Medicare supp. coverage

AN ACT Relating to requiring guaranteed issue of medicare 1
supplemental coverage to an individual who voluntarily disenrolls 2
from a medicare advantage plan and enrolls in medicare parts A and B; 3
and amending RCW 48.66.055. 4
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:5
Sec. 1. RCW 48.66.055 and 2019 c 38 s 2 are each amended to read 6
as follows: 7
(1) Under this section, persons eligible for a medicare 8
supplement policy or certificate are those individuals described in 9
subsection (3) of this section who, subject to subsection (3)(b)(ii) 10
of this section, apply to enroll under the policy not later than 11
sixty-three days after the date of the termination of enrollment 12
described in subsection (3) of this section, and who submit evidence 13
of the date of termination or disenrollment, or medicare part D 14
enrollment, with the application for a medicare supplement policy.15
(2) With respect to eligible persons, an issuer may not deny or 16
condition the issuance or effectiveness of a medicare supplement 17
policy described in subsection (4) of this section that is offered 18
and is available for issuance to new enrollees by the issuer, shall 19
not discriminate in the pricing of such a medicare supplement policy 20
because of health status, claims experience, receipt of health care, 21
H-0726.1
HOUSE BILL 1603
State of Washington 69th Legislature 2025 Regular Session
By Representatives Berg, Parshley, Reed, Bernbaum, Thai, Kloba, and
Hill
Read first time 01/27/25. Referred to Committee on Health Care &
Wellness.
p. 1 HB 1603
or medical condition, and shall not impose an exclusion of benefits 1
based on a preexisting condition under such a medicare supplement 2
policy. 3
(3) "Eligible persons" means an individual that meets the 4
requirements of (a), (b), (c), (d), (e), or (f) of this subsection, 5
as follows: 6
(a) The individual is enrolled under an employee welfare benefit 7
plan that provides health benefits that supplement the benefits under 8
medicare; and the plan terminates, or the plan ceases to provide all 9
such supplemental health benefits to the individual;10
(b)(i) The individual is enrolled with a medicare advantage 11
organization under a medicare advantage plan under part C of 12
medicare, and any of the following circumstances apply, or the 13
individual is sixty-five years of age or older and is enrolled with a 14
program of all inclusive care for the elderly (PACE) provider under 15
section 1894 of the social security act, and there are circumstances 16
similar to those described in this subsection (3)(b) that would 17
permit discontinuance of the individual's enrollment with the 18
provider if the individual were enrolled in a medicare advantage 19
plan: 20
(A) The certification of the organization or plan has been 21
terminated; 22
(B) The organization has terminated or otherwise discontinued 23
providing the plan in the area in which the individual resides;24
(C) The individual is no longer eligible to elect the plan 25
because of a change in the individual's place of residence or other 26
change in circumstances specified by the secretary of the United 27
States department of health and human services, but not including 28
termination of the individual's enrollment on the basis described in 29
section 1851 (g)(3)(B) of the federal social security act (where the 30
individual has not paid premiums on a timely basis or has engaged in 31
disruptive behavior as specified in standards under section 1856 of 32
the federal social security act), or the plan is terminated for all 33
individuals within a residence area; 34
(D) The individual demonstrates, in accordance with guidelines 35
established by the secretary of the United States department of 36
health and human services, that: 37
(I) The organization offering the plan substantially violated a 38
material provision of the organization's contract under this part in 39
relation to the individual, including the failure to provide an 40
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enrollee on a timely basis medically necessary care for which 1
benefits are available under the plan or the failure to provide such 2
covered care in accordance with applicable quality standards; or3
(II) The organization, an insurance producer, or other entity 4
acting on the organization's behalf materially misrepresented the 5
plan's provisions in marketing the plan to the individual; ((or))6
(E) The individual, during an established open enrollment or 7
special enrollment period during which a medicare beneficiary may 8
switch from medicare advantage to medicare parts A and B, voluntarily 9
terminates the individual's enrollment in the medicare advantage plan 10
and enrolls in medicare parts A and B; or11
(F) The individual meets other exceptional conditions as the 12
secretary of the United States department of health and human 13
services may provide. 14
(ii)(A) An individual described in (b)(i) of this subsection may 15
elect to apply (a) of this subsection by substituting, for the date 16
of termination of enrollment, the date on which the individual was 17
notified by the medicare advantage organization of the impending 18
termination or discontinuance of the medicare advantage plan it 19
offers in the area in which the individual resides, but only if the 20
