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2021 Revised Code of Washington
Title 48 - Insurance
Chapter 48.43 - Insurance Reform.
- 48.43.001 - Intent.
- 48.43.005 - Definitions.
- 48.43.007 - Availability of price and quality information—Transparency tools for members—Requirements.
- 48.43.008 - Enrollment in employer-sponsored health plan—Person eligible for medical assistance.
- 48.43.009 - Health care sharing ministries.
- 48.43.012 - Health plans—Preexisting conditions—Rules.
- 48.43.01211 - Health plans—Eligibility—Health status-related factors—Rules.
- 48.43.0122 - Individual health benefit plans—Open enrollment and special enrollment periods—Rules—Enforcement.
- 48.43.0123 - Health plans—Rescission of coverage—Rules.
- 48.43.0124 - Health plans—Cost sharing for essential health benefits—Rules.
- 48.43.0125 - Essential health benefits—Annual or lifetime dollar limits.
- 48.43.0126 - Summary of benefits and explanation of coverage—Standards and requirements—Notice of modification—Fines—Standards for definitions of health insurance terms—Rules.
- 48.43.0127 - Group health plans—Waiting period—Rules.
- 48.43.0128 - Nongrandfathered health plans and plans issued or renewed on or after January 1, 2022—Prohibited discrimination—Rules.
- 48.43.016 - Utilization management standards and criteria—Health carrier requirements—Definitions.
- 48.43.0161 - Prior authorization practices—Carrier annual reporting requirements—Commissioner's standardized report.
- 48.43.021 - Personally identifiable health information—Restrictions on release.
- 48.43.022 - Enrollee identification card—Social security number restriction.
- 48.43.023 - Pharmacy identification cards—Rules.
- 48.43.028 - Eligibility to purchase certain health benefit plans—Small employers and small groups.
- 48.43.035 - Group health benefit plans—Guaranteed issue and continuity of coverage—Exceptions.
- 48.43.038 - Individual health plans—Guarantee of continuity of coverage—Exceptions.
- 48.43.039 - Grace period—Notification or information—Information concerning delinquencies or nonpayment of premiums—Defined.
- 48.43.041 - Individual health benefit plans—Mandatory benefits.
- 48.43.043 - Colorectal cancer examinations and laboratory tests—Required benefits or coverage.
- 48.43.045 - Health plan requirements—Annual reports—Exemptions.
- 48.43.047 - Health plans—Minimum coverage for preventative services—No cost-sharing requirements.
- 48.43.049 - Health carrier data—Information from annual statement—Format prescribed by commissioner—Public availability.
- 48.43.055 - Procedures for review and adjudication of health care provider complaints—Requirements.
- 48.43.059 - Payments made by a second-party payment process—Definition.
- 48.43.065 - Right of individuals to receive services—Right of providers, carriers, and facilities to refuse to participate in or pay for services for reason of conscience or religion—Requirements.
- 48.43.071 - Health care information—Requirement to provide free copy to covered person appealing denial of social security benefits—Exceptions.
- 48.43.072 - Required reproductive health care coverage—Restrictions on copayments, deductibles, and other form of cost sharing.
- 48.43.073 - Required abortion coverage—Limitations.
- 48.43.074 - Qualified health plans—Single invoice billing—Certification of compliance required in the segregation plan for premium amounts attributable to coverage of abortion services.
- 48.43.078 - Digital breast tomosynthesis—Intent to ensure women with access—Commissioner's and health care authority's duty to clarify mandates.
- 48.43.081 - Anatomic pathology services—Payment for services—Definitions.
- 48.43.083 - Chiropractor services—Participating provider agreement—Health carrier reimbursement.
- 48.43.085 - Health carrier may not prohibit its enrollees from contracting for services outside the health care plan.
- 48.43.087 - Contracting for services at enrollee's expense—Mental health care practitioner—Conditions—Exception.
