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Insurance Reform.
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Revised Code of Washington
Insurance
Insurance Reform.
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Section
48.43.001
Intent.
Section
48.43.005
Definitions.
Section
48.43.007
Availability of price and quality information—Transparency tools for members—Requirements.
Section
48.43.008
Enrollment in employer-sponsored health plan—Person eligible for medical assistance.
Section
48.43.009
Health care sharing ministries.
Section
48.43.012
Health plans—Preexisting conditions—Rules.
Section
48.43.016
Utilization management standards and criteria—Health carrier requirements—Definitions.
Section
48.43.021
Personally identifiable health information—Restrictions on release.
Section
48.43.022
Enrollee identification card—Social security number restriction.
Section
48.43.023
Pharmacy identification cards—Rules.
Section
48.43.028
Eligibility to purchase certain health benefit plans—Small employers and small groups.
Section
48.43.035
Group health benefit plans—Guaranteed issue and continuity of coverage—Exceptions.
Section
48.43.038
Individual health plans—Guarantee of continuity of coverage—Exceptions.
Section
48.43.039
Grace period—Notification or information—Information concerning delinquencies or nonpayment of premiums—Defined.
Section
48.43.041
Individual health benefit plans—Mandatory benefits.
Section
48.43.043
Colorectal cancer examinations and laboratory tests—Required benefits or coverage.
Section
48.43.045
Health plan requirements—Annual reports—Exemptions.
Section
48.43.047
Health plans—Minimum coverage for preventative services—No cost-sharing requirements.
Section
48.43.049
Health carrier data—Information from annual statement—Format prescribed by commissioner—Public availability.
Section
48.43.055
Procedures for review and adjudication of health care provider complaints—Requirements.
Section
48.43.059
Payments made by a second-party payment process—Definition.
Section
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.
Section
48.43.071
Health care information—Requirement to provide free copy to covered person appealing denial of social security benefits—Exceptions.
Section
48.43.072
Required reproductive health care coverage—Restrictions on copayments, deductibles, and other form of cost sharing.
Section
48.43.073
Required abortion coverage—Limitations.
Section
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.
Section
48.43.078
Digital breast tomosynthesis—Intent to ensure women with access—Commissioner's and health care authority's duty to clarify mandates.
Section
48.43.081
Anatomic pathology services—Payment for services—Definitions.
Section
48.43.083
Chiropractor services—Participating provider agreement—Health carrier reimbursement.
Section
48.43.085
Health carrier may not prohibit its enrollees from contracting for services outside the health care plan.
Section
48.43.087
Contracting for services at enrollee's expense—Mental health care practitioner—Conditions—Exception.
Section
48.43.091
Health carrier coverage of outpatient mental health services—Requirements.
Section
48.43.093
Health carrier coverage of emergency medical services—Requirements—Conditions.
Section
48.43.094
Pharmacist provided services—Health plan requirements.
Section
48.43.096
Medication synchronization policy required for health plans covering prescription drugs—Requirements—Definitions.
Section
48.43.097
Filing of financial statements—Every health carrier.
Section
48.43.0122
Individual health benefit plans—Open enrollment and special enrollment periods—Rules—Enforcement.
Section
48.43.0123
Health plans—Rescission of coverage—Rules.
Section
48.43.0124
Health plans—Cost sharing for essential health benefits—Rules.
Section
48.43.0125
Essential health benefits—Annual or lifetime dollar limits.
Section
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.
Section
48.43.0127
Group health plans—Waiting period—Rules.
Section
48.43.0128
Nongrandfathered health plans and plans issued or renewed on or after January 1, 2022—Prohibited discrimination—Rules.
Section
48.43.0161
Prior authorization practices—Carrier annual reporting requirements—Commissioner's standardized report.
Section
48.43.01211
Health plans—Eligibility—Health status-related factors—Rules.
Section
48.43.105
Preparation of documents that compare health carriers—Immunity—Due diligence.
Section
48.43.115
Maternity services—Intent—Definitions—Patient preference—Clinical sovereignty of provider—Notice to policyholders—Application.
Section
48.43.125
Coverage at a long-term care facility following hospitalization—Definition.
Section
48.43.176
Eosinophilic gastrointestinal associated disorder—Elemental formula.
Section
48.43.180
Denturist services.
Section
48.43.185
General anesthesia services for dental procedures.
Section
48.43.190
Payment of chiropractic services—Parity.
Section
48.43.195
Contraceptive drugs—Twelve-month refill coverage.
Section
48.43.200
Disclosure of certain material transactions—Report—Information is confidential.
Section
48.43.205
Material acquisitions or dispositions.
Section
48.43.210
Asset acquisitions—Asset dispositions.
Section
48.43.215
Report of a material acquisition or disposition of assets—Information required.
Section
48.43.220
Material nonrenewals, cancellations, or revisions of ceded reinsurance agreements.
Section
48.43.225
Report of a material nonrenewal, cancellation, or revision of ceded reinsurance agreements—Information required.
Section
48.43.290
Coverage for prescribed durable medical equipment and mobility enhancing equipment—Sales and use taxes—Definitions.
Section
48.43.300
Definitions.
Section
48.43.305
Report of RBC levels—Distribution of report—Formula for determination—Commissioner may make adjustments.
Section
48.43.310
Company action level event—Required RBC plan—Commissioner's review—Notification—Challenge by carrier.
Section
48.43.315
Regulatory action level event—Required RBC plan—Commissioner's review—Notification—Challenge by carrier.
Section
48.43.320
Authorized control level event—Commissioner's options.
