The bill adds a new section to chapter 48.43 RCW creating a statutory medical loss ratio (MLR) requirement. It establishes a minimum MLR of 90 percent for health plans issued or renewed on or after January 1, 2028. It authorizes the insurance commissioner to require carriers to submit specified information about how they calculate MLR as part of health plan rate filings for plan years beginning on or after January 1, 2027. Examples of information the commissioner may require include reimbursements or payments to carrier-owned or affiliated providers, use of nonclaims-based payments (such as subcapitation or bundled payments), and payments for quality improvement, risk mitigation, and other incentive-based activities. The commissioner may adopt rules to implement the section, and the statute defines “medical loss ratio” by reference to 45 C.F.R. Sec. 158.221 (2025) as of January 1, 2026. The bill expressly states this authority does not modify or limit the commissioner’s existing rate review authority under RCW 48.43.733, 48.44.017, and 48.46.062. Affected parties include the commissioner, health insurance carriers, health plans subject to the 90 percent MLR, and carrier-owned or affiliated providers and entities referenced in filings. Read for the first time February 3, 2026; the House Health Care & Wellness committee and sponsoring representatives are listed on the bill cover. The text does not specify the exact new section number, does not define “commissioner” or “carrier” within the excerpt, does not include the federal MLR calculation text, and does not state enforcement mechanisms, penalties, or whether any plan types are excluded or treated differently.

If enacted, the bill would require health plans issued or renewed on or after January 1, 2028 to meet a minimum medical loss ratio (MLR) of 90 percent, using the federal MLR definition in effect as of January 1, 2026. Starting with plan years that begin on or after January 1, 2027, the insurance commissioner can require carriers to include detailed MLR calculation information in rate filings and can adopt rules to implement these requirements; the bill specifically authorizes asking for data on payments to carrier‑owned or affiliated providers, nonclaims payment arrangements like subcapitation or bundled payments, and payments for quality improvement, risk mitigation, and incentive activities. The practical effects will fall mostly on carriers and the provider entities they own or contract with: insurers will face new reporting duties and likely need to change how premium dollars are allocated to ensure at least 90 percent goes to medical care and approved quality activities, which could squeeze administrative margins, alter provider payment arrangements, or influence premium setting. The commissioner gains expanded oversight authority. Key details are missing here, including who exactly counts as the “commissioner” or “carrier,” any enforcement or penalties for noncompliance, whether certain plan types are excluded, and the exact federal MLR calculation text the bill references.