- 48.43.091 - Health carrier coverage of outpatient mental health services—Requirements.
- 48.43.093 - Health carrier coverage of emergency medical services—Requirements—Conditions.
- 48.43.094 - Pharmacist provided services—Health plan requirements.
- 48.43.096 - Medication synchronization policy required for health plans covering prescription drugs—Requirements—Definitions.
- 48.43.097 - Filing of financial statements—Every health carrier.
- 48.43.105 - Preparation of documents that compare health carriers—Immunity—Due diligence.
- 48.43.115 - Maternity services—Intent—Definitions—Patient preference—Clinical sovereignty of provider—Notice to policyholders—Application.
- 48.43.125 - Coverage at a long-term care facility following hospitalization—Definition.
- 48.43.176 - Eosinophilic gastrointestinal associated disorder—Elemental formula.
- 48.43.180 - Denturist services.
- 48.43.185 - General anesthesia services for dental procedures.
- 48.43.190 - Payment of chiropractic services—Parity.
- 48.43.195 - Contraceptive drugs—Twelve-month refill coverage.
- 48.43.200 - Disclosure of certain material transactions—Report—Information is confidential.
- 48.43.205 - Material acquisitions or dispositions.
- 48.43.210 - Asset acquisitions—Asset dispositions.
- 48.43.215 - Report of a material acquisition or disposition of assets—Information required.
- 48.43.220 - Material nonrenewals, cancellations, or revisions of ceded reinsurance agreements.
- 48.43.225 - Report of a material nonrenewal, cancellation, or revision of ceded reinsurance agreements—Information required.
- 48.43.290 - Coverage for prescribed durable medical equipment and mobility enhancing equipment—Sales and use taxes—Definitions.
- 48.43.600 - Overpayment recovery—Carrier.
- 48.43.605 - Overpayment recovery—Health care provider.
- 48.43.650 - Fixed payment insurance products—Commissioner's annual report.
- 48.43.670 - Plan or contract renewal—Modification of wellness program.
- 48.43.680 - Lifetime limit on transplants—Definition.
- 48.43.690 - Assessments under RCW 70.290.040 considered medical expenses.
- 48.43.700 - Exchange—Plans that a carrier must offer—Review—Rules.
- 48.43.705 - Plans offered outside of exchange.
- 48.43.710 - Certification as qualified health plan not an exemption.
- 48.43.715 - Individual and small group market—Selection of benchmark plan—Minimum requirements—Criteria—List of state-mandated health benefits.
- 48.43.720 - Reinsurance and risk adjustment programs—Affordable care act—Rules.
- 48.43.725 - Exclusion of mandated benefits from health plan—Carrier requirements—Notice—Fees—Commissioner's duties.
- 48.43.730 - Carrier must file provider contracts and compensation agreements with commissioner—Approval or disapproval—Confidentiality—Hearings—Rules—Definitions.
- 48.43.731 - Health care benefit management contracts—Carrier filing requirements—Notice to enrollees—Confidentiality of filings.
- 48.43.733 - Rates and forms of group health benefit plans—Timing of filings—Exceptions—Rules.
- 48.43.734 - Health carrier rate filings—Review of surplus, capital, and profit levels.
- 48.43.735 - Reimbursement of health care services provided through telemedicine or store and forward technology—Audio-only telemedicine.
- 48.43.740 - Dental only plan—Emergency dental conditions—Definitions.
- 48.43.743 - Dental only plan—Annual data statement—Contents—Public use—Definition.
- 48.43.750 - Health care provider credentialing applications—Use of electronic database by health carriers.
- 48.43.755 - Health care provider credentialing applications—Use of electronic database by providers.
- 48.43.757 - Health care provider credentialing applications—Reimbursement requirements.
- 48.43.760 - Opioid use disorder—Coverage without prior authorization.
- 48.43.761 - Withdrawal management services—Substance use disorder treatment services—Prior authorization—Utilization review—Medical necessity review.
