WA State Updates - 2015 Jan 06 No.01

On Sept. 29, 2015, the Washington State Office of the Insurance Commissioner issued Rule Order No. R 2015-02, which amends: WAC 284-43-865, -877, -878, -879 and -880 (adding language stating that these WACs expire on Dec. 31, 2016); and adopts: WAC 284-43-8651, -8771, -8781, -8791 and -8801 (applying to plans that have an effective date on or after Jan. 1, 2017).

The reason for amending and adopting these rules was to finish updating essential health benefits rules. The Office of the Insurance Commissioner implemented an emergency rule (R 2015-01) in May 2015 to designate the state’s base benchmark plan for plan year 2017, but that rule recently expired and required replacement to keep the state in compliance with federal regulations.

As background, the base benchmark plan sets the essential health benefits packages that are available in the non-grandfathered individual and small group health insurance market within a particular state. The services and items covered within the plan include: ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder services (including behavioral health treatment, prescription drugs, rehabilitative and habilitative services and devices), laboratory services, preventive and wellness services and chronic disease management and pediatric services, including oral and vision care as well as state-mandated benefits enacted before Dec. 31, 2011.

This order finalizes the new base-benchmark plan selection and makes necessary changes to the essential health benefits rule to bring the rule into compliance with changes that have occurred since the Department originally adopted it in 2013.

Changes include but are not limited to:

Adding language that health plans must cover medically necessary services for transgender individuals

Updating the definition of “habilitative services” to more closely fit the new federal definition

Adding language that health plans must know and comply with the federal guidance related to essential health benefits

While employers are not required to purchase or enroll in the base benchmark plan, it is recommended that employers familiarize themselves with the benefits available under the benchmark plan, as other plans subject to the essential health benefits requirement must offer benefits substantially equal to the benefits offered by the benchmark plan.

Rule Order No. R 2015-02 »