Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-43 - Health carriers and health plans › Subchapter M - SHORT-TERM LIMITED DURATION MEDICAL PLANS › Section 284-43-8130 - Association health plan compliance with statutory or regulatory changes

Current through Register Vol. 24-14, July 15, 2024
(1) Issuers must
				file a group health plan, other than a small group health plan, rate and form
				filing as provided in
				RCW
				 48.43.733. An issuer offering plans through
				an association or member-governed group must implement all new applicable
				federal or state health plan market requirements when they become effective.
				Replacement requirements for this section apply based on whether the purchaser
				is classified as an individual, small group, or large group purchaser. These
				requirements also apply to employer member groups of less than two or to
				individual member purchasers.
(2)
				An issuer providing plans of the type referenced in subsection (1) of this
				section must discontinue a noncompli-ant plan, and offer replacement plans
				effective on the renewal date of the master group contract for large groups,
				and on the group's anniversary renewal date for nongrandfathered small group
				and individual plans.
(3) If the
				association is a large group as defined in WAC
				284-43-8140(1),
				the same renewal date must apply to all employer members and individual
				employer members, and the replacement coverage must take effect on the same
				date for each participant. The purchaser's anniversary date must not be used in
				lieu of this uniform renewal date for purposes of discontinuation and
				replacement of noncompliant coverage.
(4) If the association is not a large group
				as defined in WAC
				284-43-8140(1),
				and the master group contract and an employer member's contract do not have the
				same renewal date, an issuer must provide notice of the discontinuation and
				replacement of the plan to the affected employer member or plan sponsor, and
				each enrollee in the affected employer member plan, not fewer than ninety days
				prior to the employer member's anniversary renewal date.
(5) If an issuer does not have a replacement
				plan approved by the commissioner to offer in place of a discontinued plan, the
				issuer must assist each enrollee in identifying a replacement option offered by
				another issuer.
(6) For purposes of
				this section, "purchaser" means the group or individual whose eligibility for
				the plan is based in whole or in part on membership in the association or
				member-governed group.
(7) For
				purposes of this section, the "anniversary renewal date" means the initial or
				first date on which a purchasing group's health benefit plan coverage became
				effective with the issuer, regardless of whether the issuer is subject to other
				agreements, contracts or trust documents that establish requirements related to
				the purchaser's coverage in addition to the health benefit plan.
(8) An issuer must not adjust the master
				contract renewal or anniversary date to delay or prevent application of any
				federal or state health plan market requirement.