- 48.43.762 - Opioid overdose reversal medication bulk purchasing and distribution program.
- 48.43.765 - Health carrier network adequacy—Mental health and substance abuse treatment.
- 48.43.770 - Individual market health plan availability—Annual report.
- 48.43.775 - Qualified health plan participation—Reimbursement rate for other health plans.
- 48.43.780 - Insulin drugs—Cap on enrollee's required payment amount—Cost-sharing requirements.
- 48.43.785 - COVID-19 personal protective equipment expenses—Health care provider reimbursement.
- 48.43.790 - Behavioral services—Next-day appointments.
- 48.43.795 - Qualified health plans—Acceptance of premium and cost-sharing assistance.
- 48.43.300 - Definitions.
- 48.43.305 - Report of RBC levels—Distribution of report—Formula for determination—Commissioner may make adjustments.
- 48.43.310 - Company action level event—Required RBC plan—Commissioner's review—Notification—Challenge by carrier.
- 48.43.315 - Regulatory action level event—Required RBC plan—Commissioner's review—Notification—Challenge by carrier.
- 48.43.320 - Authorized control level event—Commissioner's options.
- 48.43.325 - Mandatory control level event—Commissioner's duty—Regulatory control.
- 48.43.330 - Carrier's right to hearing—Request by carrier—Date set by commissioner.
- 48.43.335 - Confidentiality of RBC reports and plans—Use of certain comparisons prohibited—Certain information intended solely for use by commissioner.
- 48.43.340 - Powers or duties of commissioner not limited—Rules.
- 48.43.345 - Foreign or alien carriers—Required RBC report—Commissioner may require RBC plan—Mandatory control level event.
- 48.43.350 - No liability or cause of action against commissioner or department.
- 48.43.355 - Notice by commissioner to carrier—When effective.
- 48.43.360 - Initial RBC reports—Calculation of initial RBC levels—Subsequent reports.
- 48.43.366 - Self-funded multiple employer welfare arrangements.
- 48.43.370 - RBC standards not applicable to certain carriers.
- 48.43.400 - Prescription drug utilization management—Definitions.
- 48.43.410 - Prescription drug utilization management—Clinical review criteria—Requirement to be evidence-based and updated regularly.
- 48.43.420 - Prescription drug utilization management—Exception request process—Conditions, requirements, and time frames for approval or denial of requests—Emergency fill coverage—Notice of new policies and procedures.
- 48.43.430 - Prescription medication—Maximum charge at point of sale—Requirements.
- 48.43.500 - Intent—Purpose—2000 c 5.
- 48.43.505 - Enrollee's and protected individual's right to privacy and confidential services—Health carrier or insurer duties—Requests for confidential communications—Rules.
- 48.43.5051 - Requests for confidential communications—Monitoring and ensuring compliance—Standardized form for submission of requests—Rules.
- 48.43.510 - Carrier required to disclose health plan information—Marketing and advertising restrictions—Rules.
- 48.43.515 - Access to appropriate health services—Enrollee options—Rules.
- 48.43.517 - Enrollment of child participating in medical assistance program—Employer-sponsored health plan.
- 48.43.520 - Requirement to maintain a documented utilization review program description and written utilization review criteria—Rules.
- 48.43.525 - Prohibition against retrospective denial of health plan coverage—Rules.
- 48.43.530 - Requirement for carriers to have comprehensive grievance and appeal processes—Carrier's duties—Procedures—Appeals—Rules.
- 48.43.535 - Independent review of health care disputes—System for using certified independent review organizations—Rules.
- 48.43.537 - Health care disputes—Certifying independent review organizations—Application—Restrictions—Maximum fee schedule for conducting reviews—Rules.
- 48.43.540 - Requirement to designate a licensed medical director—Exemption.
- 48.43.545 - Standard of care—Liability—Causes of action—Defense—Exception.
- 48.43.550 - Delegation of duties—Carrier accountability.
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