(1) The health insurance partnership board shall:
(a) Develop policies for enrollment of small employers in
the partnership, including minimum participation rules for small
employer groups. The small employer shall determine the criteria
for eligibility and enrollment in his or her plan and the terms
and amounts of the employer's contributions to that plan,
consistent with any minimum employer premium contribution level
established by the board under (d) of this subsection;
(b) Designate health benefit plans that are currently
offered in the small group market that will be offered to
participating small employers through the health insurance
partnership and those plans that will qualify for premium subsidy
payments. Up to five health benefit plans shall be chosen, with
multiple deductible and point-of-service cost-sharing options.
The health benefit plans shall range from catastrophic to
comprehensive coverage, and one health benefit plan shall be a
high deductible health plan accompanied by a health savings
account. Every effort shall be made to include health benefit
plans that include components to maximize the quality of care
provided and result in improved health outcomes, such as
preventive care, wellness incentives, chronic care management
services, and provider network development and payment policies
related to quality of care;
(c) Approve a mid-range benefit plan from those selected to
be used as a benchmark plan for calculating premium subsidies;
(d) Determine whether there should be a minimum employer
premium contribution on behalf of employees, and if so, how much;
(e) Develop policies related to partnership participant
enrollment in health benefit plans. The board may focus its
initial efforts on access to coverage and affordability of
coverage for participating small employers and their employees.
To the extent necessary for successful implementation of the
partnership, the board may:
(i) Limit partnership participant health benefit plan
choice; and
(ii) Offer former employees of participating small employers
the opportunity to continue coverage after separation from
employment to the extent that a former employee is eligible for
continuation coverage under 29 U.S.C. Sec. 1161 et seq.;
(f) Determine appropriate health benefit plan rating
methodologies. The methodologies shall be based on the small
group adjusted community rate as defined in Title 48 RCW. The
board shall evaluate the impact of applying the small group
adjusted community rating methodology to health benefit plans
purchased through the partnership on the principle of allowing
each partnership participant to choose his or her health benefit
plan, and may implement one or more risk adjustment or
reinsurance mechanisms to reduce uncertainty for carriers and
provide for efficient risk management of high-cost enrollees;
(g) Determine whether the partnership should be designated
as the administrator of a participating small employer health
benefit plan and undertake the obligations required of a plan
administrator under federal law in order to minimize
administrative burdens on participating small employers;
(h) Conduct analyses and provide recommendations as
requested by the legislature and the governor, with the
assistance of staff from the health care authority and the office
of the insurance commissioner.
(2) The board may authorize one or more limited health care
service plans for dental care services to be offered by limited
health care service contractors under RCW 48.44.035. However,
such plan shall not qualify for subsidy payments.
(3) In fulfilling the requirements of this section, the
board shall consult with small employers, the office of the
insurance commissioner, members in good standing of the American
academy of actuaries, health carriers, agents and brokers, and
employees of small business.
[2011 c 287 § 4; 2008 c 143 § 5; 2007 c 260 § 5.]