reglab/housing_qa huggingface dataset:
WA Rev Code § 48.46.235 (2021)
2021 Revised Code of Washington|Title 48 - Insurance|Chapter 48.46 - Health Maintenance Organizations.|48.46.235 - Minimum net worth—Requirement to maintain—Determination of amount.

RCW 48.46.235 Minimum net worth—Requirement to maintain—Determination of amount.(1) Except as provided in subsection (2) of this section, every health maintenance organization must have and maintain a minimum net worth equal to the greater of:(a) Three million dollars; or(b) Two percent of annual premium earned as reported on the most recent annual financial statement filed with the commissioner on the first one hundred fifty million dollars of premium and one percent of annual premium on the premium in excess of one hundred fifty million dollars; or(c) An amount equal to the sum of three months' uncovered expenditures as reported on the most recent financial statement filed with the commissioner.(2) A health maintenance organization registered before July 27, 1997, that, on July 27, 1997, has a minimum net worth equal to or greater than that required by subsection (1) of this section must continue to have and maintain the minimum net worth required by subsection (1) of this section. A health maintenance organization registered before July 27, 1997, that, on July 27, 1997, does not have the minimum net worth required by subsection (1) of this section must have and maintain a minimum net worth of:(a) The amount required immediately prior to July 27, 1997, until December 31, 1997;(b) Fifty percent of the amount required by subsection (1) of this section by December 31, 1997;(c) Seventy-five percent of the amount required by subsection (1) of this section by December 31, 1998; and(d) One hundred percent of the amount required by subsection (1) of this section by December 31, 1999.(3)(a) In determining net worth, no debt shall be considered fully subordinated unless the subordination clause is in a form acceptable to the commissioner. An interest obligation relating to the repayment of a subordinated debt must be similarly subordinated.(b) The interest expenses relating to the repayment of a fully subordinated debt shall not be considered uncovered expenditures.(c) A subordinated debt incurred by a note meeting the requirement of this section, and otherwise acceptable to the commissioner, shall not be considered a liability and shall be recorded as equity.(4) Every health maintenance organization shall, when determining liabilities, include an amount estimated in the aggregate to provide for any unearned premium and for the payment of all claims for health care expenditures that have been incurred, whether reported or unreported, which are unpaid and for which such organization is or may be liable, and to provide for the expense of adjustment or settlement of such claims.Such liabilities shall be computed in accordance with rules promulgated by the commissioner upon reasonable consideration of the ascertained experience and character of the health maintenance organization.[ 1997 c 212 § 6; 1990 c 119 § 5.]
WA Rev Code § 48.46.237 (2021)
2021 Revised Code of Washington|Title 48 - Insurance|Chapter 48.46 - Health Maintenance Organizations.|48.46.237 - Minimum net worth—Domestic or foreign health maintenance organization.

RCW 48.46.237 Minimum net worth—Domestic or foreign health maintenance organization.(1) For purposes of this section:(a) "Domestic health maintenance organization" means a health maintenance organization formed under the laws of this state; and(b) "Foreign health maintenance organization" means a health maintenance organization formed under the laws of the United States, of a state or territory of the United States other than this state, or of the District of Columbia.(2) If the minimum net worth of a domestic health maintenance organization falls below the minimum net worth required by this chapter, the commissioner shall at once ascertain the amount of the deficiency and serve notice upon the domestic health maintenance organization to cure the deficiency within ninety days after that service of notice.(3) If the deficiency is not cured, and proof thereof filed with the commissioner within the ninety-day period, the domestic health maintenance organization shall be declared insolvent and shall be proceeded against as authorized by this code or the commissioner shall, consistent with chapters 48.04 and 34.05 RCW, suspend or revoke the registration of the domestic health maintenance organization as being hazardous to its subscribers and the people in this state.(4) If the deficiency is not cured the domestic health maintenance organization shall not issue or deliver any health maintenance agreement after the expiration of the ninety-day period.(5) If the minimum net worth of a foreign health maintenance organization falls below the minimum net worth required by this chapter, the commissioner shall, consistent with chapters 48.04 and 34.05 RCW, suspend or revoke the foreign health maintenance organization's registration as being hazardous to its subscribers, enrollees, or the people in this state.[ 1997 c 212 § 7.]
WA Rev Code § 48.46.240 (2021)
2021 Revised Code of Washington|Title 48 - Insurance|Chapter 48.46 - Health Maintenance Organizations.|48.46.240 - Funded reserve requirements.

