reglab/statecodes huggingface dataset:
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.20 - Disability Insurance. › 48.20.360 - Extended disability benefit.

RCW 48.20.360
Extended disability benefit.
A disability insurance contract which provides a reasonable amount of disability indemnity for both accidental injuries and sickness, other than a contract of group or blanket insurance, may provide a benefit in amount not exceeding two hundred dollars payable in event of death from any causes. Such benefit shall be deemed to constitute the payment of disability benefits beyond the period for which otherwise payable, and shall not be deemed to constitute life insurance.
[1947 c 79 § .20.36; Rem. Supp. 1947 § 45.20.36.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.20 - Disability Insurance. › 48.20.380 - Incontestability after reinstatement.

RCW 48.20.380
Incontestability after reinstatement.
The reinstatement of any policy of noncancellable disability insurance hereafter delivered or issued for delivery in this state shall be contestable only on account of fraud or misrepresentation of facts material to the reinstatement and only for the same period following reinstatement as is provided in the policy with respect to the contestability thereof after the original issuance of the policy.
[1947 c 79 § .20.38; Rem. Supp. 1947 § 45.20.38.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.20 - Disability Insurance. › 48.20.385 - When injury caused by intoxication or use of narcotics.

RCW 48.20.385
When injury caused by intoxication or use of narcotics.
An insurer may not deny coverage for the treatment of an injury solely because the injury was sustained as a consequence of the insured's being intoxicated or under the influence of a narcotic.
[ 2004 c 112 § 2.]
NOTES:
Finding—2004 c 112: "The legislature finds that an alcohol or drug-related injury that requires treatment in an emergency department can be a critical moment in the life of a person with a substance abuse problem. Studies have demonstrated that appropriate interventions by hospital staff at these times can reduce substance abuse and lower future health care costs. The perception among health care providers that they may be penalized by insurers for conducting these interventions prevents many of them from performing interventions which can make all the difference to a person at the crossroads of a substance abuse problem." [ 2004 c 112 § 1.]
Application—2004 c 112: "This act applies to all contracts issued or renewed on or after June 10, 2004." [ 2004 c 112 § 7.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.20 - Disability Insurance. › 48.20.389 - Prescribed, self-administered anticancer medication.

RCW 48.20.389
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 § 19; 2011 c 159 § 3.]
NOTES:
*Reviser's note: RCW 48.43.005 was alphabetized pursuant to RCW 1.08.015(2)(k), changing subsections (25) and (26) to subsections (27) and (28).
Explanatory statement—2020 c 18: See note following RCW 43.79A.040.
Findings—2011 c 159: See note following RCW 41.05.175.
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.20 - Disability Insurance. › 48.20.390 - Podiatric medicine and surgery.

RCW 48.20.390
Podiatric medicine and surgery.
Notwithstanding any provision of any disability insurance contract, benefits shall not be denied thereunder for any medical or surgical service performed by a holder of a license issued pursuant to chapter 18.22 RCW provided that (1) the service performed was within the lawful scope of such person's license, and (2) such contract would have provided benefits if such service had been performed by a holder of a license issued pursuant to chapter 18.71 RCW.
[ 1963 c 87 § 1.]
NOTES:
Application—1963 c 87: "This act shall apply to all contracts issued on or after the effective date of this act." [ 1963 c 87 § 3.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.20 - Disability Insurance. › 48.20.392 - Prostate cancer screening.

RCW 48.20.392
Prostate cancer screening.
(1) Each disability insurance policy 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) 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 an insurer 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 § 2.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.20 - Disability Insurance. › 48.20.393 - Mammograms—Insurance coverage.

RCW 48.20.393
Mammograms—Insurance coverage.
Each disability insurance policy issued or renewed after January 1, 1990, that provides coverage for hospital or medical expenses shall provide coverage 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.
This section shall not be construed to prevent the application of standard policy provisions, other than the cost-sharing prohibition provided in RCW 48.43.076, that are applicable to other benefits. This section does not limit the authority of an insurer 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.
[ 2023 c 366 § 3; 1994 sp.s. c 9 § 728; 1989 c 338 § 1.]
NOTES:
*Reviser's note: The reference to "nursing care quality assurance commission" was changed to "board of nursing" by 2023 c 123.
Intent—2023 c 366: See note following RCW 48.43.076.
Severability—Headings and captions not law—Effective date—1994 sp.s. c 9: See RCW 18.79.900 through 18.79.902.
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.20 - Disability Insurance. › 48.20.395 - Reconstructive breast surgery.

