollees.(37) "Wellness activity" means an explicit program of an activity consistent with department of health guidelines, such as, smoking cessation, injury and accident prevention, reduction of alcohol misuse, appropriate weight reduction, exercise, automobile and motorcycle safety, blood cholesterol reduction, and nutrition education for the purpose of improving enrollee health status and reducing health service costs.(38) "Essential health benefit categories" means:(a) Ambulatory patient services;(b) Emergency services;(c) Hospitalization;(d) Maternity and newborn care;(e) Mental health and substance use disorder services, including behavioral health treatment;(f) Prescription drugs;(g) Rehabilitative and habilitative services;(h) Laboratory services;(i) Preventive and wellness services and chronic disease management;
and(j) Pediatric services, including oral and vision care.PART IIGUARANTEED ISSUE AND ELIGIBILITYSec.
and(j) Pediatric services, including oral and vision care.PART IIMODIFIED COMMUNITY RATINGNEW SECTION.  Sec.
A new section is added to chapter 48.43 RCW to read as follows:(1) The premium rate charged by a health carrier for nongrandfathered health plans offered in the individual or small group market may vary with respect to the particular plan involved only by:(a) Whether the plan covers an individual or family;(b) Rating area established under subsection (2) of this section;(c) Age, except the rate may not vary by more than three to one for adults;
and(d) Tobacco use, except the rate may not vary by more than one and one-half to one.(2) The commissioner shall establish by rule:(a) Rating areas for purposes of subsection (1)(b) of this section;
and(b) Permissible age bands for purposes of subsection (1)(c) of this section.(3) With respect to family coverage, the rating variations permitted under subsection (1)(d) of this section must be applied based on the portion of the premium that is attributable to each family member covered under the plan.(4) Unless preempted by federal law, the commissioner shall adopt any rules necessary to implement this section, consistent with federal rules and guidance in effect on January 1, 2017, implementing the patient protection and affordable care act.Sec.
3.
RCW 48.20.028 and 2006 c 100 s 1 are each amended to read as follows:(1) Premiums for health benefit plans for individuals shall be calculated using the adjusted community rating method that spreads financial risk across the carrier's entire individual product population, except the individual product population covered under RCW 48.20.029.
All such rates shall conform to the following:(a) The insurer shall develop its rates based on an adjusted community rate and may only vary the adjusted community rate for:(i) Geographic area;(ii) Family size;(iii) Age;(iv) Tenure discounts;
and(v) Wellness activities.(b) The adjustment for age in (a)(iii) of this subsection may not use age brackets smaller than five-year increments which shall begin with age twenty and end with age sixty-five.
Individuals under the age of twenty shall be treated as those age twenty.(c) The insurer shall be permitted to develop separate rates for individuals age sixty-five or older for coverage for which medicare is the primary payer and coverage for which medicare is not the primary payer.
Both rates shall be subject to the requirements of this subsection.(d) The permitted rates for any age group shall be no more than four hundred twenty-five percent of the lowest rate for all age groups on January 1, 1996, four hundred percent on January 1, 1997, and three hundred seventy-five percent on January 1, 2000, and thereafter.(e) A discount for wellness activities shall be permitted to reflect actuarially justified differences in utilization or cost attributed to such programs not to exceed twenty percent.(f) The rate charged for a health benefit plan offered under this section may not be adjusted more frequently than annually except that the premium may be changed to reflect:(i) Changes to the family composition;(ii) Changes to the health benefit plan requested by the individual;
or(iii) Changes in government requirements affecting the health benefit plan.(g) For the purposes of this section, a health benefit plan that contains a restricted network provision shall not be considered similar coverage to a health benefit plan that does not contain such a provision, provided that the restrictions of benefits to network providers result in substantial differences in claims costs.
((This subsection does not restrict or enhance the portability of benefits as provided in RCW 48.43.015.))(h) A tenure discount for continuous enrollment in the health plan of two years or more may be offered, not to exceed ten percent.(2) Adjusted community rates established under this section shall pool the medical experience of all individuals purchasing coverage, except individuals purchasing coverage under RCW 48.20.029, and shall not be required to be pooled with the medical experience of health benefit plans offered to small employers under RCW 48.21.045.(3) As used in this section, "health benefit plan," "adjusted community rate," and "wellness activities" mean the same as defined in RCW 48.43.005.(4) This section shall not apply to premiums for health benefit plans covered under RCW 48.20.029.(5) This section applies only to grandfathered health plans as defined in RCW 48.43.005.Sec.
4.
RCW 48.21.045 and 2010 c 292 s 7 are each amended to read as follows:(1)(a) An insurer offering any health benefit plan to a small employer, either directly or through an association or member-governed group formed specifically for the purpose of purchasing health care, may offer and actively market to the small employer a health benefit plan featuring a limited schedule of covered health care services.
Nothing in this subsection shall preclude an insurer from offering, or a small employer from purchasing, other health benefit plans that may have more comprehensive benefits than those included in the product offered under this subsection.
An insurer offering a health benefit plan under this subsection shall clearly disclose all covered benefits to the small employer in a brochure filed with the commissioner.(b) A health benefit plan offered under this subsection shall provide coverage for hospital expenses and services rendered by a physician licensed under chapter 18.57 or 18.71 RCW but is not subject to the requirements of RCW 48.21.130, 48.21.140, 48.21.141, 48.21.142, 48.21.144, 48.21.146, 48.21.160 through 48.21.197, 48.21.200, 48.21.220, 48.21.225, 48.21.230, 48.21.235, 48.21.244, 48.21.250, 48.21.300, 48.21.310, or 48.21.320.(2) Nothing in this section shall prohibit an insurer from offering, or a purchaser from seeking, health benefit plans with benefits in excess of the health benefit plan offered under subsection (1) of this section.
All forms, policies, and contracts shall be submitted for approval to the commissioner, and the rates of any plan offered under this section shall be reasonable in relation to the benefits thereto.(3) Premium rates for health benefit plans for small employers as defined in this section shall be subject to the following provisions:(a) The insurer shall develop its rates based on an adjusted community rate and may only vary the adjusted community rate for:(i) Geographic area;(ii) Family size;(iii) Age;
and(iv) Wellness activities.(b) The adjustment for age in (a)(iii) of this subsection may not use age brackets smaller than five-year increments, which shall begin with age twenty and end with age sixty-five.