RCW 48.46.240 Funded reserve requirements.(1) Each health maintenance organization obtaining a certificate of registration from the commissioner shall provide and maintain a funded reserve of one hundred fifty thousand dollars. The funded reserve shall be deposited with the commissioner or with any organization/trustee acceptable to him or her in the form of cash, securities eligible for investment by the health maintenance organization pursuant to chapter 48.13 RCW, approved surety bond or any combination of these, and must equal or exceed one hundred fifty thousand dollars. The funded reserve shall be established as an assurance that the uncovered expenditure obligations of the health maintenance organization to the enrolled participants will be performed.(2) All income from reserves on deposit with the commissioner shall belong to the depositing health maintenance organization and shall be paid to it as it becomes available.(3) Any funded reserve required by this section shall be considered an asset of the health maintenance organization in determining the organization's net worth.(4) A health maintenance organization that has made a securities deposit with the commissioner may, at its option, withdraw the securities deposit or any part of the deposit after first having deposited or provided in lieu thereof an approved surety bond, a deposit of cash or securities, or any combination of these or other deposits of equal amount and value to that withdrawn. Any securities and surety bond shall be subject to approval by the commissioner before being substituted.[ 2009 c 549 § 7154; 1990 c 119 § 6; 1985 c 320 § 4; 1982 c 151 § 3.]NOTES:Effective date—1982 c 151: See note following RCW 48.46.020.
WA Rev Code § 48.46.243 (2021)
2021 Revised Code of Washington|Title 48 - Insurance|Chapter 48.46 - Health Maintenance Organizations.|48.46.243 - Contract—Participant liability.

RCW 48.46.243 Contract—Participant liability.(1) Subject to subsection (2) of this section, every contract between a health maintenance organization and its participating providers of health care services shall be in writing and shall set forth that in the event the health maintenance organization fails to pay for health care services as set forth in the agreement, the enrolled participant shall not be liable to the provider for any sums owed by the health maintenance organization. Every such contract shall provide that this requirement shall survive termination of the contract.(2) The provisions of subsection (1) of this section shall not apply:(a) To emergency care from a provider who is not a participating provider;(b) To out-of-area services;(c) To the delivery of covered pediatric oral services that are substantially equal to the essential health benefits benchmark plan; or(d) In exceptional situations approved in advance by the commissioner, if the health maintenance organization is unable to negotiate reasonable and cost-effective participating provider contracts.(3) No participating provider, or insurance producer, trustee, or assignee thereof, may maintain an action against an enrolled participant to collect sums owed by the health maintenance organization.[ 2016 c 122 § 3. Prior: 2013 c 325 § 2; 2013 c 277 § 3; 2008 c 217 § 56; 1990 c 119 § 7.]NOTES:Intent—2016 c 122: "It is the intent of the legislature to allow certain provider compensation exhibits to remain confidential by making permanent the provisions of chapter 277, Laws of 2013, which currently expire July 1, 2017, thereby maintaining efficient review and approval of health care plans by the insurance commissioner and fostering innovation in the Washington health insurance market." [ 2016 c 122 § 1.]Severability—Effective date—2008 c 217: See notes following RCW 48.03.020.
WA Rev Code § 48.46.245 (2021)
2021 Revised Code of Washington|Title 48 - Insurance|Chapter 48.46 - Health Maintenance Organizations.|48.46.245 - Plan for handling insolvency—Commissioner's review.

