For Insurers

Washington state health plan mapping hierarchy criteria

Washington state mapping hierarchy criteria for enrollment of enrollees of qualified health plans (QHP) discontinued in the Washington Health Benefit Exchange.

Overview

We worked with the Health Benefit Exchange to develop qualified health plan-mapping criteria. This page describes the process for how the Washington Health Benefit Exchange will map enrollees for Plan Year 2020. It provides links to the hierarchy that the Health Benefit Exchange will use to map enrollees to qualified health plans when their existing carrier will continue to offer coverage in their county in the upcoming year (“within carrier mapping”) and when their carrier will not be offering coverage in their county in the upcoming year (“cross-carrier mapping”). Washington’s hierarchy is based on the federal hierarchy and adapted for use in our state.

The 2017 Notice of Benefits and Payment Parameters (2017 Payment Notice (www.gpo.gov)) at 45 CFR 155.335(j)(4) (www.ecrf.gov) established, beginning in Plan Year 2017, that if no Qualified Health Plans (QHPs) from the same issuer are available through the Health Benefit Exchange (wahealthplanfinder.org), then the Health Benefit Exchange could map these enrollees to a different QHP offered by a different issuer.

When qualified health plans are available from the same issuer, the mapping process is directed by the Exchange. When no qualified health plans are available within an enrollee’s same issuer, the mapping process is directed by the applicable state regulatory authority. In our state, the state regulatory authority for cross-carrier mapping is the Office of Insurance Commissioner (OIC).

The Centers for Medicare and Medicaid Services (CMS) created a hierarchy it will use in states where the federal government, not the state, will direct the mapping process. You can see the federal hierarchy used by CMS (www.cms.gov) on their website.

Questions

If you have questions about the number of enrollees that will be mapped to your company, please contact the Health Benefit Exchange.

Hierarchy