Structure and Administration
WSHIP is an independent, non-profit health plan. The Office of the Insurance Commissioner (OIC) has regulatory oversight of the Pool and approval authority for the Pool’s Plan of Operations, benefit documents, and compliance with relevant statutes and regulations. Pool premiums and Member Plan assessments are not subject to approval by the Insurance Commissioner.
Board of Directors
Pool oversight is the responsibility of an eleven-member Board of Directors, ten of whom serve three-year terms. Six directors are appointed by the Governor; they represent consumers (two positions); small employers (one); large employers (one); health care providers (one), and agents (one). Four directors are elected by Member Plans. The Insurance Commissioner or his designee is an ex-officio, non-voting director.
An Executive Director oversees the day-to-day operations of the Pool augmented as necessary with consulting services. An Executive Assistant provides administrative support to the Executive Director and Board.
Third Party Administrator & Contractors
WSHIP contracts with a third party administrator – Benefit Management, LLC (BML) – for health plan enrollment, premium billing, claims processing, customer service, on-line information access, accounting, and reporting.
Pharmacy benefit management is provided by Express Scripts Inc. These services include pharmacy network pricing, drug claims processing and reporting, delivery-by-mail pharmacy services, and customer service.
Provider network services are provided by First Choice Health Network.
Care management services are provided by MedWatch LLC. These services include utilization management, case management, disease management, and care coaching.
All Disability Carriers, Health Care Service Contractors, and Health Maintenance Organizations licensed under Title 48 RCW that sell health and/or stop-loss coverage in Washington are Members of the Pool. Carriers that exclusively offer only life or dental products are not Members. Self-insured multiple employer welfare associations are Members, but ERISA groups are not. (Note: The law provides that the term “Member” shall be expanded to include ERISA groups at such time as permitted by federal law.)
The State of Washington’s self-insured Uniform Medical Plan (UMP) is also a Member. The UMP and Members that provide stop-loss insurance are assessed at a rate 1/10 of what the other carriers pay per fully insured covered life.