November 2009
Legislative update
In compliance with recent Washington state legislation, the following benefit changes will go into effect January 1, 2010, unless another date is specified. These changes will be applied to all new groups and to our Individual products on January 1. They will apply to our group products at the group's renewal on or after January 1.
Note: Mandated changes with minimal or no impact to current Asuris benefits or policies are not included in the changes listed below.
Chemical dependency benefit maximum
For employer group plans with 2 to 50 employees, the benefit maximum for chemical dependency treatment will increase from $14,500 to $15,000 every two calendar years. These limits do not apply to employer groups with more than 51 employees due to the federal Mental Health Parity Act.
Coordination of Benefits changes
The following changes apply to claims for dates of services on or after September 1 that include Coordination of Benefits (COB) with another health plan (except when Medicare is the primary payer):
- Secondary plans no longer have to estimate payment.
- Primary plans must pay 95% of "clean claims" within 30 days and all clean claims within 60 days.
- If a primary plan fails to pay a clean claim within 60 days, the claim can be submitted to the secondary plan to pay as primary within 30 days.
- Secondary plans can delay payment of claims that lack primary payment information until such information is received.
- Plans must work together within 30 days to determine which payer is primary. If an agreement cannot be reached, both plans must share the allowable expenses equally.
- Secondary plans can use their highest allowable if the primary plan has paid the claim but has not submitted the payment information to the secondary plan within 60 days.
Organ transplant lifetime maximum
The organ transplant lifetime maximum will increase to $350,000. The maximum applies one day prior to the date of the transplant or, for a patient who receives a transplant during the course of a longer hospital stay, the date of hospital admission through 100 days after the transplant.
Organ transplant waiting periods
The organ transplant waiting period (six or 12 months depending on the product) will be decreased by the amount of time a person had prior creditable coverage. Creditable coverage, for the purposes of this law, means the same as set forth in Health Insurance Portability and Accountability Act (HIPAA) guidelines. It includes coverage that terminated during the period beginning 90 days before and ending 64 days before the date of application for the new plan if that coverage would otherwise have qualified as creditable coverage.