On May 19th at 3:29 P.M., the Washington Insurance Commissioner (OIC) filed a notice that the OIC would be considering the adoption of a rule to select a new Essential Health Benefits “benchmark plan” for the 2017 health plan year. The public was informed in the notice that comments could be submitted to the OIC until July 7, 2015. [CR-101 R2015-02]
On May 19th at 3:12 P.M., the OIC adopted an emergency rule designating Regence Direct Gold + small group plan as the new “benchmark” plan [CR-103E R2015-01].
You read correctly. Technically, the OIC adopted an emergency rule that it proposed after adoption. My guess is that both were filed simultaneously, but one got stamped before the other. In any case, this type of rulemaking drives folks nuts. The emergency rule is so fresh that at the time of this writing, the Washington State Register providing public notice of agency actions hasn’t even been published yet. The emergency was described by OIC as:
New federal rules require choosing a base benchmark plan from a designated list of 10 plans, based on enrollment in each plan as of March 31, 2014. This emergency rulemaking is solely for the purpose of meeting the federal government’s June 1 deadline for designating a base benchmark plan; the subsequent supplementation is anticipated to be achieved by normal rule making. [CR-103E R2015-01]
This “benchmark” plan serves as a reference plan for insurers in the state to satisfy requirements to provide all ten of the essential health benefits mandated by federal health care reform. CMS describes this process as follows:
“States can choose a benchmark plan from among the following health insurance plans:
- – the largest plan by enrollment in any of the three largest small group insurance products in the State’s small group market;
- – any of the largest three State employee health benefit plans by enrollment; • any of the largest three national FEHBP plan options by enrollment; or
- – the largest insured commercial non-Medicaid Health Maintenance Organization (HMO) operating in the State.” [CMS Essential Health Benefits: List of the Largest Three Small Group Products by State 04/2015]
In April, CMS identified the top three Washington State small group products as:
- 80473WA057, Group Health Cooperative, GHC Non-Exxchange Core 3, HMO
- 87718WA069, Regence BlueShield, Regence Group Direct, PPO
- 87718WA070, Regence BlueShield, Regence Group Direct EHB+Vis, PPO
In May, CMS updated its information stating:
“On April 8, 2015, HHS released an initial list of the largest three small group products by State. The information provided in that list was based on first quarter 2014 enrollment data collected through HealthCare.gov. HHS collects data (self-reported) from issuers of individual and small group major medical insurance on their products, as required by the Affordable Care Act. HHS worked with States and issuers to correct erroneous or missing enrollment information for small group products and updated the list accordingly. In some cases, States may have identified products other than the products on the initial list as one of their three largest small group products.” [CMS Essential Health Benefits: List of the Largest Three Small Group Products by State 05/2015]
In May, CMS identified the top three Washington State small group products as:
- 18699WA016, UnitedHealthcare Insurance Company, Choice Plus – SEP, POS
- 87718WA069, Regence BlueShield, Regence Group Direct, PPO
- 87718WA070, Regence BlueShield, Regence Group Direct EHB+Vis, PPO
Those interested in deep analysis can review the SERF filing identified by the OIC including the redlined versions of the plan documents to decide what has changed from the last designation of a benchmark plan and how this affects future benefits.
As for myself, I wish could travel back in time and propose to do something I already did.
