2018 Plan Certification FAQ’s

What is the Exchange Board?
The Exchange is a bipartisan board created in state statute that governs the Washington Health Benefit Exchange, the state’s health insurance marketplace that operates Washington Healthplanfinder. The 11-member board comprised of a chair and eight members appointed by the governor from nominees put forward by each of the legislative caucuses. These individuals have expertise in variety of health care areas including individual coverage, small employer coverage, plan administration, finance and economics, and actuarial science. The director of the Health Care Authority and the Insurance Commissioner also serve on the board in an ex-officio, non-voting capacity. More information available at www.wahbexchange.org/about-the-exchange/exchange-board.

Why do they certify plans?
The Exchange Board is provided statutory authority to certify health insurance plans that participate in the Exchange marketplace, Washington Healthplanfinder. Plans are provided to the Exchange from the Office of the Insurance Commissioner (OIC) who must first approve each insurance company’s rate filing for their respective insurance products. This includes approving items such as rates, network adequacy, benefits, terms and conditions, to ensure that each company and product may legally operate in accordance with state and federal law.

Can the Exchange Board change plans or rates as part of their certification process?
No. The Exchange may only accept or reject filing provided for certification by the OIC. The OIC approval process accounts for the legal review and setting of plan rates, benefits for the coverage year.

Why did the Exchange Board certify two rates this year?
The Exchange Board received two legally approved rates from OIC. The first set of rates accounts for the continued federal funding of cost-sharing reductions (CSR) by the federal government. The second set account for the elimination of federal funding for CSRs. Since insurance companies are required by law to discount out of pocket costs to customers who qualify for CSRs, the second set reflects price changes that account for the insurance company’s costs associated with assuming those payments.

The OIC has made the legal determination that they may change 2018 rates during the 2018 coverage year should the federal government stop its funding of CSRs.  For more information on this justification and when a new rate may take effect, please contact the OIC. More information available at www.insurance.wa.gov.

Where can I get more information on this year’s rates?
The Exchange will be posting more information related to CSRs and the potential for rate changes at www.wahbexchange.org/plans. You may also contact your insurance company and the OIC for specifics related to your situation.

Will consumers be able to offset increases to their health insurance premium rates?
Many consumers will have rate increases offset by federally-provided tax credits, which are designed to help lower the cost of monthly health insurance premiums. These tax credits are offered only through the Exchange and are calculated based on the price of second-lowest cost silver plan.

Which plans will be affected if the OIC adjusts to the higher set of rates?
The approved higher set of rates impacts silver plans offered inside the Exchange. Rates for gold, bronze and catastrophic plans are not affected.

Because federal law requires insurance companies to discount out-of-pocket costs to customers who qualify for CSRs in silver plans, if the federal government stops funding CSRs, insurance companies would be responsible for those payments. The increase takes into account the impact of insurance companies assuming CSR payments.