RCW 48.20.395
Reconstructive breast surgery.
(1) Any disability insurance contract providing hospital and medical expenses and health care services delivered or issued in this state after July 24, 1983, shall provide coverage for reconstructive breast surgery resulting from a mastectomy which resulted from disease, illness, or injury.
(2) Any disability insurance contract providing hospital and medical expenses and health care services delivered or issued in this state 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 § 5; 1983 c 113 § 1.]
NOTES:
Effective date—1985 c 54: See note following RCW 48.20.397.
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.20 - Disability Insurance. › 48.20.397 - Mastectomy, lumpectomy.

RCW 48.20.397
Mastectomy, lumpectomy.
No person engaged in the business of insurance under this chapter may refuse to issue any contract of insurance or cancel or decline to renew the contract 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 § 1.]
NOTES:
Effective date—1985 c 54: "This act shall take effect January 1, 1986." [ 1985 c 54 § 9.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.20 - Disability Insurance. › 48.20.410 - Optometry.

RCW 48.20.410
Optometry.
Notwithstanding any provision of any disability insurance contract, benefits shall not be denied thereunder for any eye care service rendered by a holder of a license issued pursuant to chapter 18.53 RCW, provided, that (1) the service rendered was within the lawful scope of such person's license, and (2) such contract would have provided the benefits for such service if rendered by a holder of a license issued pursuant to chapter 18.71 RCW.
[ 1965 c 149 § 2.]
NOTES:
Construction—1965 c 149: "Sections 1 through 3 of this act shall not apply to contracts in force prior to the effective date of this 1965 act, nor to any renewal of such contracts where there has been no change in any provisions thereof." [ 1965 c 149 § 4.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.20 - Disability Insurance. › 48.20.411 - Registered nurses or advanced registered nurses.

RCW 48.20.411
Registered nurses or advanced registered nurses.
Notwithstanding any provision of any disability insurance contract as provided for in this chapter, benefits shall not be denied thereunder for any health care service performed by a holder of a license for registered nursing practice or advanced registered nursing practice issued pursuant to chapter 18.79 RCW if (1) the service performed was within the lawful scope of such person's license, and (2) such contract would have provided benefits if such service had been performed by a holder of a license issued pursuant to chapter 18.71 RCW: PROVIDED, HOWEVER, That no provision of chapter 18.71 RCW shall be asserted to deny benefits under this section.
The provisions of this section are intended to be remedial and procedural to the extent they do not impair the obligation of any existing contract.
[ 1994 sp.s. c 9 § 729; 1973 1st ex.s. c 188 § 3.]
NOTES:
Severability—Headings and captions not law—Effective date—1994 sp.s. c 9: See RCW 18.79.900 through 18.79.902.
Severability—1973 1st ex.s. c 188: See note following RCW 48.18.298.
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.20 - Disability Insurance. › 48.20.412 - Chiropractic.

RCW 48.20.412
Chiropractic.
Notwithstanding any provision of any disability insurance contract as provided for in this chapter, benefits shall not be denied thereunder for any health care service performed by a holder of a license issued pursuant to chapter 18.25 RCW if (1) the service performed was within the lawful scope of such person's license, and (2) such contract would have provided benefits if such service had been performed by a holder of a license issued pursuant to chapter 18.71 RCW: PROVIDED, HOWEVER, That no provision of chapter 18.71 RCW shall be asserted to deny benefits under this section.
The provisions of this section are intended to be remedial and procedural to the extent they do not impair the obligation of any existing contract.
[ 1971 ex.s. c 13 § 1.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.20 - Disability Insurance. › 48.20.414 - Psychological services.

RCW 48.20.414
Psychological services.
Notwithstanding any provision of any disability insurance contract, benefits shall not be denied thereunder for any psychological service rendered by a holder of a license issued pursuant to chapter 18.83 RCW: PROVIDED, That (1) the service rendered was within the lawful scope of such person's license, and (2) such contract would have provided the benefits for such service if rendered by a holder of a license issued pursuant to chapter 18.71 RCW.
[ 1971 ex.s. c 197 § 1.]
NOTES:
Application—1971 ex.s. c 197: "Sections 1 and 2 of this act shall not apply to any contract in force prior to the effective date of this 1971 act, nor to any renewal of such contract where there has been no change in any provision thereof." [ 1971 ex.s. c 197 § 3.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.20 - Disability Insurance. › 48.20.416 - Dentistry.

RCW 48.20.416
Dentistry.
Notwithstanding any provision of any disability insurance contract as provided for in this chapter, benefits shall not be denied thereunder for any health care service performed by a holder of a license issued pursuant to chapter 18.32 RCW if (1) the service performed was within the lawful scope of such person's license, and (2) such contract would have provided benefits if such service has [had] been performed by a holder of a license issued [pursuant] to chapter 18.71 RCW: PROVIDED, HOWEVER, That no provision of chapter 18.71 RCW shall be asserted to deny benefits under this section.
The provisions of this section are intended to be remedial and procedural to the extent they do not impair the obligation of any existing contract.
[ 1974 ex.s. c 42 § 1.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.20 - Disability Insurance. › 48.20.417 - Dental services that are not subject to contract or provider agreement.