Employees under the age of twenty shall be treated as those age twenty.(c) The insurer shall be permitted to develop separate rates for individuals age sixty-five or older for coverage for which medicare is the primary payer and coverage for which medicare is not the primary payer.
Both rates shall be subject to the requirements of this subsection (3).(d) The permitted rates for any age group shall be no more than four hundred twenty-five percent of the lowest rate for all age groups on January 1, 1996, four hundred percent on January 1, 1997, and three hundred seventy-five percent on January 1, 2000, and thereafter.(e) A discount for wellness activities shall be permitted to reflect actuarially justified differences in utilization or cost attributed to such programs.
Up to a twenty percent variance may be allowed for small employers that develop and implement a wellness program or activities that directly improve employee wellness.
Employers shall document program activities with the carrier and may, after three years of implementation, request a reduction in premiums based on improved employee health and wellness.
While carriers may review the employer's claim history when making a determination regarding whether the employer's wellness program has improved employee health, the carrier may not use maternity or prevention services claims to deny the employer's request.
Carriers may consider issues such as improved productivity or a reduction in absenteeism due to illness if submitted by the employer for consideration.
Interested employers may also work with the carrier to develop a wellness program and a means to track improved employee health.(f) The rate charged for a health benefit plan offered under this section may not be adjusted more frequently than annually except that the premium may be changed to reflect:(i) Changes to the enrollment of the small employer;(ii) Changes to the family composition of the employee;(iii) Changes to the health benefit plan requested by the small employer;
or(iv) Changes in government requirements affecting the health benefit plan.(g) On the census date, as defined in RCW 48.21.047, rating factors shall produce premiums for identical groups that differ only by the amounts attributable to plan design, and differences in census date between new and renewal groups, with the exception of discounts for health improvement programs.(h) For the purposes of this section, a health benefit plan that contains a restricted network provision shall not be considered similar coverage to a health benefit plan that does not contain such a provision, provided that the restrictions of benefits to network providers result in substantial differences in claims costs.
A carrier may develop its rates based on claims costs due to network provider reimbursement schedules or type of network.
((This subsection does not restrict or enhance the portability of benefits as provided in RCW 48.43.015.))(i) Adjusted community rates established under this section shall pool the medical experience of all small groups purchasing coverage, including the small group participants in the health insurance partnership established in RCW 70.47A.030.
However, annual rate adjustments for each small group health benefit plan may vary by up to plus or minus four percentage points from the overall adjustment of a carrier's entire small group pool, such overall adjustment to be approved by the commissioner, upon a showing by the carrier, certified by a member of the American academy of actuaries that:
(i) The variation is a result of deductible leverage, benefit design, or provider network characteristics;
and (ii) for a rate renewal period, the projected weighted average of all small group benefit plans will have a revenue neutral effect on the carrier's small group pool.
Variations of greater than four percentage points are subject to review by the commissioner, and must be approved or denied within sixty days of submittal.
A variation that is not denied within sixty days shall be deemed approved.
The commissioner must provide to the carrier a detailed actuarial justification for any denial within thirty days of the denial.(j) For health benefit plans purchased through the health insurance partnership established in chapter 70.47A RCW:(i) Any surcharge established pursuant to RCW 70.47A.030(2)(e) shall be applied only to health benefit plans purchased through the health insurance partnership;
and(ii) Risk adjustment or reinsurance mechanisms may be used by the health insurance partnership program to redistribute funds to carriers participating in the health insurance partnership based on differences in risk attributable to individual choice of health plans or other factors unique to health insurance partnership participation.
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Use of such mechanisms shall be limited to the partnership program and will not affect small group health plans offered outside the partnership.(k) If the rate developed under this section varies the adjusted community rate for the factors listed in (a) of this subsection, the date for determining those factors must be no more than ninety days prior to the effective date of the health benefit plan.(4) Nothing in this section shall restrict the right of employees to collectively bargain for insurance providing benefits in excess of those provided herein.(5)(a) Except as provided in this subsection and subsection (3)(g) of this section, requirements used by an insurer in determining whether to provide coverage to a small employer shall be applied uniformly among all small employers applying for coverage or receiving coverage from the carrier.(b) An insurer shall not require a minimum participation level greater than:(i) One hundred percent of eligible employees working for groups with three or less employees;
and(ii) Seventy-five percent of eligible employees working for groups with more than three employees.(c) In applying minimum participation requirements with respect to a small employer, a small employer shall not consider employees or dependents who have similar existing coverage in determining whether the applicable percentage of participation is met.(d) An insurer may not increase any requirement for minimum employee participation or modify any requirement for minimum employer contribution applicable to a small employer at any time after the small employer has been accepted for coverage.(e) Minimum participation requirements and employer premium contribution requirements adopted by the health insurance partnership board under RCW 70.47A.110 shall apply only to the employers and employees who purchase health benefit plans through the health insurance partnership.(6) An insurer must offer coverage to all eligible employees of a small employer and their dependents.
An insurer may not offer coverage to only certain individuals or dependents in a small employer group or to only part of the group.
An insurer may not modify a health plan with respect to a small employer or any eligible employee or dependent, through riders, endorsements or otherwise, to restrict or exclude coverage or benefits for specific diseases, medical conditions, or services otherwise covered by the plan.(7) As used in this section, "health benefit plan," "small employer," "adjusted community rate," and "wellness activities" mean the same as defined in RCW 48.43.005.(8) This section applies only to grandfathered health plans as defined in RCW 48.43.005.Sec.
5.
