Overview
The Office of the Insurance Commissioner (OIC) worked with the Washington state Health Benefit Exchange (HBE) to develop mapping criteria for qualified health plans (QHPs). This page describes the process for how HBE will map enrollees for Plan Year 2025. It provides links to the hierarchy that HBE will use to map enrollees to QHPs when their existing carrier will continue to offer coverage in their county in the upcoming year (“within carrier mapping”) and when their carrier will drop coverage in their county in the upcoming year (“cross-carrier mapping”). Washington state adapted the federal hierarchy for use in the state.
The 2017 Notice of Benefits and Payment Parameters at 45 CFR 155.335(j)(4) established, that if no QHPs from the same issuer are available through the Health Benefit Exchange, then HBE could map these enrollees to a different QHP offered by a different issuer.
- The exchange directs the mapping when QHPs are available from the same issuer.
- The OIC directs the mapping when QHPs are unavailable within an enrollee’s same issuer.
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 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.