Chapter 48.43 - INSURANCE REFORM

Section 48.43.001 - Intent
Section 48.43.005 - [Effective Until 6/6/2024] Definitions
Section 48.43.005 - [Effective 6/6/2024] 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 48.43.01211 - Health plans-Eligibility-Health status-related factors-Rules
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 48.43.016 - Utilization management standards and criteria-Health carrier requirements-Definitions
Section 48.43.0161 - Prior authorization practices-Carrier annual reporting requirements-Commissioner's standardized report
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 - [Effective Until 6/6/2024] Health plans-Minimum coverage for preventative services-No cost-sharing requirements
Section 48.43.047 - [Effective 6/6/2024] 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 48.43.0725 - Reproductive health plan coverage-Immediate postpartum contraception devices
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 48.43.076 - Digital breast examinations-Cost sharing
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 48.43.0961 - Continuity of coverage for health plans covering prescription drugs for behavioral health
Section 48.43.097 - Filing of financial statements-Every health carrier
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 48.43.135 - Hearing instruments-Coverage
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 48.43.435 - Prescription medication-Cost-sharing calculation-Application-Rules
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 48.43.5051 - Requests for confidential communications-Monitoring and ensuring compliance-Standardized form for submission of requests-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 - [Effective Until 6/6/2024] Reimbursement of health care services provided through telemedicine or store and forward technology-Audio-only telemedicine
Section 48.43.735 - [Effective 6/6/2024] 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 48.43.745 - Dental only plan-Denturist services
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 - [Effective Until 6/6/2024] Withdrawal management services-Substance use disorder treatment services-Prior authorization-Utilization review-Medical necessity review
Section 48.43.761 - [Effective 6/6/2024] Withdrawal management services-Substance use disorder treatment services-Prior authorization-Utilization review-Medical necessity review
Section 48.43.762 - [Effective Until 6/6/2024] Opioid overdose reversal medication bulk purchasing and distribution program
Section 48.43.762 - [Effective 6/6/2024] Opioid overdose reversal medication bulk purchasing and distribution program
Section 48.43.765 - Health carrier network adequacy-Mental health and substance abuse treatment
Section 48.43.767 - Behavioral health services-Network access
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 - [Effective Until 6/6/2024] Insulin drugs-Cap on enrollee's required payment amount-Cost-sharing requirements
Section 48.43.780 - [Effective 6/6/2024] Insulin drugs-Cap on enrollee's required payment amount-Cost-sharing requirements
Section 48.43.785 - [Contingent expiration date] 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 48.43.800 - Primary care expenditures assessment-Review
Section 48.43.805 - Prescription drug upper payment limit-Rules
Section 48.43.810 - Biomarker testing-Standards-Construction
Section 48.43.815 - Donor human milk-Standards
Section 48.43.820 - Consolidated appropriations act enforcement-Implementation of federal regulations
Section 48.43.825 - Certified peer specialist services-Network access standards
Section 48.43.830 - Prior authorization
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.NEW-001 - [Newly enacted section not yet numbered] [Effective 1/1/2025]
Section 48.43.NEW-002 - [Newly enacted section not yet numbered] [Effective 6/6/2024] [Coverage for ground ambulance transports to behavioral health emergency services]
Section 48.43.NEW-003 - [Newly enacted section not yet numbered] [Effective 1/1/2025]
Section 48.43.NEW-004 - [Newly enacted section not yet numbered] [Effective 6/6/2024]