For Insurers

Small group and individual templates

The U.S. Department of Health and Human Services (HHS) requires issuers to send discontinuation and renewal notices for individual and small-group plans to consumers. This applies to both individual plans and small-group health plans, regardless of whether they are grandfathered or not.

For small-group health plans, issuers must notify consumers of discontinuations or renewals in writing, but they do not need to use a specific template as long as they include all of the required elements in the notices.

For individual health plans, issuers must notify consumers of discontinuations or renewals in writing using approved templates. Links to the templates can be found below.

Requirements for plan year 2022 notices

For individual health plans, issuers must use the Washington state individual health plan templates.

Issuers may not change the content of the templates except where indicated within the template by the bracketed text. For questions about how to use the bracketed text or for situations that aren’t covered by the templates, call the Health Forms Program Manager at 360-725-7119.

For both individual and small-group plans, issuers need to submit their draft notices to the Office of the Insurance Commissioner (OIC) through the System for Electronic Rate and Form Filing (SERFF) for review and approval.

Cover letters

Issuers shouldn't send consumers cover letters with the templates, but if a cover letter is sent, don't include information that conflicts with information on the OIC's template. Also, don't tell Exchange enrollees they will be auto-enrolled unless you're certain that is the case.

Issuers must email a copy of the letter to the OIC's senior health policy analyst for review and must give the OIC a minimum of three business days to complete the review.

If you refer to the open enrollment dates in your cover letter please use the following language, “Between November 1, 2021 and December 15, 2021, you can choose a new plan that starts on January 1, 2022 for coverage during 2022. You can also change plans from December 16, 2021 through January 15, 2022, but your new plan coverage would not start until February 1, 2022.”

Individual plans

Renewal notices

Discontinuation notices

With mapping or suggested new plan:

Without mapping

Catastrophic plan discontinuation

Withdrawal notices

Group plans

Notice of language and disability accommodations

  • Issuers must include notice of language accommodations as required by 45 CFR 156.250 (

  • Language taglines per CCIIO Technical Guidance ( – March 30, 2016 Guidance and Population Data for Exchanges, Qualified Health Plan Issuers, and Web-Brokers to Ensure Meaningful Access by Limited-English Proficient Speakers Under 45 CFR §155.205(c) and §156.250.  The OIC will allow the Notice and Taglines to be "posted" with forms either by being embedded in the forms or as an inset enclosed with the forms.

  • Appendix A ( – Top 15 Non-English Languages by State