For Insurers

What issuers need to know

Information to help issuers with the discontinuation and renewal process for the 2019 plan year:

Small-group issuers using the Washington state templates or writing their own templates

Although small-group issuers may write their own templates, we strongly recommend that they use the Washington templates. By using the Washington templates, issuers can ensure that their notices comply with all the requirements and will be approved. Please see our templates on the small group templates page. Using the Washington templates also reduces the time it takes us to review and approve the notices. See our small-group notice checklist below for a list of elements issuers must include in the notices.

Cover letters and additional items

If you are attaching a cover letter to the template discontinuation or renewal letter for the individual market, please do not tell an Exchange enrollee that they will be auto-enrolled unless you are certain that is the case.

If you include a cover letter with your template letter, please use the following language in your cover letters to Exchange enrollees:

"You may or may not be auto-enrolled in coverage next year. The Washington Health Benefit Exchange (Healthplanfinder) will be contacting you if you need to take any action to renew your coverage."

    Nothing in the cover letter or any additional items may conflict with the information in the renewal/discontinuation notices.

    Issuers must e-mail 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.

    Language taglines

    • Issuers must include notice of language accommodations as required by 45 CFR 155.250 (www.ecfr.gov). For Plan Year 2019, OIC will allow the Notice and Taglines to be “posted” with forms either by being embedded in the forms, or as an insert enclosed with the forms.

    • Language taglines per CCIIO Technical Guidance (www.cms.gov) – 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;

    • Appendix A (www.cms.wa.gov) – Top 15 non-English languages by state; 

    • Appendix B (www.cms.wa.gov) –  Sample translated taglines – languages are listed in alphabetical order.

    Adding issuer identification to the notices

    At the bottom of each template is a space for issuers to add their company's identification. A logo and identification information can be added to the top of each template (or the templates can be printed on the company's letterhead, if no changes are made to the wording in the template).

    Sending notices by email

    Issuers can email the notices to consumers who have agreed to receive electronic notification for important issues. If an issuer emails a notice to a consumer and the email is returned undeliverable, the issuer must send a paper notice to that consumer.

    Listing the names of all enrollees on notices for individual plans

    We encourage issuers to list the names of all enrollees in the household who are on the plan. This can help to minimize confusion in households where some people have different coverage, such as coverage through an Exchange plan and coverage through Apple Health.

    Small-group plans requirement to notify each employee

    When issuers send discontinuation notices for small-group plans, they need to send the notices to each employee on the plan, not just to the employer. This requirement can be found at WAC 284-43-0290(3) (leg.wa.gov).

    The requirements in WAC 284-43-0290(3) (leg.wa.gov) also apply where a product is being renewed but a plan or plans within the renewing product are being discontinued. See the "Sending a renewal notice versus a discontinuation notice" section below for additional information.

    Requirement to provide written notice of open enrollment  

    Under WAC 284-43-1080(4) (leg.wa.gov), issuers must provide written notice of open enrollment to consumers each September. Issuers can meet this requirement by adding the notice to their websites.

    Filing notices with the Office of the Insurance Commissioner (OIC)

    Issuers only need to file one template for each type of notice. For example, if an issuer's portfolio has:

    One Exchange-only individual product with seven plans, but the issuer isn’t renewing any of them,

    One individual product offered both on and off the Exchange with three plans. The issuer is renewing one of the plans and discontinuing the other two.

    Three small-group products offered only through Small Business Health Options Program (SHOP). One of the small-group products has one plan, which is renewing. One of the small-group products has three plans, two of which are renewing and one isn’t. One of the small-group products has three plans, and the issuer is discontinuing all three.

    Using the example above, this issuer will make four filings:

    1. One discontinuation notice for individual products sold on the Exchange,

    2. One renewal notice for individual products sold both on and off of the SHOP ,

    3. One renewal notice for small-group products offered off of SHOP, and

    4. One discontinuation notice for small-group products offered off of SHOP.

    Note: Discontinuation happens at the product level, so although the issuer is discontinuing the enrollees’ plans, the issuer will map them to a different plan in the same product. Under the federal Uniform Product Modification rules, this is a renewal,

    Changes to include in the benefits and cost-sharing tables

    Issuers should include any material changes between the 2018 benefits and cost-sharing levels versus the 2019 levels. “Cost-sharing” includes – but isn’t limited to – changes in metal tier, out-of-pocket maximum and deductible.

    Student health plans

    For student health plans, issuers can send the notice to the school instead of having to send a notice to every student who’s enrolled in the plan.

    Stand-alone pediatric dental plans

    The OIC encourages, but does not require, issuers of stand-alone pediatric dental plans to use the OIC’s templates to notify consumers about renewals and discontinuations.

    Notices for large-group plans

    Large-group plans don't require renewal notifications.

    Sending a renewal notice vs. a discontinuation notice

    The correct notice for a particular enrollee is based upon whether the enrollee’s product (not plan) is being renewed for plan year 2019. Under federal law, renewal and discontinuation happen at the product (not plan) level. Therefore: Issuers must send a renewal notice if:

    • The enrollee’s plan is being renewed for plan year 2019, or

    • The enrollee’s plan is no longer being offered for 2019, but the enrollee’s product is being renewed, with the enrollee being mapped to a different plan within that renewal product.

    Issuers must send a discontinuation notice if the enrollee’s 2018 product (not plan) is no longer being offered for 2019.  This is true whether or not the enrollee is being mapped to a new product, and no matter how similar the new product is to the old one.

    Notices for American Indian/Alaskan Native and cost-sharing reduction plans – filing with the OIC through Systems for Electronic Rate and Form Filing (SERFF)

    There are no differences between the standard plans and these reduced-cost plans, other than cost sharing. As a result, issuers should send the same notices to people who are on these plans as they send to people who are on standard health plans, so issuers don’t have to file these notices separately with the OIC through SERFF.

    The federal government’s waiver of the 90-day requirement for discontinuation notices

    Washington state requires issuers to provide discontinuation notices 90 days before discontinuation.

    Process for Qualified Health Plans (QHP) through the Exchange

    The Washington Health Benefit Exchange provides additional information to issuers about mapping consumers for plan and product discontinuations. If you have questions related to QHP offered on Healthplanfinder or questions about the process, please contact the Washington Health Benefit Exchange directly.