Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-43 - Health carriers and health plans › Subchapter B - PLAN MANAGEMENT › Section 284-43-0210 - Transitional reinsurance program

Current through Register Vol. 24-14, July 15, 2024
(1) Issuers of health benefit plans in
				Washington state, and third party administrators of health benefit coverage
				offered in Washington, must participate as contributing entities in the
				transitional reinsurance program established pursuant to RCW
				 48.43.720.
(2) The U.S. Department
				of Health and Human Services (HHS) will operate the transitional health plan
				reinsurance program for the state of Washington. The program ceases operation
				on June 30, 2017, for payment of claims incurred through December 31,
				2016.
(3) Contributing entities are
				not required to remit reinsurance contributions for the following types of
				coverage:
(a) Coverage only for accident, or
				disability income insurance, or any combination thereof;
(b) Coverage issued as a supplement to
				liability insurance;
(c) Liability
				insurance, including general liability insurance and automobile liability
				insurance;
(d) Workers'
				compensation or similar insurance;
(e) Automobile medical payment
				insurance;
(f) Credit-only
				insurance;
(g) Coverage for on-site
				medical clinics;
(h) Limited scope
				dental or vision benefits;
(i)
				Benefits for long-term care, nursing home care, home health care,
				community-based care or any combination thereof;
(j) Benefits provided under a health flexible
				spending arrangement as defined in Internal Revenue Code, Section 106 (c)(2)
				("Health FSA") if other group health plan coverage, not limited to excepted
				benefits, is made available for the year to the class of participants by reason
				of their employment, and the Health FSA is structured so that the maximum
				benefit payable to any participant in the class for a year cannot exceed two
				times the participant's salary reduction election under the arrangement for the
				year (or, if greater, cannot exceed five hundred dollars plus the amount of the
				participant's salary reduction election). For this purpose, any amount that an
				employee can elect to receive as taxable income but elects to apply to the
				Health FSA is considered a salary reduction election (regardless of whether the
				amount is characterized as salary or as a credit under the Health
				FSA);
(k) Coverage for a specified
				disease or illness, if offered as independent, noncoordinated
				benefits;
(l) Hospital indemnity or
				other fixed indemnity insurance if offered as independent, noncoordinated
				benefits;
(m) Medicare supplemental
				health insurance, and similar supplemental coverage provided to coverage under
				a group health plan, provided such coverage is offered as a separate insurance
				policy;
(n) Other similar insurance
				coverage under which benefits for medical care are secondary or incidental to
				other insurance benefits, or that qualify as HIPAA-excepted benefits;
(o) Medicare advantage, medicaid, or any
				federal coverage program except multistate Office of Personnel Management
				plans;
(p) Washington state health
				insurance pool and the Preexisting Condition Insurance Plan -
				Washington.