(1) On or before December
31, 2007, the pool shall cancel all existing pool policies and
replace them with policies that are identical to the existing
policies except for the inclusion of a provision providing for a
guarantee of the continuity of coverage consistent with this
section. As a means to minimize the number of policy changes for
enrollees, replacement policies provided under this subsection
also may include the plan modifications authorized in RCW 48.41.100, 48.41.110, and 48.41.120.
(2) A pool policy shall contain a guarantee of the
individual's right to continued coverage, subject to the
provisions of subsections (4) and (5) of this section.
(3) The guarantee of continuity of coverage required by this
section shall not prevent the pool from canceling or nonrenewing
a policy for:
(a) Nonpayment of premium;
(b) Violation of published policies of the pool;
(c) Failure of a covered person who becomes eligible for
medicare benefits by reason of age to apply for a pool medical
supplement plan, or a medicare supplement plan or other similar
plan offered by a carrier pursuant to federal laws and
regulations;
(d) Failure of a covered person to pay any deductible or
copayment amount owed to the pool and not the provider of health
care services;
(e) Covered persons committing fraudulent acts as to the
pool;
(f) Covered persons materially breaching the pool policy; or
(g) Changes adopted to federal or state laws when such
changes no longer permit the continued offering of such coverage.
(4)(a) The guarantee of continuity of coverage provided by
this section requires that if the pool replaces a plan, it must
make the replacement plan available to all individuals in the
plan being replaced. The replacement plan must include all of
the services covered under the replaced plan, and must not
significantly limit access to the kind of services covered under
the replacement plan through unreasonable cost-sharing
requirements or otherwise. The pool may also allow individuals
who are covered by a plan that is being replaced an unrestricted
right to transfer to a fully comparable plan.
(b) The guarantee of continuity of coverage provided by this
section requires that if the pool discontinues offering a plan:
(i) The pool must provide notice to each individual of the
discontinuation at least ninety days prior to the date of the
discontinuation; (ii) the pool must offer to each individual
provided coverage under the discontinued plan the option to
enroll in any other plan currently offered by the pool for which
the individual is otherwise eligible; and (iii) in exercising the
option to discontinue a plan and in offering the option of
coverage under (b)(ii) of this subsection, the pool must act
uniformly without regard to any health status-related factor of
enrolled individuals or individuals who may become eligible for
this coverage.
(c) The pool cannot replace or discontinue a plan under this
subsection (4) until it has completed an evaluation of the impact
of replacing the plan upon:
(i) The cost and quality of care to pool enrollees;
(ii) Pool financing and enrollment;
(iii) The board's ability to offer comprehensive and other
plans to its enrollees;
(iv) Other items identified by the board.
In its evaluation, the board must request input from the
constituents represented by the board members.
(d) The guarantee of continuity of coverage provided by this
section does not apply if the pool has zero enrollment in a plan.
(5) The pool may not change the rates for pool policies
except on a class basis, with a clear disclosure in the policy of
the pool's right to do so.
(6) A pool policy offered under this chapter shall provide
that, upon the death of the individual in whose name the policy
is issued, every other individual then covered under the policy
may elect, within a period specified in the policy, to continue
coverage under the same or a different policy.
[2007 c 259 § 27; 1987 c 431 § 16.]
NOTES:
Severability -- Subheadings not law -- 2007 c 259: See notes following RCW 41.05.033.