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 284-43-8110 - Requirements for Pathway 1 Association Health Plan form filings related to the bona fide status of Pathway 1 Associations

Current through Register Vol. 24-14, July 15, 2024
(1) Carriers must file a group health plan,
				other than a small group health plan, rate and form filing as provided in
				RCW
				 48.43.733. The form filing for an association
				health plan submitted by a carrier must include documents related to "Evidence
				as an Employer." The documents must include, at a minimum:
(a) The member-governed group or
				association's bylaws, or other comparable controlling documents if no bylaws
				exist;
(b) A trust agreement or
				other organizational document that shows the purpose of the member-governed
				group or association and who governs the member-governed group or
				association;
(c) A statement of the
				member-governed group or association's history;
(d) An advisory opinion from the Department,
				if available, demonstrating that the member-governed group or association is
				qualified to purchase association health plan coverage; and
(e) If a Department advisory opinion is not
				available or if changes have been made to the documents related to "Evidence as
				an Employer" such that the Department advisory opinion no longer accurately
				reflects the composition, organization or structure of the member-governed
				group or association with respect to the factors included in (e)(ii) of this
				subsection, an opinion from an attorney attesting to the fact that the
				member-governed group or association qualifies as an employer under  29 U.S.C. Sec. 1002(5). The attorney attestation must explain how and why the
				member-governed group or association meets each of the criteria below, based
				upon the facts and circumstances of the member-governed group's or
				association's governance and operations during the twelve months immediately
				preceding submission of the form filing, with explicit references to relevant
				language drawn from the member-governed group or association's bylaws, trust
				agreement, or other organizational document:
(i) The member-governed group or association
				has been formed for some purpose other than the provision of health coverage or
				other employee benefits;
(ii) The
				employer members of the member-governed group or association are in the same
				trade, industry, line of business or profession. A list of the occupational
				categories/industrial classifications of the employers eligible to participate
				in the member-governed group or association must be submitted with the
				attestation, along with a description of the following:
(A) How employer members are
				solicited;
(B) Eligibility criteria
				to participate in the member-governed group or association;
(C) Employer members who are currently
				participating in the member-governed group or association;
(D) The process by which the member-governed
				group or association was formed;
(E) The purpose for the formation of the
				member-governed group or association;
(F) Preexisting relationships of any of the
				employer members of the member-governed group or association;
(G) The powers, rights, and privileges of
				employer members that exist by reason of their status as employers;
(H) The functions and activities of the
				member-governed group or association are controlled by its employer members,
				and the member-governed group's or association's employer members that
				participate in the group health plan control the plan. Control must be present
				both in form and substance.
(f) Each employer member of the
				member-governed group or association participating in the group health plan is
				a person acting directly as an employer of at least one employee who is a
				participant covered under the health plan.