RCW 48.20.417
Dental services that are not subject to contract or provider agreement.
(1) Notwithstanding any other provisions of law, no disability insurance policy of any disability insurer as provided in this chapter subject to the jurisdiction of the state of Washington that covers any dental services, and no contract or participating provider agreement with a dentist may:
(a) Require, directly or indirectly, that a dentist who is a participating provider provide services to a subscriber at a fee set by, or at a fee subject to the approval of, the disability insurer unless the dental services are covered services, including services that would be reimbursable but for the application of contractual limitations such as benefit maximums, deductibles, coinsurance, waiting periods, or frequency limitations, under the applicable disability insurance policy; nor
(b) Prohibit, directly or indirectly, a dentist who is a participating provider from offering or providing to a subscriber dental services that are not covered services on any terms or conditions acceptable to the dentist and the subscriber.
(2) For the purposes of this section, "covered services" means dental services that are reimbursable under the applicable insurance policy or subscriber agreement or would be reimbursable but for the application of contractual limitations such as benefit maximums, deductibles, coinsurance, waiting periods or frequency limitations.
[ 2010 c 228 § 1.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.20 - Disability Insurance. › 48.20.418 - Denturist services.

RCW 48.20.418
Denturist services.
Notwithstanding any provision of any disability insurance contract covering dental care as provided for in this chapter, effective January 1, 1995, benefits shall not be denied thereunder for any service performed by a denturist licensed under chapter 18.30 RCW if (1) the service performed was within the lawful scope of such person's license, and (2) such contract would have provided benefits if such service had been performed by a dentist licensed under chapter 18.32 RCW.
[ 1995 c 1 § 21 (Initiative Measure No. 607, approved November 8, 1994).]
NOTES:
Short title—1995 c 1 (Initiative Measure No. 607): See RCW 18.30.900.
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.20 - Disability Insurance. › 48.20.420 - Dependent child coverage—Continuation for incapacity.

RCW 48.20.420
Dependent child coverage—Continuation for incapacity.
Any disability insurance contract providing health care services, delivered or issued for delivery in this state more than one hundred twenty days after August 11, 1969, which provides that coverage of a dependent child shall terminate upon attainment of the limiting age for dependent children specified in the contract, 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, provided proof of such incapacity and dependency is furnished to the insurer by the subscriber within thirty-one days of the child's attainment of the limiting age and subsequently as may be required by the insurer but not more frequently than annually after the two year period following the child's attainment of the limiting age.
[ 2020 c 274 § 30; 1985 c 264 § 10; 1969 ex.s. c 128 § 3.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.20 - Disability Insurance. › 48.20.430 - Dependent child coverage—From moment of birth—Congenital anomalies—Notification of birth.

RCW 48.20.430
Dependent child coverage—From moment of birth—Congenital anomalies—Notification of birth.
(1) Any disability insurance contract providing hospital and medical expenses and health care services, delivered or issued for delivery in this state more than one hundred twenty days after February 16, 1974, which provides coverage for dependent children of the insured, shall provide coverage for newborn infants of the insured from and after the moment of birth. Coverage provided in accord with this section shall include, but not be limited to, coverage for congenital anomalies of such infant children from the moment of birth.
(2) If payment of an additional premium is required to provide coverage for a child, the contract may require that notification of birth of a newly born child and payment of the required premium must be furnished to the insurer. The notification period shall be no less than sixty days from the date of birth. This subsection applies to policies issued or renewed on or after January 1, 1984.
[ 1983 1st ex.s. c 32 § 18; 1974 ex.s. c 139 § 1.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.20 - Disability Insurance. › 48.20.435 - Option to cover dependents under age twenty-six.

RCW 48.20.435
Option to cover dependents under age twenty-six.
(1) Each disability insurance contract that is not grandfathered and that provides coverage for a subscriber's child must offer the option of covering any child under the age of twenty-six.
(2) Each grandfathered disability insurance contract that provides coverage for a subscriber's child must offer the option of covering any child under the age of twenty-six unless the child is eligible to enroll in an eligible health plan sponsored by the child's employer or the child's spouse's employer.
(3) As used in this section, "grandfathered" has the same meaning as "grandfathered health plan" in RCW 48.43.005.
[ 2012 c 211 § 15; 2011 c 314 § 1; 2007 c 259 § 19.]
NOTES:
Effective date—2007 c 259 §§ 18-22: See note following RCW 41.05.095.
Subheadings not law—2007 c 259: See note following RCW 7.70.060.
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.20 - Disability Insurance. › 48.20.450 - Standardization and simplification of terms and coverages—Disclosure requirements.