RCW 48.46.245 Plan for handling insolvency—Commissioner's review.Each health maintenance organization shall have a plan for handling insolvency which allows for continuation of benefits for the duration of the agreement period for which premiums have been paid and continuation of benefits to members who are confined on the date of insolvency in an inpatient facility until their discharge or expiration of benefits. The commissioner shall approve such a plan if it includes:(1) Insurance to cover the expenses to be paid for continued benefits after insolvency;(2) Provisions in provider contracts that obligate the provider to provide services for the duration of the period after the health maintenance organization's insolvency for which premium payment has been made and until the enrolled participants' discharge from inpatient facilities;(3) Use of insolvency reserves established under RCW 48.46.240;(4) Acceptable letters of credit or approved surety bonds; or(5) Any other arrangements the commissioner and the organization mutually agree are appropriate to assure that benefits are continued.[ 1990 c 119 § 8.]
WA Rev Code § 48.46.250 (2021)
2021 Revised Code of Washington|Title 48 - Insurance|Chapter 48.46 - Health Maintenance Organizations.|48.46.250 - Coverage of dependent children—Newborn infants, congenital anomalies—Notification period.

RCW 48.46.250 Coverage of dependent children—Newborn infants, congenital anomalies—Notification period.(1) Any health maintenance agreement under this chapter which provides coverage for dependent children of the enrolled participant shall provide the same coverage for newborn infants of the enrolled participant from and after the moment of birth. Coverage provided under this section shall include, but not be limited to, coverage for congenital anomalies of such children from the moment of birth.(2) If payment of an additional premium is required to provide coverage for a child, the agreement may require that notification of birth of a newly born child and payment of the required premiums must be furnished to the health maintenance organization. The notification period shall be no less than sixty days from the date of birth. This subsection applies to agreements issued or renewed on or after January 1, 1984.[ 1984 c 4 § 2; 1983 c 202 § 12.]
WA Rev Code § 48.46.260 (2021)
2021 Revised Code of Washington|Title 48 - Insurance|Chapter 48.46 - Health Maintenance Organizations.|48.46.260 - Individual health maintenance agreement—Return within ten days of delivery—Refunds—Void from beginning.

RCW 48.46.260 Individual health maintenance agreement—Return within ten days of delivery—Refunds—Void from beginning.Every subscriber of an individual health maintenance agreement may return the agreement to the health maintenance organization or the insurance producer through whom it was purchased within ten days of its delivery to the subscriber if, after examination of the agreement, the subscriber is not satisfied with it for any reason. The health maintenance organization shall refund promptly any fee paid for the agreement. An additional ten percent penalty shall be added to any premium refund due which is not paid within thirty days of return of the policy to the health maintenance organization or insurance producer. Upon such return of the agreement, it shall be void from the beginning and the parties shall be in the same position as if no agreement had been issued. Notice of the provisions of this section shall be printed on the face of each such agreement or be attached thereto.[ 2008 c 217 § 57; 1983 c 202 § 13.]NOTES:Severability—Effective date—2008 c 217: See notes following RCW 48.03.020.
WA Rev Code § 48.46.270 (2021)
2021 Revised Code of Washington|Title 48 - Insurance|Chapter 48.46 - Health Maintenance Organizations.|48.46.270 - Financial interests of health maintenance organization authorities, restricted—Exceptions, regulations.

RCW 48.46.270 Financial interests of health maintenance organization authorities, restricted—Exceptions, regulations.(1) No person having any authority in the investment or disposition of the funds of a health maintenance organization and no officer or director of a health maintenance organization shall accept, except for the health maintenance organization, or be the beneficiary of any fee, brokerage, gift, commission, or other emolument because of any sale of health care service agreements or any investment, loan, deposit, purchase, sale, payment, or exchange made by or for the health maintenance organization, or be pecuniarily interested therein in any capacity; except, that such a person may procure a loan from the health maintenance organization directly upon approval by two-thirds of its directors and upon the pledge of securities eligible for the investment of the health maintenance organization's funds under this title.(2) The commissioner may, by regulations, from time to time, define and permit additional exceptions to the prohibition contained in subsection (1) of this section solely to enable payment of reasonable compensation to a director who is not otherwise an officer or employee of the health maintenance organization, or to a corporation or firm in which the director is interested, for necessary services performed or sales or purchases made to or for the health maintenance organization in the ordinary course of the health maintenance organization's business and in the usual private professional or business capacity of the director or the corporation or firm.[ 1985 c 320 § 5; 1983 c 202 § 14.]
WA Rev Code § 48.46.274 (2021)
2021 Revised Code of Washington|Title 48 - Insurance|Chapter 48.46 - Health Maintenance Organizations.|48.46.274 - Prescribed, self-administered anticancer medication.