RCW 48.44.022 and 2006 c 100 s 3 are each amended to read as follows:(1) Except for health benefit plans covered under RCW 48.44.021, premium rates for health benefit plans for individuals shall be subject to the following provisions:(a) The health care service contractor shall develop its rates based on an adjusted community rate and may only vary the adjusted community rate for:(i) Geographic area;(ii) Family size;(iii) Age;(iv) Tenure discounts;
and(v) Wellness activities.(b) The adjustment for age in (a)(iii) of this subsection may not use age brackets smaller than five-year increments which shall begin with age twenty and end with age sixty-five.
Individuals under the age of twenty shall be treated as those age twenty.(c) The health care service contractor shall be permitted to develop separate rates for individuals age sixty-five or older for coverage for which medicare is the primary payer and coverage for which medicare is not the primary payer.
Both rates shall be subject to the requirements of this subsection.(d) The permitted rates for any age group shall be no more than four hundred twenty-five percent of the lowest rate for all age groups on January 1, 1996, four hundred percent on January 1, 1997, and three hundred seventy-five percent on January 1, 2000, and thereafter.(e) A discount for wellness activities shall be permitted to reflect actuarially justified differences in utilization or cost attributed to such programs.(f) The rate charged for a health benefit plan offered under this section may not be adjusted more frequently than annually except that the premium may be changed to reflect:(i) Changes to the family composition;(ii) Changes to the health benefit plan requested by the individual;
or(iii) Changes in government requirements affecting the health benefit plan.(g) For the purposes of this section, a health benefit plan that contains a restricted network provision shall not be considered similar coverage to a health benefit plan that does not contain such a provision, provided that the restrictions of benefits to network providers result in substantial differences in claims costs.
((This subsection does not restrict or enhance the portability of benefits as provided in RCW 48.43.015.))(h) A tenure discount for continuous enrollment in the health plan of two years or more may be offered, not to exceed ten percent.(2) Adjusted community rates established under this section shall pool the medical experience of all individuals purchasing coverage, except individuals purchasing coverage under RCW 48.44.021, and shall not be required to be pooled with the medical experience of health benefit plans offered to small employers under RCW 48.44.023.(3) As used in this section and RCW 48.44.023 "health benefit plan," "small employer," "adjusted community rates," and "wellness activities" mean the same as defined in RCW 48.43.005.(4) This section applies only to grandfathered health plans as defined in RCW 48.43.005.Sec.
6.
RCW 48.44.023 and 2010 c 292 s 4 are each amended to read as follows:(1)(a) A health care services contractor offering any health benefit plan to a small employer, either directly or through an association or member-governed group formed specifically for the purpose of purchasing health care, may offer and actively market to the small employer a health benefit plan featuring a limited schedule of covered health care services.
Nothing in this subsection shall preclude a contractor from offering, or a small employer from purchasing, other health benefit plans that may have more comprehensive benefits than those included in the product offered under this subsection.
A contractor offering a health benefit plan under this subsection shall clearly disclose all covered benefits to the small employer in a brochure filed with the commissioner.(b) A health benefit plan offered under this subsection shall provide coverage for hospital expenses and services rendered by a physician licensed under chapter 18.57 or 18.71 RCW but is not subject to the requirements of RCW 48.44.225, 48.44.240, 48.44.245, 48.44.290, 48.44.300, 48.44.310, 48.44.320, 48.44.325, 48.44.330, 48.44.335, 48.44.344, 48.44.360, 48.44.400, 48.44.440, 48.44.450, and 48.44.460.(2) Nothing in this section shall prohibit a health care service contractor from offering, or a purchaser from seeking, health benefit plans with benefits in excess of the health benefit plan offered under subsection (1) of this section.
All forms, policies, and contracts shall be submitted for approval to the commissioner, and the rates of any plan offered under this section shall be reasonable in relation to the benefits thereto.(3) Premium rates for health benefit plans for small employers as defined in this section shall be subject to the following provisions:(a) The contractor shall develop its rates based on an adjusted community rate and may only vary the adjusted community rate for:(i) Geographic area;(ii) Family size;(iii) Age;
and(iv) Wellness activities.(b) The adjustment for age in (a)(iii) of this subsection may not use age brackets smaller than five-year increments, which shall begin with age twenty and end with age sixty-five.
Employees under the age of twenty shall be treated as those age twenty.(c) The contractor shall be permitted to develop separate rates for individuals age sixty-five or older for coverage for which medicare is the primary payer and coverage for which medicare is not the primary payer.
Both rates shall be subject to the requirements of this subsection (3).(d) The permitted rates for any age group shall be no more than four hundred twenty-five percent of the lowest rate for all age groups on January 1, 1996, four hundred percent on January 1, 1997, and three hundred seventy-five percent on January 1, 2000, and thereafter.(e) A discount for wellness activities shall be permitted to reflect actuarially justified differences in utilization or cost attributed to such programs.
Up to a twenty percent variance may be allowed for small employers that develop and implement a wellness program or activities that directly improve employee wellness.
Employers shall document program activities with the carrier and may, after three years of implementation, request a reduction in premiums based on improved employee health and wellness.
While carriers may review the employer's claim history when making a determination regarding whether the employer's wellness program has improved employee health, the carrier may not use maternity or prevention services claims to deny the employer's request.
Carriers may consider issues such as improved productivity or a reduction in absenteeism due to illness if submitted by the employer for consideration.
Interested employers may also work with the carrier to develop a wellness program and a means to track improved employee health.(f) The rate charged for a health benefit plan offered under this section may not be adjusted more frequently than annually except that the premium may be changed to reflect:(i) Changes to the enrollment of the small employer;(ii) Changes to the family composition of the employee;(iii) Changes to the health benefit plan requested by the small employer;
or(iv) Changes in government requirements affecting the health benefit plan.(g) On the census date, as defined in RCW 48.44.010, rating factors shall produce premiums for identical groups that differ only by the amounts attributable to plan design, and differences in census date between new and renewal groups, with the exception of discounts for health improvement programs.(h) For the purposes of this section, a health benefit plan that contains a restricted network provision shall not be considered similar coverage to a health benefit plan that does not contain such a provision, provided that the restrictions of benefits to network providers result in substantial differences in claims costs.
