Insurers and other Office of the Insurance Commissioner (OIC)-regulated companies should be aware of several new requirements that went into effect January 1, 2017.
Life insurance companies
SB 5180 (leg.wa.gov) requires life companies to institute new reserving requirements under the NAIC Valuation Manual for certain products offered to the insurance-buying public. These new requirements were enacted under chapters 48.74 RCW and new subchapter A under 284-74 WAC (leg.wa.gov).
Dental-only health plans
Companies that offer dental-only health plans must comply with SHB 1002 (leg.wa.gov), which requires them to submit certain information to the OIC. After the OIC receives the year-end filings it will publish the information on its website.
Health insurance companies
New laws under RCW 48.43.016 (leg.wa.gov) require certain companies to disclose prior authorization related information to certain consumers and providers. The OIC requires the online publishing of all prior authorization standards, criteria, or information a company uses for medically necessary decisions, regardless of any contractual prohibitions. This includes all standards, criteria, or information that are proprietary, confidential, licensed or copyright-protected.
Companies may require covered persons or contracting providers to use a password protected login in order to limit the distribution of the criteria to the intended audiences. Carriers may also limit their sharing of prior authorization standards, criteria, or information to the service in question. These restrictions are reasonable, so companies can protect the interests of third-party vendors to the extent possible under law.
Pharmacy benefit managers
Companies that act as a pharmacy benefit manager (PBM) must register with the OIC to meet the requirements under 5ESSB 5857 (leg.wa.gov). These new requirements were enacted under chapters 19.340 RCW and 284-180 WAC (leg.wa.gov).
In addition to current information for PBMs, more information about the annual report, renewal fees, and appeal process will be available later this year.
Independent review organizations
Companies that act as an independent review organization (IRO) are now regulated by the OIC under HB 2326 (leg.wa.gov). These new requirements were enacted under RCW 48.43.537 and chapter 284-43A WAC(leg.wa.gov).
Existing IROs previously certified by the Washington Department of Health automatically transfer to the OIC. Information about the independent review process for carriers and IROs is available on the OIC’s website.
For more information, contact:
Company Supervision Division
Washington State Office of the Insurance Commissioner
Insurance 5000 Building
P.O. Box 40255
Olympia, WA 98504-0255