RCW 48.20.450
Standardization and simplification of terms and coverages—Disclosure requirements.
The commissioner shall issue regulations to establish specific standards, including standards of full and fair disclosure, that set forth the manner, content, and required disclosure for the sale of individual policies of disability insurance which shall be in addition to and in accordance with applicable laws of this state, including RCW 48.20.450 through 48.20.480, which may cover but shall not be limited to:
(1) Terms of renewability;
(2) Initial and subsequent conditions of eligibility;
(3) Nonduplication of coverage provisions;
(4) Coverage of dependents;
(5) Preexisting conditions;
(6) Termination of insurance;
(7) Probationary periods;
(8) Limitations;
(9) Exceptions;
(10) Reductions;
(11) Elimination periods;
(12) Requirements for replacement;
(13) Recurrent conditions; and
(14) The definition of terms including but not limited to the following: Hospital, accident, sickness, injury, physician, accidental means, total disability, partial disability, nervous disorder, guaranteed renewable, and noncancellable.
[ 1985 c 264 § 11; 1975 1st ex.s. c 266 § 16.]
NOTES:
Purpose—1975 1st ex.s. c 266: "The purpose of *sections 14 through 18 of this 1975 amendatory act is to provide reasonable standardization and simplification of terms and coverages of individual disability insurance policies to facilitate public understanding and comparison, to eliminate provisions contained in individual disability insurance policies which may be misleading or unreasonably confusing in connection either with the purchase of such coverages or with the settlement of claims, and to provide for full disclosure in the sale of disability coverages." [ 1975 1st ex.s. c 266 § 15.]
*Reviser's note: During the course of passage of 1975 1st ex.s. c 266 [Substitute House Bill No. 198], the section numbering was changed, but the internal references were not changed accordingly. Thus the reference "sections 14 through 18 of this 1975 amendatory act" appears to be erroneous. Reference to "sections 15 through 19," codified herein as this section and RCW 48.20.450 through 48.20.480, was apparently intended.
Severability—1975 1st ex.s. c 266: See note following RCW 48.01.010.
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.20 - Disability Insurance. › 48.20.460 - Standardization and simplification—Minimum standards for benefits and coverages.

RCW 48.20.460
Standardization and simplification—Minimum standards for benefits and coverages.
(1) The commissioner shall issue regulations to establish minimum standards for benefits under each of the following categories of coverage in individual policies, other than conversion policies issued pursuant to a contractual conversion privilege under a group policy, of disability insurance:
(a) Basic hospital expense coverage;
(b) Basic medical-surgical expense coverage;
(c) Hospital confinement indemnity coverage;
(d) Major medical expense coverage;
(e) Disability income protection coverage;
(f) Accident only coverage;
(g) Specified disease or specified accident coverage;
(h) Medicare supplemental coverage; and
(i) Limited benefit coverage.
(2) Nothing in this section shall preclude the issuance of any policy which combines two or more of the categories of coverage enumerated in items (a) through (f) of subsection (1) of this section.
(3) No policy shall be delivered or issued for delivery in this state which does not meet the prescribed minimum standards for the categories of coverage listed in items (a) through (i) of subsection (1) of this section, unless the commissioner finds such policy will be in the public interest and such policy meets the requirements set forth in RCW 48.18.110.
(4) The commissioner shall prescribe the method of identification of policies based upon coverages provided.
[ 1981 c 339 § 19; 1975 1st ex.s. c 266 § 17.]
NOTES:
Severability—1975 1st ex.s. c 266: See note following RCW 48.01.010.
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.20 - Disability Insurance. › 48.20.470 - Standardization and simplification—Outline of coverage—Format and contents.

RCW 48.20.470
Standardization and simplification—Outline of coverage—Format and contents.
(1) No policy of individual disability insurance shall be delivered or issued for delivery in this state unless an outline of coverage described in subsection (2) of this section is furnished to the applicant in accord with such rules or regulations as the commissioner shall prescribe.
(2) The commissioner shall prescribe the format and content of the outline of coverage required by subsection (1) of this section. "Format" means style, arrangement, and overall appearance, including such items as the size, color, and prominence of type and the arrangement of text and captions. Such outline of coverage shall include:
(a) A statement identifying the applicable category or categories of coverage provided by the policy as prescribed in RCW 48.20.450;
(b) A description of the principal benefits and coverage provided in the policy;
(c) A statement of the exceptions, reductions and limitations contained in the policy;
(d) A statement of the renewal provisions including any reservation by the insurer of a right to change premiums; and
(e) A statement that the outline is a summary of the policy issued or applied for and that the policy should be consulted to determine governing contractual provisions.
[ 1985 c 264 § 12; 1975 1st ex.s. c 266 § 18.]
NOTES:
Severability—1975 1st ex.s. c 266: See note following RCW 48.01.010.
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.20 - Disability Insurance. › 48.20.480 - Standardization and simplification—Simplified application form—Coverage of loss from preexisting health condition.