A carrier may develop its rates based on claims costs due to network provider reimbursement schedules or type of network.
((This subsection does not restrict or enhance the portability of benefits as provided in RCW 48.43.015.))(i) Adjusted community rates established under this section shall pool the medical experience of all groups purchasing coverage, including the small group participants in the health insurance partnership established in RCW 70.47A.030.
(j) For health benefit plans purchased through the health insurance partnership established in chapter 70.47A RCW:(i) Any surcharge established pursuant to RCW 70.47A.030(2)(e) shall be applied only to health benefit plans purchased through the health insurance partnership;
and(ii) Risk adjustment or reinsurance mechanisms may be used by the health insurance partnership program to redistribute funds to carriers participating in the health insurance partnership based on differences in risk attributable to individual choice of health plans or other factors unique to health insurance partnership participation.
Use of such mechanisms shall be limited to the partnership program and will not affect small group health plans offered outside the partnership.(k) If the rate developed under this section varies the adjusted community rate for the factors listed in (a) of this subsection, the date for determining those factors must be no more than ninety days prior to the effective date of the health benefit plan.(4) Nothing in this section shall restrict the right of employees to collectively bargain for insurance providing benefits in excess of those provided herein.(5)(a) Except as provided in this subsection and subsection (3)(g) of this section, requirements used by a contractor in determining whether to provide coverage to a small employer shall be applied uniformly among all small employers applying for coverage or receiving coverage from the carrier.(b) A contractor shall not require a minimum participation level greater than:(i) One hundred percent of eligible employees working for groups with three or less employees;
and(ii) Seventy-five percent of eligible employees working for groups with more than three employees.(c) In applying minimum participation requirements with respect to a small employer, a small employer shall not consider employees or dependents who have similar existing coverage in determining whether the applicable percentage of participation is met.(d) A contractor may not increase any requirement for minimum employee participation or modify any requirement for minimum employer contribution applicable to a small employer at any time after the small employer has been accepted for coverage.(e) Minimum participation requirements and employer premium contribution requirements adopted by the health insurance partnership board under RCW 70.47A.110 shall apply only to the employers and employees who purchase health benefit plans through the health insurance partnership.(6) A contractor must offer coverage to all eligible employees of a small employer and their dependents.
A contractor may not offer coverage to only certain individuals or dependents in a small employer group or to only part of the group.
A contractor may not modify a health plan with respect to a small employer or any eligible employee or dependent, through riders, endorsements or otherwise, to restrict or exclude coverage or benefits for specific diseases, medical conditions, or services otherwise covered by the plan.(7) This section applies only to grandfathered health plans as defined in RCW 48.43.005.Sec.
7.
RCW 48.46.064 and 2006 c 100 s 5 are each amended to read as follows:(1) Except for health benefit plans covered under RCW 48.46.063, premium rates for health benefit plans for individuals shall be subject to the following provisions:(a) The health maintenance organization shall develop its rates based on an adjusted community rate and may only vary the adjusted community rate for:(i) Geographic area;(ii) Family size;(iii) Age;(iv) Tenure discounts;
and(v) Wellness activities.(b) The adjustment for age in (a)(iii) of this subsection may not use age brackets smaller than five-year increments which shall begin with age twenty and end with age sixty-five.
Individuals under the age of twenty shall be treated as those age twenty.(c) The health maintenance organization shall be permitted to develop separate rates for individuals age sixty-five or older for coverage for which medicare is the primary payer and coverage for which medicare is not the primary payer.
Both rates shall be subject to the requirements of this subsection.(d) The permitted rates for any age group shall be no more than four hundred twenty-five percent of the lowest rate for all age groups on January 1, 1996, four hundred percent on January 1, 1997, and three hundred seventy-five percent on January 1, 2000, and thereafter.(e) A discount for wellness activities shall be permitted to reflect actuarially justified differences in utilization or cost attributed to such programs.(f) The rate charged for a health benefit plan offered under this section may not be adjusted more frequently than annually except that the premium may be changed to reflect:(i) Changes to the family composition;(ii) Changes to the health benefit plan requested by the individual;
or(iii) Changes in government requirements affecting the health benefit plan.(g) For the purposes of this section, a health benefit plan that contains a restricted network provision shall not be considered similar coverage to a health benefit plan that does not contain such a provision, provided that the restrictions of benefits to network providers result in substantial differences in claims costs.
((This subsection does not restrict or enhance the portability of benefits as provided in RCW 48.43.015.))(h) A tenure discount for continuous enrollment in the health plan of two years or more may be offered, not to exceed ten percent.(2) Adjusted community rates established under this section shall pool the medical experience of all individuals purchasing coverage, except individuals purchasing coverage under RCW 48.46.063, and shall not be required to be pooled with the medical experience of health benefit plans offered to small employers under RCW 48.46.066.(3) As used in this section and RCW 48.46.066, "health benefit plan," "adjusted community rate," "small employer," and "wellness activities" mean the same as defined in RCW 48.43.005.(4) This section applies only to grandfathered health plans as defined in RCW 48.43.005.Sec.
8.
RCW 48.46.066 and 2010 c 292 s 6 are each amended to read as follows:(1)(a) A health maintenance organization offering any health benefit plan to a small employer, either directly or through an association or member-governed group formed specifically for the purpose of purchasing health care, may offer and actively market to the small employer a health benefit plan featuring a limited schedule of covered health care services.
Nothing in this subsection shall preclude a health maintenance organization from offering, or a small employer from purchasing, other health benefit plans that may have more comprehensive benefits than those included in the product offered under this subsection.
