Current through Chapter 376 of the 2024 Regular Session
Section 48.49.090 - Carrier-Requirement to update website and provider directory-Requirement to provide enrollee with certain information(1) A carrier must update its website and provider directory no later than thirty days after the addition or termination of a facility or provider.(2) A carrier must provide an enrollee with: (a) A clear description of the health plan's out-of-network health benefits;(b) The notice of consumer rights developed under RCW 48.49.060;(c) Notification that if the enrollee receives services from an out-of-network provider, facility, behavioral health emergency services provider, or ground ambulance services organization, under circumstances other than those described in RCW 48.49.020 and section 8 of this act, the enrollee will have the financial responsibility applicable to services provided outside the health plan's network in excess of applicable cost-sharing amounts and that the enrollee may be responsible for any costs in excess of those allowed by the health plan;(d) Information on how to use the carrier's member transparency tools under RCW 48.43.007;(e) Upon request, information regarding whether a health care provider is in-network or out-of-network, and whether there are in-network providers available to provide emergency medicine, anesthesiology, pathology, radiology, neonatology, surgery, hospitalist, intensivist, and diagnostic services, including radiology and laboratory services at specified in-network hospitals or ambulatory surgical facilities; and(f) Upon request, an estimated range of the out-of-pocket costs for an out-of-network benefit.Amended by 2024 c 218,§ 5, eff. 6/6/2024.Amended by 2022 c 263,§ 15, eff. 3/31/2022.Added by 2019 c 427,§ 13, eff. 1/1/2020.Effective date- 2022 c 263: See note following RCW 43.371.100.