WA: Exchange Board Grapples With Insufficient Plan Participation In SHOP Market

The Washington Health Benefit Exchange Board of Directors held a special meeting yesterday where staff briefed them on the status of the SHOP (small business) marketplace.

Only one carrier, offering coverage in four counties, is participating in the Exchange’s SHOP marketplace rendering the network inadequate statewide. That plan is Kaiser and is only in Southwest Washington.

Three carriers had submitted for approval, but two later withdrew.  Those two are Regence and CHPW.

Staff indicated that the main concern they have heard from carriers is the defined contribution structure. Some also felt that the operational requirements and accessing the tax credit were cumbersome, and decided to set aside SHOP for this year and concentrate on the Individual marketplace.

Staff presented the Board with possible scenarios as well as steps they are taking to be able to make a recommendation for the Board to act upon next week.

Beth Berendt with the Office of the Insurance Commissioner (OIC) explained that if the SHOP marketplace is delayed for a term less than one year, all carriers offering small business plans would have to refile their small group rates with the OIC to be submitted to CCIIO for reevaluation of the entire risk pool (this includes the 11 carriers outside of the Exchange). Listen to Berendt’s explanation here.

With the tight implementation timelines, board members will be faced with a tough decision next week.