This bill establishes a new requirement for health plans in Washington State, mandating that the medical loss ratio (MLR) be at least 90 percent for plans issued or renewed on or after January 1, 2028. A new section is added to chapter 48.43 RCW, which outlines that the commissioner has the authority to require health carriers to submit detailed information regarding their calculation of medical loss ratios as part of their rate filings for plan years beginning on or after January 1, 2027. This information may include various forms of payments and reimbursement to healthcare providers and facilities, as well as details on nonclaims-based payments and incentive-based activities.

Additionally, the bill clarifies that the authority granted does not alter the commissioner's existing rate review authority under specified RCWs. The commissioner is also empowered to adopt any necessary rules to implement this new section. The definition of "medical loss ratio" is aligned with federal regulations as of January 1, 2026, ensuring consistency with national standards.