RCW 48.46.274 Prescribed, self-administered anticancer medication.(1) Each health plan issued or renewed on or after January 1, 2012, that provides coverage for cancer chemotherapy treatment must provide coverage for prescribed, self-administered anticancer medication that is used to kill or slow the growth of cancerous cells on a basis at least comparable to cancer chemotherapy medications administered by a health care provider or facility as defined in RCW 48.43.005 (25) and (26).(2) Nothing in this section may be interpreted to prohibit a health plan from administering a formulary or preferred drug list, requiring prior authorization, or imposing other appropriate utilization controls in approving coverage for any chemotherapy.[ 2020 c 18 § 22; 2011 c 159 § 6.]NOTES:Explanatory statement—2020 c 18: See note following RCW 43.79A.040.Findings—2011 c 159: See note following RCW 41.05.175.
WA Rev Code § 48.46.275 (2021)
2021 Revised Code of Washington|Title 48 - Insurance|Chapter 48.46 - Health Maintenance Organizations.|48.46.275 - Mammograms—Insurance coverage.

RCW 48.46.275 Mammograms—Insurance coverage.Each health maintenance agreement issued or renewed after January 1, 1990, that provides benefits for hospital or medical care shall provide benefits for screening or diagnostic mammography services, provided that such services are delivered upon the recommendation of the patient's physician or advanced registered nurse practitioner as authorized by the nursing care quality assurance commission pursuant to chapter 18.79 RCW or physician assistant pursuant to chapter 18.71A RCW.All services must be provided by the health maintenance organization or rendered upon referral by the health maintenance organization. This section shall not be construed to prevent the application of standard agreement provisions applicable to other benefits such as deductible or copayment provisions. This section does not limit the authority of a health maintenance organization to negotiate rates and contract with specific providers for the delivery of mammography services. This section shall not apply to medicare supplement policies or supplemental contracts covering a specified disease or other limited benefits.[ 1994 sp.s. c 9 § 735; 1989 c 338 § 4.]NOTES:Severability—Headings and captions not law—Effective date—1994 sp.s. c 9: See RCW 18.79.900 through 18.79.902.
WA Rev Code § 48.46.277 (2021)
2021 Revised Code of Washington|Title 48 - Insurance|Chapter 48.46 - Health Maintenance Organizations.|48.46.277 - Prostate cancer screening.

RCW 48.46.277 Prostate cancer screening.(1) Each health maintenance agreement issued or renewed after December 31, 2006, that provides coverage for hospital or medical expenses shall provide coverage for prostate cancer screening, provided that the screening is delivered upon the recommendation of the patient's physician, advanced registered nurse practitioner, or physician assistant.(2) All services must be provided by the health maintenance organization or rendered upon a referral by the health maintenance organization.(3) This section shall not be construed to prevent the application of standard policy provisions applicable to other benefits, such as deductible or copayment provisions. This section does not limit the authority of a health maintenance organization to negotiate rates and contract with specific providers for the delivery of prostate cancer screening services. This section shall not apply to medicare supplemental policies or supplemental contracts covering a specified disease or other limited benefits.[ 2006 c 367 § 5.]
WA Rev Code § 48.46.280 (2021)
2021 Revised Code of Washington|Title 48 - Insurance|Chapter 48.46 - Health Maintenance Organizations.|48.46.280 - Reconstructive breast surgery.

RCW 48.46.280 Reconstructive breast surgery.(1) Any health care service plan issued, amended, or renewed after July 24, 1983, shall provide coverage for reconstructive breast surgery resulting from a mastectomy which resulted from disease, illness, or injury.(2) Any health care service plan issued, amended, or renewed after January 1, 1986, shall provide coverage for all stages of one reconstructive breast reduction on the nondiseased breast to make it equal in size with the diseased breast after definitive reconstructive surgery on the diseased breast has been performed.[ 1985 c 54 § 8; 1983 c 113 § 4.]NOTES:Effective date—1985 c 54: See note following RCW 48.20.397.
WA Rev Code § 48.46.285 (2021)
2021 Revised Code of Washington|Title 48 - Insurance|Chapter 48.46 - Health Maintenance Organizations.|48.46.285 - Mastectomy, lumpectomy.

