28A.400.270  <<  28A.400.275 >>   28A.400.280

RCW 28A.400.275

Employee benefits—Contracts or agreements—Submission of information to the office of the insurance commissioner (as amended by 2017 3rd sp.s. c 7).

(1) Any contract or agreement for employee benefits executed after April 13, 1990, between a school district and a benefit provider or employee bargaining unit is null and void unless it contains an agreement to abide by state laws relating to school district employee benefits. The term of the contract or agreement may not exceed one year.
(2) ((School districts and their benefit providers shall annually submit, by a date determined by the office of the insurance commissioner, the following information and data for the prior calendar year to the office of the insurance commissioner:
(a) Progress by the district and its benefit providers toward greater affordability for full family coverage, health care cost savings, and significantly reduced administrative costs;
(b) Compliance with the requirement to provide a high deductible health plan option with a health savings account;
(c) An overall plan summary including the following:
(i) The financial plan structure and overall performance of each health plan including:
(A) Total premium expenses;
(B) Total claims expenses;
(C) Claims reserves; and
(D) Plan administration expenses, including compensation paid to brokers;
(ii) A description of the plan's use of innovative health plan features designed to reduce health benefit premium growth and reduce utilization of unnecessary health services including but not limited to the use of enrollee health assessments or health coach services, care management for high cost or high-risk enrollees, medical or health home payment mechanisms, and plan features designed to create incentives for improved personal health behaviors;
(iii) Data to provide an understanding of employee health benefit plan coverage and costs, including: The total number of employees and, for each employee, the employee's full-time equivalent status, types of coverage or benefits received including numbers of covered dependents, the number of eligible dependents, the amount of the district's contribution to premium, additional premium costs paid by the employee through payroll deductions, and the age and sex of the employee and each dependent;
(iv) Data necessary for school districts to more effectively and competitively manage and procure health insurance plans for employees. The data must include, but not be limited to, the following:
(A) A summary of the benefit packages offered to each group of district employees, including covered benefits, employee deductibles, coinsurance, and copayments, and the number of employees and their dependents in each benefit package;
(B) Aggregated employee and dependent demographic information, including age band and gender, by insurance tier and by benefit package;
(C) Total claim payments by benefit package, including premiums paid, inpatient facility claims paid, outpatient facility claims paid, physician claims paid, pharmacy claims paid, capitation amounts paid, and other claims paid;
(D) Total premiums paid by benefit package;
(E) A listing of large claims defined as annual amounts paid in excess of one hundred thousand dollars including the amount paid, the member enrollment status, and the primary diagnosis.
(3) Annually, school districts and their benefit providers shall jointly report to the office of the insurance commissioner on their health insurance-related efforts and achievements to:
(a) Significantly reduce administrative costs for school districts;
(b) Improve customer service;
(c) Reduce differential plan premium rates between employee only and family health benefit premiums;
(d) Protect access to coverage for part-time K-12 employees.
(4) The information and data shall be submitted in a format and according to a schedule established by the office of the insurance commissioner under RCW 48.02.210 to enable the commissioner to meet the reporting obligations under that section.
(5))) Any benefit provider offering a benefit plan by contract or agreement with a school district under subsection (1) of this section shall make available to the school district the benefit plan descriptions and, where available, the demographic information on plan subscribers that the district and benefit provider are required to *report to the office of the insurance commissioner under this section.
(((6) This section shall not apply to benefit plans offered in the 1989-90 school year.))
NOTES:
*Reviser's note: The report referenced in subsection (2) of this section was eliminated by 2017 3rd sp.s. c 7.

RCW 28A.400.275

Employee benefits—Contracts or agreements—Submission of information to the office of the insurance commissioner—Annual reports (as amended by 2017 3rd sp.s. c 13).