RCW 48.20.480
Standardization and simplification—Simplified application form—Coverage of loss from preexisting health condition.
Notwithstanding the provisions of RCW 48.20.052, if an insurer elects to use a simplified application form, with or without a question as to the applicant's health at the time of application, but without any questions concerning the insured's health history or medical treatment history, the policy must cover any loss occurring after twelve months from any preexisting condition not specifically excluded from coverage by terms of the policy, and, except as so provided, the policy shall not include wording that would permit a defense based upon preexisting conditions.
[ 1975 1st ex.s. c 266 § 19.]
NOTES:
Severability—1975 1st ex.s. c 266: See note following RCW 48.01.010.
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.20 - Disability Insurance. › 48.20.490 - Continuation of coverage by former spouse and dependents.

RCW 48.20.490
Continuation of coverage by former spouse and dependents.
Every policy of disability insurance issued, amended, or renewed after June 12, 1980, for an individual and his/her dependents shall contain provisions to assure that the covered spouse and/or dependents, in the event that any cease to be a qualified family member by reason of termination of marriage or death of the principal insured, shall have the right to continue the policy coverage without a physical examination, statement of health, or other proof of insurability.
[ 1980 c 10 § 1.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.20 - Disability Insurance. › 48.20.500 - Coverage for adopted children.

RCW 48.20.500
Coverage for adopted children.
(1) Any disability insurance contract providing hospital and medical expenses and health care services, delivered or issued for delivery in this state, which provides coverage for dependent children, as defined in the contract of the insured, shall cover adoptive children placed with the insured on the same basis as other dependents, as provided in RCW 48.01.180.
(2) If payment of an additional premium is required to provide coverage for a child, the contract may require that notification of placement of a child for adoption and payment of the required premium must be furnished to the insurer. The notification period shall be no less than sixty days from the date of placement.
[ 1986 c 140 § 2.]
NOTES:
Effective date, application—Severability—1986 c 140: See notes following RCW 48.01.180.
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.20 - Disability Insurance. › 48.20.510 - Cancellation of rider.

RCW 48.20.510
Cancellation of rider.
Upon application by an insured, a rider shall be canceled if at least five years after its issuance, no health care services have been received by the insured during that time for the condition specified in the rider, and a physician, selected by the carrier for that purpose, agrees in writing to the full medical recovery of the insured from that condition, such agreement not to be unreasonably withheld. The option of the insured to apply for cancellation shall be disclosed on the face of the rider in clear and conspicuous language.
For purposes of this section, a rider is a legal document that modifies a contract to exclude, limit, or reduce coverage or benefits for specifically named or described preexisting diseases or physical conditions.
[ 1987 c 37 § 1.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.20 - Disability Insurance. › 48.20.520 - Phenylketonuria.

RCW 48.20.520
Phenylketonuria.
(1) The legislature finds that:
(a) Phenylketonuria is a rare inherited genetic disorder.
(b) Children with phenylketonuria are unable to metabolize an essential amino acid, phenylalanine, which is found in the proteins of most food.
(c) To remain healthy, children with phenylketonuria must maintain a strict diet and ingest a mineral and vitamin-enriched formula.
(d) Children who do not maintain their diets with the formula acquire severe mental and physical difficulties.
(e) Originally, the formulas were listed as prescription drugs but were reclassified as medical foods to increase their availability.
(2) Subject to requirements and exceptions which may be established by rules adopted by the commissioner, any disability insurance contract delivered or issued for delivery or renewed in this state on or after September 1, 1988, that insures for hospital or medical expenses shall provide coverage for the formulas necessary for the treatment of phenylketonuria.
[ 1988 c 173 § 1.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.20 - Disability Insurance. › 48.20.525 - Prescriptions—Preapproval of individual claims—Subsequent rejection prohibited—Written record required.

RCW 48.20.525
Prescriptions—Preapproval of individual claims—Subsequent rejection prohibited—Written record required.
Disability insurance companies who through an authorized representative have first approved, by any means, an individual prescription claim as eligible may not reject that claim at some later date. Pharmacists or drug dispensing outlets who obtain preapproval of claims shall keep a written record of the preapproval that consists of identification by name and telephone number of the person who approved the claim.
[ 1993 c 253 § 2.]
NOTES:
Findings—1993 c 253: "The legislature finds that many health care insurance entities are initially approving claims as eligible under an identified program, over the telephone, but denying those same claims when they are submitted for payment. The legislature finds this to be an untenable situation for the providers." [ 1993 c 253 § 1.]
Effective date—1993 c 253: "This act is necessary for the immediate preservation of the public peace, health, or safety, or support of the state government and its existing public institutions, and shall take effect immediately [May 7, 1993]." [ 1993 c 253 § 6.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.20 - Disability Insurance. › 48.20.530 - Nonresident pharmacies.

