2015 May/June OIC

Insurance producers:

This is an update about the Office of Insurance Commissioner's review of association health plans in Washington.

Since January 2014, we have been reviewing all association health plans as they renew. To date, we have approved 11 plans, including the most recent approval for the Washington Education Association.

Our review is focused on two factors:

• Does the association meet the federal definition of being a true large employer?
• Are the rates fair?

How the review process works:

• Large-employer status. First, we determine if an association meets the federal test of being a true or bonafide large employer and therefore able to sell large-employer coverage. Association members must share a common industry or trade and the association must be formed for a purpose other than to sell health insurance. If an association does not meet this definition, it can still offer health insurance to its members, but it cannot offer a large-employer health plan to its members.
• Review of rates. Second, we review rating practices. Rates must be fair in relation to the benefits. This is true for every health insurance plan, not just for association health plans. If the rates are not justified, the plan is disapproved.

Guidance for producers about selling association health plans

• You may sell approved plans and any plan that is “under review.”
• When a review results in a disapproval, you may not sell the plan unless there is a pending appeal of the disapproval. We will provide information on our website about all pending plan appeals (see link at bottom of this email).
• If the plan you sell has been disapproved, the insurer should notify you about the process for moving your clients to new coverage. This may not happen immediately, because the insurer has 90 days to appeal our decision, and may choose to ask for a stay.

Get additional guidance from the insurer

• Producers who work on behalf of an association should contact the insurer to receive an update. The insurer is the best source of information about activity regarding the review and appeal process.

Contact the Insurance Commissioner for questions

• Please call 1-800-562-6900.

Additional information for producers

• Commissioner Kreidler’s perspective on the review of association health plans is featured in the Summer 2015 edition of the Big I newsletter, beginning on page 9.

We update information for producers about the review of association health plans, including charts of the status of reviews and effective dates of plans for 2014 and 2015. You can also subscribe to email and text alerts when we update the page: Renewing or selling association health plans