A health maintenance organization offering a health benefit plan under this subsection shall clearly disclose all the covered benefits to the small employer in a brochure filed with the commissioner.(b) A health benefit plan offered under this subsection shall provide coverage for hospital expenses and services rendered by a physician licensed under chapter 18.57 or 18.71 RCW but is not subject to the requirements of RCW 48.46.275, 48.46.280, 48.46.285, 48.46.350, 48.46.355, 48.46.375, 48.46.440, 48.46.480, 48.46.510, 48.46.520, and 48.46.530.(2) Nothing in this section shall prohibit a health maintenance organization from offering, or a purchaser from seeking, health benefit plans with benefits in excess of the health benefit plan offered under subsection (1) of this section.
All forms, policies, and contracts shall be submitted for approval to the commissioner, and the rates of any plan offered under this section shall be reasonable in relation to the benefits thereto.(3) Premium rates for health benefit plans for small employers as defined in this section shall be subject to the following provisions:(a) The health maintenance organization shall develop its rates based on an adjusted community rate and may only vary the adjusted community rate for:(i) Geographic area;(ii) Family size;(iii) Age;
and(iv) Wellness activities.(b) The adjustment for age in (a)(iii) of this subsection may not use age brackets smaller than five-year increments, which shall begin with age twenty and end with age sixty-five.
Employees under the age of twenty shall be treated as those age twenty.(c) The health maintenance organization shall be permitted to develop separate rates for individuals age sixty-five or older for coverage for which medicare is the primary payer and coverage for which medicare is not the primary payer.
Both rates shall be subject to the requirements of this subsection (3).(d) The permitted rates for any age group shall be no more than four hundred twenty-five percent of the lowest rate for all age groups on January 1, 1996, four hundred percent on January 1, 1997, and three hundred seventy-five percent on January 1, 2000, and thereafter.(e) A discount for wellness activities shall be permitted to reflect actuarially justified differences in utilization or cost attributed to such programs.
Up to a twenty percent variance may be allowed for small employers that develop and implement a wellness program or activities that directly improve employee wellness.
Employers shall document program activities with the carrier and may, after three years of implementation, request a reduction in premiums based on improved employee health and wellness.
While carriers may review the employer's claim history when making a determination regarding whether the employer's wellness program has improved employee health, the carrier may not use maternity or prevention services claims to deny the employer's request.
Carriers may consider issues such as improved productivity or a reduction in absenteeism due to illness if submitted by the employer for consideration.
Interested employers may also work with the carrier to develop a wellness program and a means to track improved employee health.(f) The rate charged for a health benefit plan offered under this section may not be adjusted more frequently than annually except that the premium may be changed to reflect:(i) Changes to the enrollment of the small employer;(ii) Changes to the family composition of the employee;(iii) Changes to the health benefit plan requested by the small employer;
or(iv) Changes in government requirements affecting the health benefit plan.(g) On the census date, as defined in RCW 48.46.020, rating factors shall produce premiums for identical groups that differ only by the amounts attributable to plan design, and differences in census date between new and renewal groups, with the exception of discounts for health improvement programs.(h) For the purposes of this section, a health benefit plan that contains a restricted network provision shall not be considered similar coverage to a health benefit plan that does not contain such a provision, provided that the restrictions of benefits to network providers result in substantial differences in claims costs.
A carrier may develop its rates based on claims costs due to network provider reimbursement schedules or type of network.
((This subsection does not restrict or enhance the portability of benefits as provided in RCW 48.43.015.))(i) Adjusted community rates established under this section shall pool the medical experience of all groups purchasing coverage, including the small group participants in the health insurance partnership established in RCW 70.47A.030.
However, annual rate adjustments for each small group health benefit plan may vary by up to plus or minus four percentage points from the overall adjustment of a carrier's entire small group pool, such overall adjustment to be approved by the commissioner, upon a showing by the carrier, certified by a member of the American academy of actuaries that:
(i) The variation is a result of deductible leverage, benefit design, or provider network characteristics;
and (ii) for a rate renewal period, the projected weighted average of all small group benefit plans will have a revenue neutral effect on the carrier's small group pool.
Variations of greater than four percentage points are subject to review by the commissioner, and must be approved or denied within sixty days of submittal.
A variation that is not denied within sixty days shall be deemed approved.
The commissioner must provide to the carrier a detailed actuarial justification for any denial within thirty days of the denial.(j) For health benefit plans purchased through the health insurance partnership established in chapter 70.47A RCW:(i) Any surcharge established pursuant to RCW 70.47A.030(2)(e) shall be applied only to health benefit plans purchased through the health insurance partnership;
and(ii) Risk adjustment or reinsurance mechanisms may be used by the health insurance partnership program to redistribute funds to carriers participating in the health insurance partnership based on differences in risk attributable to individual choice of health plans or other factors unique to health insurance partnership participation.
Use of such mechanisms shall be limited to the partnership program and will not affect small group health plans offered outside the partnership.(k) If the rate developed under this section varies the adjusted community rate for the factors listed in (a) of this subsection, the date for determining those factors must be no more than ninety days prior to the effective date of the health benefit plan.(4) Nothing in this section shall restrict the right of employees to collectively bargain for insurance providing benefits in excess of those provided herein.(5)(a) Except as provided in this subsection and subsection (3)(g) of this section, requirements used by a health maintenance organization in determining whether to provide coverage to a small employer shall be applied uniformly among all small employers applying for coverage or receiving coverage from the carrier.(b) A health maintenance organization shall not require a minimum participation level greater than:(i) One hundred percent of eligible employees working for groups with three or less employees;
