WAC 182-26-100 Definitions. "Administrator" means the administrator of the Washington state health care authority established under chapter 41.05 RCW.

аааа "Appeal" means a formal written request to the HIP or its designee for resolution of problems or concerns that cannot be resolved informally. For the purposes of this chapter, "appeal" applies only to HIP decisions regarding subsidy determinations and employer eligibility for the HIP.

аааа "Applicant" means:

аааа Х An eligible partnership participant who applies for a premium subsidy through the HIP on behalf of the eligible partnership participant and his or her dependents; or

аааа Х An eligible partnership participant who applies or reapplies for premium subsidy through the HIP on behalf of the eligible partnership participant and his or her dependents during the annual subsidy application and renewal period as described in WAC 182-26-320.

аааа "Application" means a form developed by the administrator that an applicant must sign, complete, and submit to the administrator to apply for a premium subsidy through the HIP. To be considered complete, the application must be accompanied by all supporting documents as required and determined by the administrator.

аааа "Benchmark health benefit plan" or "benchmark plan" means a health benefit plan selected by the board and upon which the subsidy scale shall be determined and from which the administrator will calculate an eligible partnership participant's premium subsidy.

аааа "Board" or "HIP board" means the health insurance partnership board established under RCW 70.47A.100.

аааа "Carrier" or "insurance carrier" means the same as defined in RCW 48.43.005.

аааа "The department of social and health services" or "DSHS" means the department of social and health services as defined in RCW 43.20A.020.

аааа "Dependent," for the purpose of determining subsidy eligibility, "dependent" means:

аааа (a) An eligible partnership participant's spouse, as defined under RCW 70.47A.901; or

аааа (b) The child of the partnership participant or participant's dependent spouse, whether by birth, adoption, legal guardianship, or placement pending adoption, and not given up for adoption, who is:

аааа (i) Younger than age twenty-six; or

аааа (ii) Is of any age, is not able to take care of himself or herself due to disability, and is under legal guardianship of the partnership participant or the participant's dependent spouse.

аааа (c) A dependent may be placed on only one HIP account at any given time.

аааа "Designated health benefit plan" means a health benefit plan selected by the board as eligible for offer through the HIP.

аааа "Disenroll" or "disenrollment" means the termination of a partnership participants' enrollment in the HIP program. Decisions regarding eligibility or enrollment status for insurance coverage will be made by the carrier.

аааа "Eligible partnership participant" means a partnership participant who:

аааа Х Is a resident of the state of Washington;

аааа Х Has a family income that does not exceed two hundred percent of the federal poverty level, as determined annually by the federal Department of Health and Human Services; and

аааа Х Is a health plan eligible employee as defined in this section that is enrolled or is applying to enroll in the participating small employer's offered coverage.

аааа "Employee" has the same meaning as defined in RCW 48.43.005.

аааа "Employer agreement" means a form developed by the administrator that a small employer must complete, sign, and submit to the administrator to request enrollment in the HIP.

аааа "Health insurance partnership" or "HIP" means the health insurance partnership established in RCW 70.47A.030.

аааа "Health plan eligible employee" means an individual who meets the participating small employer's enrollment criteria.

аааа "HIP account" means an account maintained by the administrator for each partnership participant that includes but is not limited to:

аааа Х Demographic information for participants and dependents, if any;

аааа Х Subsidy status;

аааа Х Carrier and plan enrollment status; and

аааа Х Other information as required by the administrator.

аааа "Income" or "family gross income" means total cash receipts, as defined in WAC 182-26-345, before taxes, for participants and all dependents.

аааа "Individual health benefit plan selection." Reserved.

аааа The "office of the insurance commissioner" or "OIC" means the insurance commissioner as defined in RCW 48.02.010.

аааа "Open enrollment" means a designated time period during which partnership participants may enroll additional dependents or make other changes to their employer-sponsored health benefit plan coverage.

аааа "Participating small employer" means a small employer who:

аааа Х Enters into a written agreement with the HIP to purchase a designated health benefit plan through the HIP;

аааа Х Attests at the date of the agreement that the employer does not currently offer coverage, including insurance purchased through the small group and association health plan markets, self-funded plans, and multiple employer welfare arrangements; and

аааа Х Attests at the date of the agreement that at least fifty percent of its employees are low-wage workers, as defined by the board.

аааа "Partnership participant" means:

аааа Х A participating small employer as defined in this section;

аааа Х An employee of a participating small employer;

аааа Х A former employee of a participating small employer who chooses to continue coverage through the HIP following separation from employment, to the extent the employee is eligible for continuation of coverage under 29 U.S.C. Sec. 1161 et seq.; and

аааа Х A former employee of a participating small employer who chooses to continue coverage through HIP following separation from employment, to the extent determined by the board.

аааа "Philanthropy" means a person, organization or other entity, approved by the administrator that is responsible for payment of all or part of the monthly premium obligation on behalf of a partnership participant.

аааа "Premium" has the same meaning as described in RCW 48.43.005.

аааа "Premium subsidy" or "subsidy" means payment to or reimbursement by the HIP on behalf of an eligible partnership participant toward the purchase of a designated health benefit plan.

аааа "Qualifying change in family status" is defined in WAC 182-26-325.

аааа "Section 125 plan" means a cafeteria plan compliant with section 125 of the federal Internal Revenue Code that enables employees to use pretax dollars to pay their share of their health benefit plan premium.

аааа "Small employer" or "employer" as used in this chapter means an employer who meets the definition of "small employer" in RCW 48.43.005.

аааа "Subsidy application and renewal period" means an annual period that lasts at least sixty days, during which:

аааа Х All partnership participants may apply for premium subsidies for themselves and their dependents; and

аааа Х All partnership participants receiving a subsidy are required to provide proof of their continuing eligibility for a premium subsidy.

аааа The subsidy application and renewal period will begin ninety days before the employer-sponsored health benefit plan open enrollment period begins.

аааа "Surcharge" means an amount, determined by the administrator, that may be added to a partnership participant's premium as provided for in WAC 182-26-500. The surcharge is not part of the premium and applies only to coverage purchased through the HIP.

аааа "Washington state resident" means:

аааа (a) A person who physically resides in and maintains a residence in the state of Washington.

аааа (b) To be considered a Washington resident, individuals who are temporarily out of Washington state for any reason may be required to demonstrate their intent to return to Washington state.

аааа (c) "Residence" may include, but is not limited to:

аааа (i) A home the person owns or is purchasing or renting;

аааа (ii) A shelter or other physical location where the person stays; or

аааа (iii) Another person's home.

[Statutory Authority: RCW 41.05.160 and chapter 70.47A RCW. 10-22-039 (Order 10-04), з 182-26-100, filed 10/27/10, effective 11/27/10. Statutory Authority: RCW 70.47A.060. 08-22-041 (Order 08-02), з 182-26-100, filed 10/31/08, effective 12/1/08.]