6.2 Washington Group Health Insurance & COBRA
Key Takeaways
- Washington mini-COBRA applies to employers with fewer than 20 employees
- Washington mini-COBRA provides up to 18 months of continuation coverage
- Small group health plans (1-50 employees) have guaranteed issue protections
- Washington requires mental health parity in group health plans
- HIPAA portability requirements apply to group health coverage
Washington has specific regulations for group health insurance to ensure employees have access to and continuation of coverage.
Federal COBRA Overview
Federal COBRA applies to larger employers:
| COBRA Element | Federal Requirement |
|---|---|
| Employer Size | 20 or more employees |
| Duration | 18-36 months |
| Premium | Up to 102% of total premium |
| Qualifying Events | Termination, reduction in hours, divorce, death |
Washington Mini-COBRA
Washington provides mini-COBRA for smaller employers:
Mini-COBRA Requirements
| Element | Washington Requirement |
|---|---|
| Employer Size | Fewer than 20 employees |
| Duration | Up to 18 months |
| Premium | Up to 102% of total premium |
| Qualifying Events | Similar to federal COBRA |
Qualifying Events
- Termination (except for gross misconduct)
- Reduction in work hours
- Divorce or legal separation
- Death of covered employee
- Dependent child losing eligibility
Exam Tip: Washington mini-COBRA provides up to 18 months of continuation coverage, matching the base federal COBRA duration.
Election and Notice Requirements
Employer Obligations
| Obligation | Requirement |
|---|---|
| Notify Insurer | Within 30 days of qualifying event |
| Provide Notice | Election notice to qualified beneficiaries |
| Maintain Coverage | During election period |
Employee/Beneficiary Rights
| Element | Requirement |
|---|---|
| Election Period | 60 days from notice or loss of coverage |
| Retroactive Coverage | Coverage is continuous |
| First Payment | Within 45 days of election |
Small Group Health Insurance
Washington regulates small group health insurance (1-50 employees):
Guaranteed Issue
| Requirement | Description |
|---|---|
| Acceptance | Must accept all small employers |
| Pre-existing Conditions | Cannot exclude (ACA requirement) |
| Rating | Community rating with limited variations |
Guaranteed Renewal
Small group plans must renew unless:
- Non-payment of premium
- Fraud or material misrepresentation
- Failure to comply with plan provisions
- Insurer exits market (with proper notice)
Mental Health Parity
Washington requires mental health parity:
Parity Requirements
| Element | Must Equal Medical/Surgical |
|---|---|
| Deductibles | Same or integrated |
| Copayments | Equal cost-sharing |
| Day Limits | No more restrictive |
| Visit Limits | No more restrictive |
| Preauthorization | No more burdensome |
Covered Conditions
- Mental health disorders
- Substance use disorders
- Behavioral health conditions
- Serious mental illness
HIPAA Portability
Washington enforces HIPAA requirements:
Certificate of Creditable Coverage
| Element | Requirement |
|---|---|
| Timing | Upon loss of coverage |
| Content | Dates of coverage, type |
| Purpose | Reduce waiting periods for new coverage |
Portability Benefits
- Credit for prior continuous coverage
- Reduces new plan exclusion periods
- 63-day break rule applies
How long does Washington mini-COBRA provide continuation coverage?
Which employers are subject to Washington mini-COBRA requirements?
Under Washington small group health insurance rules, insurers must:
What does Washington's mental health parity law require for group health plans?
How long does a qualified beneficiary have to elect Washington mini-COBRA coverage?