RCW 48.46.285 Mastectomy, lumpectomy.No health maintenance organization under this chapter may refuse coverage or cancel or decline coverage solely because of a mastectomy or lumpectomy performed on the insured or prospective insured more than five years previously. The amount of benefits payable, or any term, rate, condition, or type of coverage shall not be restricted, modified, excluded, increased, or reduced solely on the basis of a mastectomy or lumpectomy performed on the insured or prospective insured more than five years previously.[ 1985 c 54 § 4.]NOTES:Effective date—1985 c 54: See note following RCW 48.20.397.
WA Rev Code § 48.46.292 (2021)
2021 Revised Code of Washington|Title 48 - Insurance|Chapter 48.46 - Health Maintenance Organizations.|48.46.292 - Mental health treatment—Waiver of preauthorization for persons involuntarily committed.

RCW 48.46.292 Mental health treatment—Waiver of preauthorization for persons involuntarily committed.A health maintenance organization providing services or benefits for hospital or medical care coverage in this state shall waive a preauthorization from the health maintenance organization before an enrolled participant or the enrolled participant's covered dependents receive mental health treatment rendered by a state hospital as defined in RCW 72.23.010 if the enrolled participant or the enrolled participant's covered dependents are involuntarily committed to a state hospital as defined in RCW 72.23.010.[ 1993 c 272 § 5.]NOTES:Savings—Severability—1993 c 272: See notes following RCW 43.20B.347.
WA Rev Code § 48.46.300 (2021)
2021 Revised Code of Washington|Title 48 - Insurance|Chapter 48.46 - Health Maintenance Organizations.|48.46.300 - Future dividends or refunds, restricted—Issuance or sale of securities regulated.

RCW 48.46.300 Future dividends or refunds, restricted—Issuance or sale of securities regulated.(1) No health maintenance organization nor any individual acting in behalf thereof may guarantee or agree to the payment of future dividends or future refunds of unused charges or savings in any specific or approximate amounts or percentages in respect to any contract being offered to the public, except in a group contract containing an experience refund provision.(2) The issuance, sale, or offer for sale in this state of securities of its own issue by any health maintenance organization domiciled in this state other than the memberships and bonds of a nonprofit corporation are subject to the provisions of chapter 48.06 RCW relating to obtaining solicitation permits.[ 1983 c 106 § 8.]
WA Rev Code § 48.46.310 (2021)
2021 Revised Code of Washington|Title 48 - Insurance|Chapter 48.46 - Health Maintenance Organizations.|48.46.310 - Registration not endorsement.

RCW 48.46.310 Registration not endorsement.The granting of a certificate of registration to a health maintenance organization is permissive only, and does not constitute an endorsement by the insurance commissioner of any person or thing related to the health maintenance organization, and no person may advertise or display a certificate of registration for use as an inducement in any solicitation.[ 1983 c 106 § 9.]
WA Rev Code § 48.46.320 (2021)
2021 Revised Code of Washington|Title 48 - Insurance|Chapter 48.46 - Health Maintenance Organizations.|48.46.320 - Dependent children, termination of coverage, conditions.

RCW 48.46.320 Dependent children, termination of coverage, conditions.Any health maintenance agreement which provides that coverage of a dependent child shall terminate upon attainment of the limiting age for dependent children specified in the agreement shall also provide in substance that attainment of such limiting age shall not operate to terminate the coverage of such child while the child is and continues to be both: (1) Incapable of self-sustaining employment by reason of developmental or physical disability; and (2) chiefly dependent upon the subscriber for support and maintenance, if proof of such incapacity and dependency is furnished to the health maintenance organization by the enrolled participant within thirty-one days of the child's attainment of the limiting age and subsequently as required by the health maintenance organization but not more frequently than annually after the two-year period following the child's attainment of the limiting age.[ 2020 c 274 § 38; 1985 c 320 § 6; 1983 c 106 § 10.]