RCW 48.20.530
Nonresident pharmacies.
For the purposes of this chapter, a nonresident pharmacy is defined as any pharmacy located outside this state that ships, mails, or delivers, in any manner, except when delivered in person to an enrolled participant or his/her representative, controlled substances, legend drugs, or devices into this state.
After October 1, 1991, an insurer providing coverage of prescription drugs from nonresident pharmacies may only provide coverage from licensed nonresident pharmacies. The insurers shall obtain proof of current licensure in conformity with this section and RCW 18.64.350 through 18.64.400 from the nonresident pharmacy and keep that proof of licensure on file.
The department of health may request from the insurer the proof of current licensure for all nonresident pharmacies through which the insurer is providing coverage for prescription drugs to residents of the state of Washington. This information, which may constitute a full or partial customer list, shall be confidential and exempt from public disclosure, and from the requirements of chapter 42.56 RCW. The board or the department shall not be restricted in the disclosure of the name of a nonresident pharmacy that is or has been licensed under RCW 18.64.360 or 18.64.370 or of the identity of a nonresident pharmacy disciplined under RCW 18.64.350 through 18.64.400.
[ 2005 c 274 § 310; 1991 c 87 § 7.]
NOTES:
Effective date—1991 c 87: See note following RCW 18.64.350.
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.20 - Disability Insurance. › 48.20.550 - Fixed payment insurance—Standard disclosure form.

RCW 48.20.550
Fixed payment insurance—Standard disclosure form.
The commissioner shall adopt rules setting forth the content of a standard disclosure form to be provided to all applicants for individual, illness-triggered fixed payment insurance, hospital confinement fixed payment insurance, or other fixed payment insurance. The standard disclosure shall provide information regarding the level, type, and amount of benefits provided and the limitations, exclusions, and exceptions under the policy, as well as additional information to enhance consumer understanding. The disclosure shall specifically disclose that the coverage is not comprehensive in nature and will not cover the cost of most hospital and other medical services. Such disclosure form must be filed for approval with the commissioner prior to use. The standard disclosure forms must be provided at the time of solicitation and completion of the application form. All advertising and marketing materials other than the standard disclosure form must be filed with the commissioner at least thirty days prior to use.
[ 2007 c 296 § 2.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.20 - Disability Insurance. › 48.20.555 - Fixed payment insurance—Benefit restrictions.

RCW 48.20.555
Fixed payment insurance—Benefit restrictions.
Illness-triggered fixed payment insurance, hospital confinement fixed payment insurance, or other fixed payment insurance policies are not considered to provide coverage for hospital or medical expenses under this chapter, if the benefits provided are a fixed dollar amount that is paid regardless of the amount charged. The benefits may not be related to, or be a percentage of, the amount charged by the provider of service and must be offered as an independent and noncoordinated benefit with any other health plan as defined in *RCW 48.43.005(19).
[ 2007 c 296 § 3.]
NOTES:
*Reviser's note: RCW 48.43.005 was amended by 2011 c 314 § 3 and by 2011 c 315 § 2, changing subsection (19) to subsection (24). RCW 48.43.005 was subsequently amended by 2012 c 87 § 1, changing subsection (24) to subsection (26). RCW 48.43.005 was subsequently alphabetized pursuant to RCW 1.08.015(2)(k), changing subsection (26) to subsection (27), and effective January 1, 2020, changing subsection (26) to subsection (29). RCW 48.43.005 was alphabetized pursuant to RCW 1.08.015(2)(k), changing subsection (29) to subsection (31).
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.20 - Disability Insurance. › 48.20.900 - Construction—Chapter applicable to state registered domestic partnerships—2009 c 521.

RCW 48.20.900
Construction—Chapter applicable to state registered domestic partnerships—2009 c 521.
For the purposes of this chapter, the terms spouse, marriage, marital, husband, wife, widow, widower, next of kin, and family shall be interpreted as applying equally to state registered domestic partnerships or individuals in state registered domestic partnerships as well as to marital relationships and married persons, and references to dissolution of marriage shall apply equally to state registered domestic partnerships that have been terminated, dissolved, or invalidated, to the extent that such interpretation does not conflict with federal law. Where necessary to implement chapter 521, Laws of 2009, gender-specific terms such as husband and wife used in any statute, rule, or other law shall be construed to be gender neutral, and applicable to individuals in state registered domestic partnerships.
[ 2009 c 521 § 115.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.21 - Group and Blanket Disability Insurance. › 48.21.010 - "Group disability insurance" defined—Issuance.

