The U.S. Department of Health and Human Services requires you to notify consumers when discontinuing or renewing individual and small group plans. This applies to both types of plans, whether they are grandfathered or not.
Requirements for plan year 2025 notices
You may only change the bracketed text within templates. If you need help filling out a template, call the Rates and Forms Help Desk at 360-725-7111.
Small group health plans
For small group health plans, you need to notify consumers of discontinuations or renewals in writing. You do not need to use a specific template as long as you include all the required elements in the notices (PDF 104.75KB). However, we recommend using the approved templates on this page.
Individual health plans
For individual health plans, you need to notify consumers of discontinuations or renewals in writing. Use the approved templates on this page.
How to submit draft notices to us
Individual and small group plan issuers need to submit their draft notices to us through the System for Electronic Rate and Form Filing (SERFF) for review and approval.
Templates for draft notices
You only need to file one template for each type of notice. For example, if you have:
- One Exchange-only individual product with seven plans, but you aren't renewing any of them.
- One individual product you offer both on and off the Exchange with three plans. You are renewing one of the plans and discontinuing the other two.
- Three small group products you offer off the Exchange. 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 you are discontinuing all three.
In the example above, you need to file four templates:
- One discontinuation notice for individual products sold on the Exchange
- One renewal notice for individual products sold both on and off of the Exchange
- One renewal notice for small group products
- One discontinuation notice for small group products
Note: Discontinuation happens at the product level. In the example above, you are discontinuing the enrollees’ plans but will map them to a different plan in the same product. Under the federal Uniform Product Modification rules, this is a renewal.
Draft notices for American Indian/Alaskan Native and cost-sharing reduction plans
Other than cost-sharing, these plans are the same as standard plans. You should send the same notices to people on these plans. You don’t need to file them separately through SERFF.
Using templates or creating small group notices
Follow these guidelines when using our approved templates or creating small group notices.
Avoid using cover letters
Cover letters may contradict our templates. If you use a cover letter:
- Don't include information that conflicts with an approved template.
- Only tell Exchange enrollees they will be auto-enrolled or mapped if you're certain that will happen.
You need to send us a copy of the cover letter and give us at least three business days to review and approve it.
Send us a copy of your cover letter.
If you mention open enrollment dates in your cover letter, use the following language:
“Between November 1, 2024 and December 15, 2024, you can choose a new plan that starts on January 1, 2025 for coverage during 2025. You can also change plans from December 16, 2024 through January 15, 2025, but your new plan coverage would not start until February 1, 2025.”
As needed, use the following language in your cover letters to Exchange enrollees:
"You may or may not be [auto-enrolled in coverage next year, or mapped to a new plan]. The Washington Health Benefit Exchange (Healthplanfinder) will be contacting you if you need to take any action to renew your coverage."
Add your issuer identification
You can:
- Add your company's identification at the bottom of each template
- Add a logo and identification at the top of each template
If there are no changes to the template's wording, you can print templates on your company's letterhead.
Include notice of language and disability accommodations
45 CFR 156.250 requires this.
- Language taglines per CCIIO Technical Guidance – 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. We allow the Notice and Taglines to be "posted" with forms either by being embedded in the forms or as an inset enclosed with the forms.
- Appendix A – Top 15 Non-English Languages by State
Include changes to benefits and cost-sharing tables
Show the differences between benefits and cost-sharing levels for the current and upcoming plans. Examples of “cost-sharing” include changes in:
- Metal tiers
- Out-of-pocket maximums
- Deductibles
Approved templates
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Individual plan templates
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Renewal notices
Use these templates for the same plan or another plan within the same product.
Discontinuation notices
With mapping or suggested new plan
Use these templates forse these templates for on- and off-Exchange discontinuation with mapping.
Without mapping
Use these templates for on- and off-Exchange discontinuation without mapping.
Catastrophic plan discontinuation
Use this plan for catastrophic plan discontinuation notices.
Withdrawal notices
Use this template for withdrawal notices.
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Small group plan templates
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Use these templates for small group plan enrollees.
Sending notices
When sending notices, follow these requirements and tips to comply with laws and rules.
Renewal versus discontinuation
Choose a notice based on whether you are renewing an enrollee's product (not plan) for plan year 2025. Under federal law, renewal and discontinuation happen at the product level. Therefore, you need to send a renewal notice if one of the following is true:
- You are renewing the enrollee’s plan for plan year 2025.
- You are not offering the enrollee’s plan in 2025, but you are renewing their product and mapping them to a different plan within that product.
You need to send a discontinuation notice if you will no longer offer an enrollee’s product (not plan) in 2025. This applies even if:
- You are mapping the enrollee to a new product.
- The new product is similar to the old one.
Notices for specific plans
List all enrollees on individual plan notices
We encourage you to list the names of all enrollees in the household who are on the plan. This can reduce confusion in households where some people have different plans.
Notify each enrollee on a small group plan
Under WAC 284-43-0290(3), you need to send discontinuation notices to each employee on a small group plan, not just to the employer.
This also applies when renewing a product but discontinuing one or more of its plans. For details, see the "Renewal versus discontinuation" section above.
Student health plans
You can send the notice to the school instead of students enrolled in the plan.
Standalone pediatric dental plans
We encourage you to use our renewal and discontinuation templates to notify consumers with standalone pediatric dental plans. However, this isn't a requirement.
Large group plans
Under RCW 48.43.035(4), you need to send notices for discontinuations, but not renewals, for plans with groups of up to 200 members.
Emailing notices
You can email notices to consumers who have agreed to receive electronic notifications for important issues. If an email notice is undeliverable, you need to mail a notice to that consumer.
Providing written notice of open enrollment
Under WAC 284-43-1080(4), you need to provide written notice of open enrollment to consumers each September. You can meet this requirement by adding the notice to your website.
The federal government’s waiver of the 90-day requirement for discontinuation notices
In Washington state, you need to send notices 90 days before discontinuing plans.
Qualified health plans (QHP) through the Exchange
Washington Health Benefit Exchange has information about mapping consumers with discontinued plans and products. If you have questions about Washington Healthplanfinder's QHPs or the process, contact the Exchange.