and(ii) Seventy-five percent of eligible employees working for groups with more than three employees.(c) In applying minimum participation requirements with respect to a small employer, a small employer shall not consider employees or dependents who have similar existing coverage in determining whether the applicable percentage of participation is met.(d) A health maintenance organization may not increase any requirement for minimum employee participation or modify any requirement for minimum employer contribution applicable to a small employer at any time after the small employer has been accepted for coverage.(e) Minimum participation requirements and employer premium contribution requirements adopted by the health insurance partnership board under RCW 70.47A.110 shall apply only to the employers and employees who purchase health benefit plans through the health insurance partnership.(6) A health maintenance organization must offer coverage to all eligible employees of a small employer and their dependents.
A health maintenance organization may not offer coverage to only certain individuals or dependents in a small employer group or to only part of the group.
A health maintenance organization may not modify a health plan with respect to a small employer or any eligible employee or dependent, through riders, endorsements or otherwise, to restrict or exclude coverage or benefits for specific diseases, medical conditions, or services otherwise covered by the plan.(7) This section applies only to grandfathered health plans as defined in RCW 48.43.005.PART IIIGUARANTEED ISSUE AND ELIGIBILITYSec.
9.
3.
10.
4.
11.
5.
12.
6.
13.
7.
14.
and(4) RCW 48.43.025 (Group health benefit plans—Preexisting conditions) and 2001 c 196 s 9, 2000 c 79 s 23, & 1995 c 265 s 6.PART IIIPROHIBITING UNFAIR RESCISSIONSNEW SECTION.  Sec.
and(4) RCW 48.43.025 (Group health benefit plans—Preexisting conditions) and 2001 c 196 s 9, 2000 c 79 s 23, & 1995 c 265 s 6.PART IVPROHIBITING UNFAIR RESCISSIONSNEW SECTION.  Sec.
8.
15.
The plan or coverage may not be canceled except as permitted under RCW 48.43.035 or 48.43.038.(2) The commissioner shall adopt any rules necessary to implement this section, consistent with federal rules and guidance in effect on January 1, 2017, implementing the patient protection and affordable care act.PART IVESSENTIAL HEALTH BENEFITSSec.
The plan or coverage may not be canceled except as permitted under RCW 48.43.035 or 48.43.038.(2) The commissioner shall adopt any rules necessary to implement this section, consistent with federal rules and guidance in effect on January 1, 2017, implementing the patient protection and affordable care act.PART VESSENTIAL HEALTH BENEFITSSec.
9.
16.
The commissioner may enforce a mandate on the list for the entire market only if funds are appropriated in an omnibus appropriations act specifically to pay the state portion of the identified costs.PART VCOST SHARINGNEW SECTION.  Sec.
The commissioner may enforce a mandate on the list for the entire market only if funds are appropriated in an omnibus appropriations act specifically to pay the state portion of the identified costs.PART VICOST SHARINGNEW SECTION.  Sec.
10.
17.
or(ii) If there are no cost-sharing requirements under federal law, sixteen thousand four hundred dollars increased by the premium adjustment percentage for the calendar year.(2) Regardless of whether an enrollee is covered by a self-only plan or a plan that is other than self-only, the enrollee's cost sharing for the essential health benefits may not exceed the self-only annual limitation on cost sharing.(3) For purposes of this section, "the premium adjustment percentage for the calendar year" means the percentage, if any, by which the average per capita premium for health insurance in Washington for the preceding year, as estimated by the commissioner no later than April 1st of such preceding year, exceeds such average per capita premium for 2020 as determined by the commissioner.(4) Unless preempted by federal law, the commissioner shall adopt any rules necessary to implement this section, consistent with federal rules and guidance in effect on January 1, 2017, implementing the patient protection and affordable care act.PART VIOPEN ENROLLMENT PERIODSSec.
or(ii) If there are no cost-sharing requirements under federal law, sixteen thousand four hundred dollars increased by the premium adjustment percentage for the calendar year.(2) Regardless of whether an enrollee is covered by a self-only plan or a plan that is other than self-only, the enrollee's cost sharing for the essential health benefits may not exceed the self-only annual limitation on cost sharing.(3) For purposes of this section, "the premium adjustment percentage for the calendar year" means the percentage, if any, by which the average per capita premium for health insurance in Washington for the preceding year, as estimated by the commissioner no later than April 1st of such preceding year, exceeds such average per capita premium for 2020 as determined by the commissioner.(4) Unless preempted by federal law, the commissioner shall adopt any rules necessary to implement this section, consistent with federal rules and guidance in effect on January 1, 2017, implementing the patient protection and affordable care act.PART VIIOPEN ENROLLMENT PERIODSSec.
11.
18.
RCW 48.43.0122 and 2011 c 315 s 4 are each amended to read as follows:(1) The commissioner shall adopt rules establishing and implementing requirements for the open enrollment periods and special enrollment periods that carriers must follow for individual health benefit plans ((and enrollment of persons under age nineteen)).(2) The commissioner shall monitor the sale of individual health benefit plans and if a carrier refuses to sell guaranteed issue policies to persons ((under age nineteen)) in compliance with rules adopted by the commissioner pursuant to subsection (1) of this section, the commissioner may levy fines or suspend or revoke a certificate of authority as provided in chapter 48.05 RCW.PART VIILIFETIME LIMITSNEW SECTION.  Sec.
RCW 48.43.0122 and 2011 c 315 s 4 are each amended to read as follows:(1) The commissioner shall adopt rules establishing and implementing requirements for the open enrollment periods and special enrollment periods that carriers must follow for individual health benefit plans ((and enrollment of persons under age nineteen)).(2) The commissioner shall monitor the sale of individual health benefit plans and if a carrier refuses to sell guaranteed issue policies to persons ((under age nineteen)) in compliance with rules adopted by the commissioner pursuant to subsection (1) of this section, the commissioner may levy fines or suspend or revoke a certificate of authority as provided in chapter 48.05 RCW.PART VIIILIFETIME LIMITSNEW SECTION.  Sec.
12.
19.
A new section is added to chapter 48.43 RCW to read as follows:A health carrier may not impose annual or lifetime dollar limits on an essential health benefit, other than those permitted as reference-based limitations under rules adopted by the commissioner.PART VIIIEXPLANATION OF COVERAGENEW SECTION.  Sec.
A new section is added to chapter 48.43 RCW to read as follows:A health carrier may not impose annual or lifetime dollar limits on an essential health benefit, other than those permitted as reference-based limitations under rules adopted by the commissioner.PART IXMEDICAL LOSS RATIOSNEW SECTION.  Sec.
13.
20.
A new section is added to chapter 48.43 RCW to read as follows:(1) A health carrier offering an individual or group health plan shall, with respect to each plan year, submit to the commissioner a report concerning the ratio of the incurred loss or incurred claims plus the loss adjustment expense or change in contract reserves to earned premiums.