RCW 48.21.010
"Group disability insurance" defined—Issuance.
(1) Group disability insurance is that form of disability insurance, including stop loss insurance as defined in RCW 48.11.030, provided by a master policy issued to an employer, to a trustee appointed by an employer or employers, or to an association of employers formed for purposes other than obtaining such insurance, covering, with or without their dependents, the employees, or specified categories of the employees, of such employers or their subsidiaries or affiliates, or issued to a labor union, or to an association of employees formed for purposes other than obtaining such insurance, covering, with or without their dependents, the members, or specified categories of the members, of the labor union or association, or issued pursuant to RCW 48.21.030. Group disability insurance includes the following groups that qualify for group life insurance:
RCW 48.24.020, 48.24.035, 48.24.040, 48.24.045, 48.24.050, 48.24.060, 48.24.070, 48.24.080, 48.24.090, and 48.24.095. A group under RCW 48.24.027 does not qualify as a group for the purposes of this chapter.
(2) Group disability insurance for lines of coverage identified in *RCW 48.43.005(26) (e), (h), (k), and (m) offered to a resident of this state under a group disability insurance policy may be issued to a group other than the groups described in subsection (1) of this section subject to the requirements in this subsection.
(a) A group disability insurance policy offered under this subsection may not be delivered in this state unless the commissioner finds that:
(i) The issuance of the group policy is not contrary to the best interest of the public;
(ii) The issuance of the group policy would result in economies of acquisition or administration; and
(iii) The benefits are reasonable in relation to the premium charged.
(b) A group disability insurance coverage may not be offered under this subsection in this state by an insurer under a policy issued in another state unless the commissioner or the insurance commissioner of another state having requirements substantially similar to those contained in this subsection has made a determination that the requirements have been met.
[ 2016 c 65 § 1; 2011 c 81 § 1; 2010 c 13 § 3; 1992 c 226 § 2; 1949 c 190 § 27; 1947 c 79 § .21.01; Rem. Supp. 1949 § 45.21.01.]
NOTES:
*Reviser's note: RCW 48.43.005 was alphabetized pursuant to RCW 1.08.015(2)(k), changing subsection (26) to subsection (27), and effective January 1, 2020, changing subsection (26) to subsection (29). RCW 48.43.005 was alphabetized pursuant to RCW 1.08.015(2)(k), changing subsection (29) to subsection (31).
Application—1992 c 226: See note following RCW 48.11.030.
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.21 - Group and Blanket Disability Insurance. › 48.21.015 - "Group stop loss insurance" defined for the purpose of exemption—Scope of application.

RCW 48.21.015
"Group stop loss insurance" defined for the purpose of exemption—Scope of application.
Group stop loss insurance is exempt from all sections of this chapter and chapter 48.32A RCW except for RCW 48.21.010 and this section. For the purpose of this exemption, group stop loss is further defined as follows:
(1) The policy must be issued to and insure the employer, the trustee or other sponsor of the plan, or the plan itself, but not the employees, members, or participants;
(2) Payment by the insurer must be made to the employer, the trustee, or other sponsor of the plan or the plan itself, but not to the employees, members, participants, or health care providers;
(3) The policy must contain a provision that establishes an aggregate attaching point or retention that is at the minimum one hundred twenty percent of the expected claims; and
(4) The policy may provide for an individual attaching point or retention that is not less than five percent of the expected claims or one hundred thousand dollars, whichever is less.
[ 2000 c 80 § 8; 1992 c 226 § 3.]
NOTES:
Application—1992 c 226: See note following RCW 48.11.030.
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.21 - Group and Blanket Disability Insurance. › 48.21.020 - "Employees," "employer" defined.

RCW 48.21.020
"Employees," "employer" defined.
The term "employees" as used in this chapter shall be deemed to include as employees of a single employer, the compensated officers, managers, and employees of the employer and of subsidiary or affiliated corporations of a corporation employer, and the individual proprietors, partners, and employees of individuals and firms of which the business is controlled by the insured employer through stock ownership, contract or otherwise. The term "employer" as used in this chapter shall be deemed to include any municipal corporation or governmental unit, agency or department thereof as well as private individuals, firms, corporations and other persons.
[1947 c 79 § .21.02; Rem. Supp. 1947 § 45.21.02.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.21 - Group and Blanket Disability Insurance. › 48.21.030 - Health care groups.

