Network Enrollment Form B

You must submit the Network Enrollment Form B report by March 31 of each year. The report must show the total number of covered persons who were entitled to health care services during each month of the year, by county and gender.

For plan year 2013, the filing requirement date has been extended to April 30, 2014.

Submit a separate Network Enrollment Form B to support each Provider Network Form A network reported in the prior calendar year. Line of business has the same categories as contract filings:

  • Small group,
  • Large group,
  • Individual, and
  • Conversion.

Effective April 7, 2014 issuers will submit network access reports in the Network Access Portal. Please contact the OIC Network Access Administrator for login and user credentials at: OICNetworkAccess@oic.wa.gov.

Network Enrollment Form B

What do I do if I have zero enrollment in a county?

  • Include all counties in your report, but simply mark "0" in the male and female fields.

Updated 05/02/2014

See also

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