The report must include the percentage of total premium revenue, after accounting for collections or receipts under the federal risk adjustment program, that the coverage expends:(a) On reimbursement for clinical services provided to enrollees under the coverage;(b) For activities that improve health care quality;
and(c) On all other nonclaims costs, including an explanation of the nature of the costs and excluding federal and state taxes and licensing or regulatory fees.(2)(a) A health carrier offering an individual or group health plan shall, with respect to each plan year, provide an annual rebate to each enrollee under the health plan, on a pro rata basis, if the ratio of the amount of premium revenue expended by the carrier on costs described in subsection (1)(a) and (b) of this section to the total amount of premium revenue, excluding federal and state taxes and licensing or regulatory fees and after accounting for payments or receipts under the federal risk adjustment program, for the plan year is less than:(i) Eighty-five percent for large group market health plans;
or(ii) Eighty percent for individual or small group market health plans.(b) The determination made under this subsection must be based on the averages of the premiums expended on the costs and total premium revenue for each of the previous three years for the plan.(3) The total amount of the rebate required under this section must be in an amount equal to the product of:(a) The amount by which the percentage required under subsection (2)(a)(i) or (ii) of this section exceeds the ratio calculated under subsection (2)(a) of this section;
and(b) The total amount of premium revenue, excluding federal and state taxes and licensing or regulatory fees and after accounting for payments or receipts under the federal risk adjustment program, for the plan year.(4) The commissioner may, by rule, increase the percentages required under subsection (2)(a)(i) and (ii) of this section.
When determining the percentages, the commissioner must seek to ensure adequate participation by health carriers, competition in the health insurance market in the state, and value for consumers so that premiums are used for clinical services and quality improvements.(5) When enforcing this section, the commissioner shall use definitions established by the national association of insurance commissioners to implement 42 U.S.C.
Sec.
300gg-18 as it existed on the effective date of this section.
The commissioner shall, by rule, adopt changes to the definitions based on changes made by the national association of insurance commissioners.(6) Unless preempted by federal law, the commissioner shall adopt any rules necessary to implement this section, consistent with federal rules and guidance in effect on January 1, 2017, implementing the patient protection and affordable care act.NEW SECTION.  Sec.
21.
The following acts or parts of acts are each repealed:(1) RCW 48.20.025 (Schedule of rates for individual health benefit plans—Loss ratio—Definitions) and 2011 c 314 s 10, 2008 c 303 s 4, 2003 c 248 s 8, 2001 c 196 s 1, & 2000 c 79 s 3;(2) RCW 48.44.017 (Schedule of rates for individual contracts—Loss ratio—Definitions) and 2011 c 314 s 11, 2008 c 303 s 5, 2001 c 196 s 11, & 2000 c 79 s 29;
and(3) RCW 48.46.062 (Schedule of rates for individual agreements—Loss ratio—Definitions) and 2011 c 314 s 12, 2008 c 303 s 6, 2001 c 196 s 12, & 2000 c 79 s 32.PART XEXPLANATION OF COVERAGENEW SECTION.  Sec.
22.
and(b) Medical terms, including hospitalization, hospital outpatient care, emergency room care, physician services, prescription drug coverage, durable medical equipment, home health care, skilled nursing care, rehabilitation services, hospice services, emergency medical transportation, and any other terms the commissioner determines are important to define so that consumers may compare the medical benefits offered by health insurance and understand the extent of those medical benefits or exceptions to those benefits.(9) Unless preempted by federal law, the commissioner shall adopt any rules necessary to implement this section, consistent with federal rules and guidance in effect on January 1, 2017, implementing the patient protection and affordable care act.PART IXWAITING PERIODS FOR GROUP COVERAGENEW SECTION.  Sec.
and(b) Medical terms, including hospitalization, hospital outpatient care, emergency room care, physician services, prescription drug coverage, durable medical equipment, home health care, skilled nursing care, rehabilitation services, hospice services, emergency medical transportation, and any other terms the commissioner determines are important to define so that consumers may compare the medical benefits offered by health insurance and understand the extent of those medical benefits or exceptions to those benefits.(9) Unless preempted by federal law, the commissioner shall adopt any rules necessary to implement this section, consistent with federal rules and guidance in effect on January 1, 2017, implementing the patient protection and affordable care act.PART XIWAITING PERIODS FOR GROUP COVERAGENEW SECTION.  Sec.
14.
23.
A new section is added to chapter 48.43 RCW to read as follows:(1) A group health plan and a health carrier offering group health coverage may not apply any waiting period that exceeds ninety days.(2) Unless preempted by federal law, the commissioner shall adopt any rules necessary to implement this section, consistent with federal rules and guidance in effect on January 1, 2017, implementing the patient protection and affordable care act.PART XPROHIBITING ISSUER AND HEALTH PLAN DISCRIMINATIONNEW SECTION.  Sec.
A new section is added to chapter 48.43 RCW to read as follows:(1) A group health plan and a health carrier offering group health coverage may not apply any waiting period that exceeds ninety days.(2) Unless preempted by federal law, the commissioner shall adopt any rules necessary to implement this section, consistent with federal rules and guidance in effect on January 1, 2017, implementing the patient protection and affordable care act.--- END ---
15.
A new section is added to chapter 48.43 RCW to read as follows:(1) A health carrier offering a health plan:(a) May not make coverage decisions, determine reimbursement rates, establish incentive programs, or design benefits in ways that discriminate against individuals because of their age, disability, or expected length of life;
and(b) Must ensure that essential health benefits are not subject to denial to individuals against their wishes on the basis of the individuals' age or expected length of life or of the individuals' present or predicted disability, degree of medical dependency, or quality of life.(2) Unless preempted by federal law, the commissioner shall adopt any rules necessary to implement this section, consistent with federal rules and guidance in effect on January 1, 2017, implementing the patient protection and affordable care act.NEW SECTION.  Sec.
16.
A new section is added to chapter 43.71 RCW to read as follows:(1) For qualified health plans, an issuer offering a qualified health plan may not employ marketing practices or benefit designs that have the effect of discouraging enrollment in the plan by individuals with significant health needs.(2) Unless preempted by federal law, the commissioner shall adopt any rules necessary to implement this section, consistent with federal rules and guidance in effect on January 1, 2017, implementing the patient protection and affordable care act.--- END ---
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Action History

