48.43.049 - Health carrier data -- Information from annual statement -- Format prescribed by commissioner -- Public availability.

Health carrier data — Information from annual statement — Format prescribed by commissioner — Public availability.

(1) Each health carrier offering a health benefit plan shall submit to the commissioner on or before April 1st of each year as part of the additional data statement or as a supplemental data statement the following information:

     (a) The following information for the preceding year that is derived from the carrier's annual statement, including the exhibit of premiums, enrollments, and utilization for its Washington business, and the additional data to the annual statement. The information must be shown for five categories, total, individual contracts, small group contracts, and large group contracts (excluding government contracts), and government contracts:

     (i) The total number of members;

     (ii) The total amount of revenue;

     (iii) The total amount of hospital and medical payments;

     (iv) The medical loss ratio, that is computed by dividing the total amount of hospital and medical payments by the total amount of revenues;

     (v) The average amount of premiums per member per month; and

     (vi) The percentage change in the average premium per member per month, measured from the previous year; and

     (b) The following aggregate financial information for the preceding year that is derived from the carrier's annual statement:

     (i) The total amount of claim adjustment expenses;

     (ii) The total amount of general administrative expenses, including identification of the five largest nonmedical administrative expenses and the assessment against the carrier for the Washington state health insurance pool;

     (iii) The total amount of the reserves maintained for unpaid claims;

     (iv) The total net underwriting gain or loss;

     (v) The carrier's net income after taxes;

     (vi) Dividends to stockholders;

     (vii) The net change in capital and surplus from the prior year; and

     (viii) The total amount of the capital and surplus.

     (2) A carrier shall electronically submit the information described in subsection (1) of this section in a format and according to instructions prescribed by the commissioner.

     (3) The commissioner shall make the information reported under this section available to the public in a format that allows comparison among carriers through a searchable public web site on the internet.

     (4) For the purposes of licensed disability insurers, the commissioner shall work collaboratively with insurers to develop an additional or supplemental data statement that utilizes to the maximum extent possible information from the annual statement forms that are currently filed by these entities.

[2006 c 104 § 2.]

Notes: Intent -- 2006 c 104: "Health carriers are currently required to file statutory annual statements with the office of the insurance commissioner or the national association of insurance commissioners. These annual statements are extensive and contain a significant amount of financial information. These annual statements are public documents; however, such financial information can be complex and difficult to read and understand.

     It is the intent of this act to provide a method of reporting certain financial data in a user friendly format. It is also the intent of this act, to the extent possible, to utilize existing information from the annual statements when developing the additional or supplemental data statement required by this act, and to the extent possible, avoid imposing additional reporting requirements that have the unintended consequences of unduly increasing administrative costs for carriers required to file such information." [2006 c 104 § 1.]