(1) Any contract or agreement for employee benefits executed after April 13, 1990, between a school district and a benefit provider or employee bargaining unit is null and void unless it contains an agreement to abide by state laws relating to school district employee benefits. The term of the contract or agreement may not exceed one year.
(2) Through December 31, 2019, school districts and their benefit providers shall annually submit, by a date determined by the office of the insurance commissioner, the following information and data for the prior calendar year to the office of the insurance commissioner:
(a) Progress by the district and its benefit providers toward greater affordability for full family coverage, health care cost savings, and significantly reduced administrative costs;
(b) Compliance with the requirement to provide a high deductible health plan option with a health savings account;
(c) An overall plan summary including the following:
(i) The financial plan structure and overall performance of each health plan including:
(A) Total premium expenses;
(B) Total claims expenses;
(C) Claims reserves; and
(D) Plan administration expenses, including compensation paid to brokers;
(ii) A description of the plan's use of innovative health plan features designed to reduce health benefit premium growth and reduce utilization of unnecessary health services including but not limited to the use of enrollee health assessments or health coach services, care management for high cost or high-risk enrollees, medical or health home payment mechanisms, and plan features designed to create incentives for improved personal health behaviors;
(iii) Data to provide an understanding of employee health benefit plan coverage and costs, including: The total number of employees and, for each employee, the employee's full-time equivalent status, types of coverage or benefits received including numbers of covered dependents, the number of eligible dependents, the amount of the district's contribution to premium, additional premium costs paid by the employee through payroll deductions, and the age and sex of the employee and each dependent;
(iv) Data necessary for school districts to more effectively and competitively manage and procure health insurance plans for employees. The data must include, but not be limited to, the following:
(A) A summary of the benefit packages offered to each group of district employees, including covered benefits, employee deductibles, coinsurance, and copayments, and the number of employees and their dependents in each benefit package;
(B) Aggregated employee and dependent demographic information, including age band and gender, by insurance tier and by benefit package;
(C) Total claim payments by benefit package, including premiums paid, inpatient facility claims paid, outpatient facility claims paid, physician claims paid, pharmacy claims paid, capitation amounts paid, and other claims paid;
(D) Total premiums paid by benefit package;
(E) A listing of large claims defined as annual amounts paid in excess of one hundred thousand dollars including the amount paid, the member enrollment status, and the primary diagnosis;
(F) After December 31, 2018, school districts shall submit such data as required by the school employees' benefits board to administer the consolidated purchasing of health services.
(3) ((Annually)) Through December 31, 2018, school districts and their benefit providers shall jointly report to the office of the insurance commissioner on their health insurance-related efforts and achievements to:
(a) Significantly reduce administrative costs for school districts;
(b) Improve customer service;
(c) Reduce differential plan premium rates between employee only and family health benefit premiums;
(d) Protect access to coverage for part-time K-12 employees.
(4) The information and data shall be submitted in a format and according to a schedule established by the office of the insurance commissioner under *RCW 48.02.210 to enable the commissioner to meet the reporting obligations under that section.
(5) Through December 31, 2018, any benefit provider offering a benefit plan by contract or agreement with a school district under subsection (1) of this section shall make available to the school district the benefit plan descriptions and, where available, the demographic information on plan subscribers that the district and benefit provider are required to report to the office of the insurance commissioner under this section. After December 31, 2018, a benefit provider shall submit such data to the school employees' benefits board.
(6) ((This section shall not apply to benefit plans offered in the 1989-90 school year.)) Each school district shall:
(a) Carry out all actions required by the school employees' benefits board and the health care authority under chapter 41.05 RCW including, but not limited to, those necessary for the operation of benefit plans, education of employees, claims administration, and appeals process; and
(b) Report all data relating to employees eligible to participate in benefits or plans administered by the school employees' benefits board and the health care authority in a format designed and communicated by the school employees' benefits board and the health care authority.
NOTES:
Reviser's note: *(1) RCW 48.02.210 was repealed by 2017 3rd sp.s. c 7 § 2.
(2) RCW 28A.400.275 was amended twice during the 2017 legislative session, each without reference to the other. For rule of construction concerning sections amended more than once during the same legislative session, see RCW 1.12.025.
Intent2017 3rd sp.s. c 13: See note following RCW 28A.150.410.
FindingsGoalsIntent2012 2nd sp.s. c 3: "(1) The legislature finds that:
(a) Each year, nearly one billion dollars in public funds are spent on the purchase of employee insurance benefits for more than two hundred thousand public school employees and their dependents;
(b) The legislature and school districts and their employees need better information to improve current practices and inform future decisions with regard to health insurance benefits;
(c) Recent work by the state auditor's office and the state health care authority have advanced discussions throughout the state on opportunities to improve the current system; and
(d) Two major themes have emerged: (i) The state, school districts, and employees need better information and data to make better health insurance purchasing decisions within the K-12 system; (ii) affordability is a significant concern for all employees, especially for employees seeking full family insurance coverage and for the lowest-paid and part-time employees.
(2) The legislature establishes the following goals:
(a) Improve the transparency of health benefit plan claims and financial data to assure prudent and efficient use of taxpayers' funds at the state and local levels;
(b) Create greater affordability for full family coverage and greater equity between premium costs for full family coverage and for employee only coverage for the same health benefit plan;
(c) Promote health care innovations and cost savings, and significantly reduce administrative costs; and
(d) Provide greater parity in state allocations for state employee and K-12 employee health benefits.
(3) The legislature intends to retain current collective bargaining for benefits, and retain state, school district, and employee contributions to benefits." [ 2012 2nd sp.s. c 3 § 1.]
Intent1990 1st ex.s. c 11: See note following RCW 28A.400.200.
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