RCW 48.21.030
Health care groups.
A policy of group disability insurance may be issued to a corporation, as policyholder, existing primarily for the purpose of assisting individuals who are its subscribers in securing medical, hospital, dental, and other health care services for themselves and their dependents, covering all and not less than five hundred such subscribers and dependents, with respect only to medical, hospital, dental, and other health care services.
[1947 c 79 § .21.03; Rem. Supp. 1947 § 45.21.03.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.21 - Group and Blanket Disability Insurance. › 48.21.040 - "Blanket disability insurance" defined.

RCW 48.21.040
"Blanket disability insurance" defined.
(1) Any policy or contract of disability insurance which conforms with the description and complies with the requirements contained in one of the following six paragraphs shall be deemed a blanket disability insurance policy:
(a) A policy issued to any common carrier of passengers, which carrier shall be deemed the policyholder, covering a group defined as all persons who may become such passengers, and whereby such passengers shall be insured against loss or damage resulting from death or bodily injury either while, or as a result of, being such passengers.
(b) A policy issued in the name of any volunteer fire department, first aid or ambulance squad or volunteer police organization, which shall be deemed the policyholder, and covering all the members of any such organization against loss from accidents resulting from hazards incidental to duties in connection with such organizations.
(c) A policy issued in the name of any established organization whether incorporated or not, having community recognition and operated for the welfare of the community and its members and not for profit, which shall be deemed the policyholder, and covering all volunteer workers who serve without pecuniary compensation and the members of the organization, against loss from accidents occurring while engaged in the actual performance of duties on behalf of such organization or in the activities thereof.
(d) A policy issued to an employer, who shall be deemed the policyholder, covering any group of employees defined by reference to exceptional hazards incident to such employment, insuring such employees against death or bodily injury resulting while, or from, being exposed to such exceptional hazards.
(e) A policy covering students or employees issued to a college, school, or other institution of learning or to the head or principal thereof, who or which shall be deemed the policyholder.
(f) A policy or contract issued to any other substantially similar group, which, in the commissioner's discretion, may be subject to the insurance of a blanket disability policy or contract.
(2) Nothing contained in this section shall be deemed to affect the liability of policyholders for the death of, or injury to, any such members of such group.
(3) Individual applications shall not be required from individuals covered under a blanket disability insurance contract.
[ 1959 c 225 § 7; 1947 c 79 § .21.04; Rem. Supp. 1947 § 45.21.04.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.21 - Group and Blanket Disability Insurance. › 48.21.047 - Requirements for plans offered to small employers—Definitions.

RCW 48.21.047
Requirements for plans offered to small employers—Definitions.
(1) An insurer may not offer any health benefit plan to any small employer without complying with RCW 48.21.045(3).
(2) Employers purchasing health plans provided through associations or through member-governed groups formed specifically for the purpose of purchasing health care are not small employers and the plans are not subject to RCW 48.21.045(3).
(3) For purposes of this section, "health benefit plan," "health plan," and "small employer" mean the same as defined in RCW 48.43.005.
(4) For purposes of this section, "census date" has the same meaning as defined in RCW 48.44.010.
[ 2010 c 292 § 8; 2005 c 223 § 11; 1995 c 265 § 22.]
NOTES:
Application—2010 c 292: See note following RCW 48.43.005.
Captions not law—Effective dates—Savings—Severability—1995 c 265: See notes following RCW 70.47.015.
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.21 - Group and Blanket Disability Insurance. › 48.21.050 - Standard provisions required.

RCW 48.21.050
Standard provisions required.
Every policy of group or blanket disability insurance shall contain in substance the provisions as set forth in RCW 48.21.060 to 48.21.090, inclusive, or provisions which in the opinion of the commissioner are more favorable to the individuals insured, or at least as favorable to such individuals and more favorable to the policyholder. No such policy of group or blanket disability insurance shall contain any provision relative to notice or proof of loss, or to the time for paying benefits, or to the time within which suit may be brought upon the policy, which in the opinion of the commissioner is less favorable to the individuals insured than would be permitted by the standard provisions required for individual disability insurance policies.
[1947 c 79 § .21.05; Rem. Supp. 1947 § 45.21.05.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.21 - Group and Blanket Disability Insurance. › 48.21.060 - The contract—Representations.

RCW 48.21.060
The contract—Representations.
There shall be a provision that a copy of the application, if any, of the policyholder shall be attached to the policy when issued; that all statements made by the policyholder or by the individuals insured shall in the absence of fraud be deemed representations and not warranties, and that no statement made by any individual insured shall be used in any contest unless a copy of the instrument containing the statement is or has been furnished to such individual or to his or her beneficiary, if any.
[ 2009 c 549 § 7102; 1947 c 79 § .21.06; Rem. Supp. 1947 § 45.21.06.]