About mapping hierarchy

We helped the Washington state Health Benefit Exchange (HBE) develop mapping for qualified health plans (QHPs) and qualified dental plans (QDPs). This page explains how HBE will map enrollees to QHPs and QDPs for plan year 2025. This includes HBE's hierarchy for mapping enrollees whose carriers will:

  • Continue to offer coverage in their county in the upcoming year (“within carrier mapping”).
  • Drop coverage in their county in the upcoming year (“cross-carrier mapping”).

Washington state's hierarchy is based on the federal hierarchy.

Who maps enrollees

The 2017 Notice of Benefits and Payment Parameters at 45 CFR 155.335(j)(4) allows HBE to map enrollees to a different issuer's QHP or QDP when qualified plans from the same issuer aren't available.

  • HBE maps enrollees when QHPs or QDPs from the same issuer are available.
  • We map enrollees when QHPs or QDPs from the same issuer aren't available.

The Centers for Medicare and Medicaid Services (CMS) created a federal hierarchy for states where the federal government maps enrollees.

Within carrier and cross-carrier mapping hierarchy

Follow this guidance from our office and HBE for within carrier and cross-carrier mapping hierarchy.

Within carrier mapping for QHPs and QDPs

For details, read HBE's policy for within carrier QHP and QDP mapping (XLSX 39.56KB)

Cross-carrier mapping for QHPs

The guidance below is based on federal guidelines for our state.

Hierarchy one: priority enrollment

First, HBE will determine an enrollee’s mapped QHP based on the following standards:

  • If more than one Cascade or Cascade Select plan is available at the enrollee's same metal level, HBE will map to the plan with the lowest yearly premium. 
  • If one Cascade or Cascade Select plan is available at the enrollee's same metal level, HBE will map to that plan. 

Hierarchy two

If no Cascade or Cascade Select plans are available at the enrollee's same metal level, HBE will map to the non-standard QHP with the lowest yearly premium. 

If no QHPs are in the same metal level, HBE will map to the Cascade or Cascade Select plan with the lowest yearly premium either one metal level lower or higher. 

Cross-carrier mapping for QDPs

When a QDP carrier leaves a county, customers enrolled with that carrier are mapped to a new carrier. 

  • If there is more than one QDP available of an appropriate plan type* (pediatric/family), map enrollees to a QDP with the same network type (PPO, EPO, HMO). 
  • If there is more than one QDP available of an appropriate plan type and same network type, map enrollees to the plan without a waiting period. 
  • If there is more than one QDP available of an appropriate plan and network type without a waiting period, map enrollees to the plan with the most similar coverage (including actuarial value, covered services, cost sharing, and benefit cap). 
  • If there is more than one QDP available of an appropriate plan type, with the same network type, without a waiting period, and similar covered services and cost sharing, map enrollees to the plan with the lowest premium. 

*Appropriate plan type: Pediatric plans can be mapped to either pediatric or family plans. Family plans can only be mapped to family plans.