Section
48.43.325
Mandatory control level event—Commissioner's duty—Regulatory control.
Section
48.43.330
Carrier's right to hearing—Request by carrier—Date set by commissioner.
Section
48.43.335
Confidentiality of RBC reports and plans—Use of certain comparisons prohibited—Certain information intended solely for use by commissioner.
Section
48.43.340
Powers or duties of commissioner not limited—Rules.
Section
48.43.345
Foreign or alien carriers—Required RBC report—Commissioner may require RBC plan—Mandatory control level event.
Section
48.43.350
No liability or cause of action against commissioner or department.
Section
48.43.355
Notice by commissioner to carrier—When effective.
Section
48.43.360
Initial RBC reports—Calculation of initial RBC levels—Subsequent reports.
Section
48.43.366
Self-funded multiple employer welfare arrangements.
Section
48.43.370
RBC standards not applicable to certain carriers.
Section
48.43.400
Prescription drug utilization management—Definitions.
Section
48.43.410
Prescription drug utilization management—Clinical review criteria—Requirement to be evidence-based and updated regularly.
Section
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.
Section
48.43.430
Prescription medication—Maximum charge at point of sale—Requirements.
Section
48.43.500
Intent—Purpose—2000 c 5.
Section
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.
Section
48.43.510
Carrier required to disclose health plan information—Marketing and advertising restrictions—Rules.
Section
48.43.515
Access to appropriate health services—Enrollee options—Rules.
Section
48.43.517
Enrollment of child participating in medical assistance program—Employer-sponsored health plan.
Section
48.43.520
Requirement to maintain a documented utilization review program description and written utilization review criteria—Rules.
Section
48.43.525
Prohibition against retrospective denial of health plan coverage—Rules.
Section
48.43.530
Requirement for carriers to have comprehensive grievance and appeal processes—Carrier's duties—Procedures—Appeals—Rules.
Section
48.43.535
Independent review of health care disputes—System for using certified independent review organizations—Rules.
Section
48.43.537
Health care disputes—Certifying independent review organizations—Application—Restrictions—Maximum fee schedule for conducting reviews—Rules.
Section
48.43.540
Requirement to designate a licensed medical director—Exemption.
Section
48.43.545
Standard of care—Liability—Causes of action—Defense—Exception.
Section
48.43.550
Delegation of duties—Carrier accountability.
Section
48.43.600
Overpayment recovery—Carrier.
Section
48.43.605
Overpayment recovery—Health care provider.
Section
48.43.650
Fixed payment insurance products—Commissioner's annual report.
Section
48.43.670
Plan or contract renewal—Modification of wellness program.
Section
48.43.680
Lifetime limit on transplants—Definition.
Section
48.43.690
Assessments under RCW 70.290.040 considered medical expenses.
Section
48.43.700
Exchange—Plans that a carrier must offer—Review—Rules.
Section
48.43.705
Plans offered outside of exchange.
Section
48.43.710
Certification as qualified health plan not an exemption.
Section
48.43.715
Individual and small group market—Selection of benchmark plan—Minimum requirements—Criteria—List of state-mandated health benefits.
Section
48.43.720
Reinsurance and risk adjustment programs—Affordable care act—Rules.
Section
48.43.725
Exclusion of mandated benefits from health plan—Carrier requirements—Notice—Fees—Commissioner's duties.
Section
48.43.730
Carrier must file provider contracts and compensation agreements with commissioner—Approval or disapproval—Confidentiality—Hearings—Rules—Definitions.
Section
48.43.731
Health care benefit management contracts—Carrier filing requirements—Notice to enrollees—Confidentiality of filings.
Section
48.43.733
Rates and forms of group health benefit plans—Timing of filings—Exceptions—Rules.
Section
48.43.734
Health carrier rate filings—Review of surplus, capital, and profit levels.
Section
48.43.735
Reimbursement of health care services provided through telemedicine or store and forward technology—Audio-only telemedicine.
Section
48.43.740
Dental only plan—Emergency dental conditions—Definitions.
Section
48.43.743
Dental only plan—Annual data statement—Contents—Public use—Definition.
Section
48.43.750
Health care provider credentialing applications—Use of electronic database by health carriers.
Section
48.43.755
Health care provider credentialing applications—Use of electronic database by providers.
Section
48.43.757
Health care provider credentialing applications—Reimbursement requirements.
Section
48.43.760
Opioid use disorder—Coverage without prior authorization.
Section
48.43.761
Withdrawal management services—Substance use disorder treatment services—Prior authorization—Utilization review—Medical necessity review.
Section
48.43.762
Opioid overdose reversal medication bulk purchasing and distribution program.
Section
48.43.765
Health carrier network adequacy—Mental health and substance abuse treatment.
Section
48.43.770
Individual market health plan availability—Annual report.
Section
48.43.775
Qualified health plan participation—Reimbursement rate for other health plans.
Section
48.43.780
Insulin drugs—Cap on enrollee's required payment amount—Cost-sharing requirements.
Section
48.43.785
COVID-19 personal protective equipment expenses—Health care provider reimbursement.
Section
48.43.790
Behavioral services—Next-day appointments.
Section
48.43.795
Qualified health plans—Acceptance of premium and cost-sharing assistance.
Section
48.43.902
Effective date—1996 c 312.
Section
48.43.904
Construction—Chapter applicable to state registered domestic partnerships—2009 c 521.
Section
48.43.5051
Requests for confidential communications—Monitoring and ensuring compliance—Standardized form for submission of requests—Rules.