individual disenrolls from the plan as a result of such notification.21
(B) In the case of an individual making the election under 22
(b)(ii)(A) of this subsection, the issuer involved shall accept the 23
application of the individual submitted before the date of 24
termination of enrollment, but the coverage under subsection (1) of 25
this section is only effective upon termination of coverage under the 26
medicare advantage plan involved; 27
(c)(i) The individual is enrolled with: 28
(A) An eligible organization under a contract under section 1876 29
(medicare risk or cost); 30
(B) A similar organization operating under demonstration project 31
authority, effective for periods before April 1, 1999;32
(C) An organization under an agreement under section 33
1833(a)(1)(A) (health care prepayment plan); or 34
(D) An organization under a medicare select policy; and35
(ii) The enrollment ceases under the same circumstances that 36
would permit discontinuance of an individual's election of coverage 37
under (b)(i) of this subsection; 38
(d) The individual is enrolled under a medicare supplement policy 39
and the enrollment ceases because: 40
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(i)(A) Of the insolvency of the issuer or bankruptcy of the 1
nonissuer organization; or 2
(B) Of other involuntary termination of coverage or enrollment 3
under the policy; 4
(ii) The issuer of the policy substantially violated a material 5
provision of the policy; or 6
(iii) The issuer, an insurance producer, or other entity acting 7
on the issuer's behalf materially misrepresented the policy's 8
provisions in marketing the policy to the individual;9
(e)(i) The individual was enrolled under a medicare supplement 10
policy and terminates enrollment and subsequently enrolls, for the 11
first time, with any medicare advantage organization under a medicare 12
advantage plan under part C of medicare, any eligible organization 13
under a contract under section 1876 (medicare risk or cost), any 14
similar organization operating under demonstration project authority, 15
any PACE program under section 1894 of the social security act or a 16
medicare select policy; and 17
(ii) The subsequent enrollment under (e)(i) of this subsection is 18
terminated by the enrollee during any period within the first twelve 19
months of such subsequent enrollment (during which the enrollee is 20
permitted to terminate such subsequent enrollment under section 21
1851(e) of the federal social security act); 22
(f) The individual, upon first becoming eligible for benefits 23
under part A of medicare at age sixty-five, enrolls in a medicare 24
advantage plan under part C of medicare, or in a PACE program under 25
section 1894, and disenrolls from the plan or program by not later 26
than twelve months after the effective date of enrollment; or27
(g) The individual enrolls in a medicare part D plan during the 28
initial enrollment period and, at the time of enrollment in part D, 29
was enrolled under a medicare supplement policy that covers 30
outpatient prescription drugs, and the individual terminates 31
enrollment in the medicare supplement policy and submits evidence of 32
enrollment in medicare part D along with the application for a policy 33
described in subsection (4)(a)(iv) of this section.34
(4)(a) An eligible person under subsection (3) of this section is 35
entitled to a medicare supplement policy as follows:36
(i) A person eligible under subsection (3)(a), (b), (c), and (d) 37
of this section is entitled to a medicare supplement policy that has 38
a benefit package classified as plan A through F (including F with a 39
high deductible), K, or L, offered by any issuer; 40
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(ii)(A) Subject to (a)(ii)(B) of this subsection, a person 1
eligible under subsection (3)(e) of this section is entitled to the 2
same medicare supplement policy in which the individual was most 3
recently previously enrolled, if available from the same issuer, or, 4
if not so available, a policy described in (a)(i) of this subsection;5
(B) After December 31, 2005, if the individual was most recently 6
enrolled in a medicare supplement policy with an outpatient 7
prescription drug benefit, a medicare supplement policy described in 8
this subsection (4)(a)(ii)(B) is: 9
(I) The policy available from the same issuer but modified to 10
remove outpatient prescription drug coverage; or 11
(II) At the election of the policyholder, an A, B, C, F 12
(including F with a high deductible), K, or L policy that is offered 13
by any issuer; 14
(iii) A person eligible under subsection (3)(f) of this section 15
is entitled to any medicare supplement policy offered by any issuer; 16
and 17
(iv) A person eligible under subsection (3)(g) of this section is 18
entitled to a medicare supplement policy that has a benefit package 19
classified as plan A, B, C, F (including F with a high deductible), 20
K, or L and that is offered and is available for issuance to new 21
enrollees by the same issuer that issued the individual's medicare 22
supplement policy with outpatient prescription drug coverage.23
(b) For purposes of this subsection (4), in the case of any 24
individual newly eligible for medicare on or after January 1, 2020, 25
any reference to a medicare supplement policy C or F, including F 26
with high deductible, is deemed to be a reference to a medicare 27