  1. By resolution, reintroduced and retained in present status.

  2. By resolution, reintroduced and retained in present status.

  3. Senate Rules "X" file.

  4. Senate Rules "X" file.

  5. Placed on second reading by Rules Committee.

  6. Placed on second reading by Rules Committee.

  7. Made eligible to be placed on second reading.

  8. Made eligible to be placed on second reading.

  9. Passed to Rules Committee for second reading.

  10. Passed to Rules Committee for second reading.

  11. Scheduled for public hearing in the Senate Committee on Health & Long Term Care at 05:30 PM

  12. Minority; without recommendation.

  13. Minority; do not pass.

  14. HLTC - Majority; 1st substitute bill be substituted, do pass.

  15. Minority; without recommendation.

  16. Minority; do not pass.

  17. HLTC - Majority; 1st substitute bill be substituted, do pass.

  18. Scheduled for public hearing in the Senate Committee on Health & Long Term Care at 08:00 AM

  19. First reading, referred to Health & Long Term Care.

Sponsors

Sponsorship breakdown

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1 sponsors · 26 co-sponsors · 124 not signed on

Sponsors (1)

Co-sponsors (26)

Not signed on (124)

124 members have not signed on to this bill.

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"Not signed on" means a member has not sponsored or co-sponsored this bill — it does not imply opposition. Members flagged Voted No have a recorded No vote on this bill.

Whip count is in markup. Polling the chamber and every recorded vote this session. Only the first open is slow. It’s instant for you after this. Calling the roll · Tallying · Engrossing

Subjects

healthcare health-insurance
Cross-referencing the record. Reading this bill against every other bill in the corpus by meaning, not keywords. Only the first open is slow. It’s instant for you after this. Matching · Ranking · Engrossing

Frequently asked questions

Who sponsors SB 5805?
SB 5805 is sponsored by Jesse Salomon (Democrat), Das, Marko Liias (Democrat), Hobbs, Palumbo, Manka Dhingra (Democrat), Annette Cleveland (Democrat), Lisa Wellman (Democrat), Randall, Billig, Jamie Pedersen (Democrat), Rebecca Saldaña (Democrat), Carlyle, Kuderer, Steve Conway (Democrat), Darneille, Bob Hasegawa (Democrat), Takko, Keiser, Frockt, Mullet, Rolfes, McCoy, Victoria Hunt (Democrat), Claire Wilson (Democrat), Joe Nguyen (Democrat), and Van De Wege.
What is the current status of SB 5805?
This bill died with 2019-2020 Regular Session. It reached “Passed Senate” and never advanced before the session ended, so it can no longer move — a new version would have to be reintroduced in the current session.
Where can I track SB 5805?
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