Because sometimes the obvious is not – a dental or vision plan is not a “health plan” as defined under federal health care reform or under Washington insurance law. These plans are often referenced in rule as “excepted benefits,” e.g., excepted from the definition of “health plan.”
Consequently, those who fear the regulatory “reaper” should relax and stop trying to turn ordinary associations into “bona fide” ERISA employer associations just to continue providing large group dental and vision benefits. State rate and form filing instructions governing proof of “bona fide” association status apply to “health plans.”
Don’t take my word for it. Read on.
February 21 , 2014
EMPLOYER STATUS DOCUMENTATION SUBMITTED WITH THIS FILING
This year, the Office of the Insurance Commissioner (OIC) developed additional filing instructions for health plans issued to Association or Member-Governed Groups that constitute a True Employer.
This requirement was made necessary by new federal law that went into effect January 1, 2014. Specifically, the instructions require the submission of one PDF document titled “Evidence as an Employer” under the Supporting Documentation tab.
Several filers have included “Evidence as an Employer” when that information was not required. Specifically, this evidence is not required for dental only or vision only plans. And as a result of the 2014 federal effective date and the OIC filing instructions, this evidence is not required for associations or member-governed group health plans filing pursuant to a Master Contract renewal date in 2013.
If you have submitted evidence that is not required, no determination will be made.
Deputy Insurance Commissioner Deputy Insurance Commissioner
Rates and Forms Division Legal Affairs Division
Here is the letter. Asked and answered.