supplement policy D or G, including G with high deductible, 28
respectively, that meets the requirements of this subsection.29
(5)(a) At the time of an event described in subsection (3) of 30
this section, and because of which an individual loses coverage or 31
benefits due to the termination of a contract, agreement, policy, or 32
plan, the organization that terminates the contract or agreement, the 33
issuer terminating the policy, or the administrator of the plan being 34
terminated, respectively, must notify the individual of his or her 35
rights under this section, and of the obligations of issuers of 36
medicare supplement policies under subsection (1) of this section. 37
The notice must be communicated contemporaneously with the 38
notification of termination. 39
p. 5 HB 1603
(b) At the time of an event described in subsection (3) of this 1
section, and because of which an individual ceases enrollment under a 2
contract, agreement, policy, or plan, the organization that offers 3
the contract or agreement, regardless of the basis for the cessation 4
of enrollment, the issuer offering the policy, or the administrator 5
of the plan, respectively, must notify the individual of his or her 6
rights under this section, and of the obligations of issuers of 7
medicare supplement policies under subsection (1) of this section. 8
The notice must be communicated within ten working days of the issuer 9
receiving notification of disenrollment. 10
(6) Guaranteed issue time periods: 11
(a) In the case of an individual described in subsection (3)(a) 12
of this section, the guaranteed issue period begins on the later of: 13
(i) The date the individual receives a notice of termination or 14
cessation of all supplemental health benefits (or, if a notice is not 15
received, notice that a claim has been denied because of a 16
termination or cessation), or (ii) the date that the applicable 17
coverage terminates or ceases, and ends sixty-three days thereafter;18
(b) In the case of an individual described in subsection (3)(b), 19
(c), (e), or (f) of this section whose enrollment is terminated 20
involuntarily, the guaranteed issue period begins on the date that 21
the individual receives a notice of termination and ends sixty-three 22
days after the date the applicable coverage is terminated;23
(c) In the case of an individual described in subsection 24
(3)(d)(i) of this section, the guaranteed issue period begins on the 25
earlier of: (i) The date that the individual receives a notice of 26
termination, a notice of the issuer's bankruptcy or insolvency, or 27
other such similar notice if any, and (ii) the date that the 28
applicable coverage is terminated, and ends on the date that is 29
sixty-three days after the date the coverage is terminated;30
(d) In the case of an individual described in subsection (3)(b), 31
(d)(ii) and (iii), (e), or (f) of this section, who disenrolls 32
voluntarily, the guaranteed issue period begins on the date that is 33
sixty days before the effective date of the disenrollment and ends on 34
the date that is sixty-three days after the effective date;35
(e) In the case of an individual described in subsection (3)(g) 36
of this section, the guaranteed issue period begins on the date the 37
individual receives notice pursuant to section 1882 (v)(2)(B) of the 38
federal social security act from the medicare supplement issuer 39
during the sixty-day period immediately preceding the initial part D 40
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enrollment period and ends on the date that is sixty-three days after 1
the effective date of the individual's coverage under medicare part 2
D; and 3
(f) In the case of an individual described in subsection (3) of 4
this section but not described in the preceding provisions of this 5
subsection, the guaranteed issue period begins on the effective date 6
of disenrollment and ends on the date that is sixty-three days after 7
the effective date. 8
(7) In the case of an individual described in subsection (3)(e) 9
of this section whose enrollment with an organization or provider 10
described in subsection (3)(e)(i) of this section is involuntarily 11
terminated within the first twelve months of enrollment, and who, 12
without an intervening enrollment, enrolls with another organization 13
or provider, the subsequent enrollment is an initial enrollment as 14
described in subsection (3)(e) of this section. 15
(8) In the case of an individual described in subsection (3)(f) 16
of this section whose enrollment with a plan or in a program 17
described in subsection (3)(f) of this section is involuntarily 18
terminated within the first twelve months of enrollment, and who, 19
without an intervening enrollment, enrolls in another plan or 20
program, the subsequent enrollment is an initial enrollment as 21
described in subsection (3)(f) of this section. 22
(9) For purposes of subsection (3)(e) and (f) of this section, an 23
enrollment of an individual with an organization or provider 24
described in subsection (3)(e)(i) of this section, or with a plan or 25
in a program described in subsection (3)(f) of this section is not an 26
initial enrollment under this subsection after the two-year period 27
beginning on the date on which the individual first enrolled with 28
such an organization, provider, plan, or program. 29
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