(1) In addition to the requirements under RCW 48.125.030,
self-funded multiple employer welfare arrangements are subject to
the following requirements:
(a) Arrangements must maintain a calendar year for
operations and reporting purposes;
(b) Arrangements must satisfy one of the following
requirements:
(i)(A) The arrangement must deposit two hundred thousand
dollars with the commissioner to be used for the payment of
claims in the event that the arrangement becomes insolvent; and
(B) The arrangement must submit to the commissioner a
written plan of operation that, in the reasonable discretion of
the commissioner, ensures the financial integrity of the
arrangement; or
(ii) The arrangement demonstrates to the reasonable
satisfaction of the commissioner the ability of the arrangement
to remain financially solvent, for which purpose the commissioner
may consider:
(A) The pro forma financial statements of the arrangement;
(B) The types and levels of excess of loss insurance
coverage, including the attachment points of the coverage and
whether the points are reflected as annual or monthly levels;
(C) Whether a deposit is required for each employee covered
under the arrangement equal to at least one month's cost of
providing benefits under the arrangement;
(D) The experience of the individuals who will be involved
in the management of the arrangement, including employees,
independent contractors, and consultants; and
(E) Other factors as reasonably determined by the
commissioner to be relevant to a determination of whether the
arrangement is able to operate in a financially solvent manner.
(2) The commissioner may require that the articles, bylaws,
agreements, trusts, or other documents or instruments describing
the rights and obligations of the employers, employees, and
beneficiaries of the arrangement provide that employers
participating in the arrangement are subject to pro rata
assessment for all liabilities of the arrangement.
(3) Self-funded multiple employer welfare arrangements with
fewer than one thousand covered persons are required to have
aggregate stop loss coverage, with an attachment point of one
hundred twenty-five percent of expected claims. If the
arrangement is allowed to assess the participating employers to
cover actual or projected claims in excess of plan assets, then
the attachment point shall be increased by the amount of the
allowable assessments. If the required attachment point exceeds
one hundred seventy-five percent of expected claims, aggregate
stop loss coverage shall be waived. Arrangements with one
thousand covered persons or more are not required to have
aggregate stop loss coverage.
(4) The arrangement must demonstrate continued compliance
with respect to the conditions set forth in this section as a
condition of receiving and maintaining a certificate of
authority. The commissioner may waive continued compliance with
respect to the conditions in this section at any time after the
commissioner has granted a certificate of authority to an
arrangement.
[2004 c 260 § 6.]