Information to help issuers with the discontinuation and renewal process for the 2025 plan year:
Federal and State Legal Protections for American Indian/Alaska Native Enrollees and Indian Health Care Providers
The State of Washington requires health insurance issuers (hereinafter “issuers”) to comply with all state and federal laws relating to the acts and practices of issuers and laws relating to health plan benefits. The purpose of this reference document is to assist issuers in complying with federal and state protections for American Indian/Alaska Native (AI/AN) enrollees and Indian health care providers, by consolidating the applicable state and federal statutes and rules in one place. Issuers, as referred to in this guidance, include entities defined as carriers under RCW 48.43.005 that are regulated by the Washington State Office of the Insurance Commissioner (OIC) and include issuers that offer qualified health plans (QHPs). This document will identify protections that apply to all issuers and those that may apply only to QHPs. This document does not address Medicaid or Medicare managed care organizations.
A joint training session was provided by the partnership between OIC and AIHC, on November 5, 2024. Additional trainings will follow. For additional information please contact Tribal Liaison Todd Dixon.
Small group issuers using the Washington state templates or writing their own templates
Although small group issuers may write their own templates, we recommend they use the Washington templates. By using the provided templates, issuers can ensure their notices follow all the requirements and will be approved. Using the Washington templates also reduces the time it takes to review and approve the notices. Please see our templates on the small group templates page. See our small group notice checklist below for a list of elements issuers must include in the notices.
Cover letters and additional items
The OIC discourages cover letters to avoid potential contradictions with the templates. If they are used, don't include information that conflicts with information on the OIC's template. Also, only tell Exchange enrollees they will be auto-enrolled or mapped if you're 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, as applicable:
"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."
Nothing in the cover letter or any extra items may conflict with the information in the renewal/discontinuation notices.
Issuers must send a copy of the letter to the OIC for review, and must allow the OIC at least three business days to complete the review and confirm if they are authorized for use.
If you refer to the open enrollment dates in your cover letter, please 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.”
Language taglines
Issuers must include notice of language accommodations as required by 45 CFR 156.250. The OIC will allow the Notice and Taglines to be “posted” with forms either by embedding in the forms, or as an insert enclosed with the forms.
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.
Appendix A – Top 15 non-English languages by state
Adding issuer identification to the notices
At the bottom of each template is a space for issuers to add their company's identification. Issuers may add a logo and identification information on the top of each template. Issuers may also print templates on the company's letterhead if there are no changes to the wording in the template.
Sending notices by email
Issuers can email 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 returns as 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 reduce confusion in households where some people have different coverage, such as coverage through an Exchange plan and through Apple Health.
Small group plans requirement to notify each enrollee
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).
The requirements in WAC 284-43-0290(3) 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 more information.
Requirement to provide written notice of open enrollment
Under WAC 284-43-1080(4), 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:
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. Although the issuer in the example above 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.
Reporting notice errors
Use our online form to report errors concerning discontinuation or renewal notices.
Changes to include in the benefits and cost-sharing tables
Issuers should include any material changes between the current plan benefits and cost-sharing levels versus the upcoming new plan benefits and cost-sharing 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
Per RCW 48.43.035(4), plans for groups of up to two hundred members are required to provide notifications for discontinuations but not for renewals.
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 2025. Under federal law, renewal and discontinuation happen at the product (not plan) level. Therefore, issuers must send a renewal notice if one of these criteria are met:
The enrollee’s plan is renewed for plan year 2025.
The enrollee’s plan is no longer offered for 2025, but the enrollee’s product is renewed, with the enrollee being mapped to a different plan within that renewal product.
Issuers must send a discontinuation notice if the enrollee’s 2024 product (not plan) is no longer being offered for 2025. 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. 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 Exchange directly.