Washington Healthcare Insurance laws & compensation compliance analysis

Washington Healthcare Insurance: What you need to know

There is currently no state law in effect requiring employers to offer group healthcare insurance to their employees, but most employers do provide this benefit. However, if any health insurance is offered, Washington's insurance laws require policies to cover certain benefits (mandated benefits) and give employees the right to convert to an individual policy in certain circumstances if the employee leaves the group.
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Under federal law, states are not allowed to regulate self-insured benefit plans. Washington's mandated benefits, continuation, and conversion provisions do not apply to health plans in which the employer pays all benefits without the proceeds of any insurance policy. An employer's health plan is self-insured if the risk of paying claims is on the employer and not on an insurance company. Self-insured plans may contract with third-party administrators (TPAs), including insurance companies, to process benefit claims. The TPA pays the claims and then is reimbursed by the employer. Many self-insured plans also buy “stop-loss” insurance to cover very large claims. The purchase of stop-loss insurance does not result in the loss of self-insured status and the exemption from state insurance law regulation.
Group health insurers may not deny or limit coverage based on sensory, mental, or physical handicaps and may not discriminate on the basis of a mastectomy or lumpectomy if 5 years have passed since the operation (Wash. Rev. Code Sec. 48.30.300 and Wash. Rev. Code Sec. 48.21.235). Discrimination against individuals based on their status as a victim of domestic abuse is also barred (Wash. Rev. Code Sec. 48.18.550). Coverage may not be changed on the basis of the results ...

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