reglab/statecodes huggingface dataset:
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.41 - Health Insurance Coverage Access Act. › 48.41.037 - Washington state health insurance pool account.

RCW 48.41.037
Washington state health insurance pool account.
The Washington state health insurance pool account is created in the custody of the state treasurer. All receipts from moneys specifically appropriated to the account must be deposited in the account. Expenditures from this account shall be used to cover deficits incurred by the Washington state health insurance pool under this chapter in excess of the threshold established in this section. To the extent funds are available in the account, funds shall be expended from the account to offset that portion of the deficit that would otherwise have to be recovered by imposing an assessment on members in excess of a threshold of seventy cents per insured person per month. The commissioner shall authorize expenditures from the account, to the extent that funds are available in the account, upon certification by the pool board that assessments will exceed the threshold level established in this section. The account is subject to the allotment procedures under chapter 43.88 RCW, but an appropriation is not required for expenditures.
Whether the assessment has reached the threshold of seventy cents per insured person per month shall be determined by dividing the total aggregate amount of assessment by the proportion of total assessed members. Thus, stop loss members shall be counted as one-tenth of a whole member in the denominator given that is the amount they are assessed proportionately relative to a fully insured medical member.
[ 2007 c 259 § 29; 2000 c 79 § 36.]
NOTES:
Subheadings not law—2007 c 259: See note following RCW 7.70.060.
Effective date—Severability—2000 c 79: See notes following RCW 48.04.010.
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.41 - Health Insurance Coverage Access Act. › 48.41.050 - Operation plan—Contents.

RCW 48.41.050
Operation plan—Contents.
The plan of operation submitted by the board to the commissioner shall:
(1) Establish procedures for the handling and accounting of assets and moneys of the pool;
(2) Establish regular times and places for meetings of the board of directors;
(3) Establish procedures for records to be kept of all financial transactions and for an annual fiscal reporting to the commissioner;
(4) Contain additional provisions necessary and proper for the execution of the powers and duties of the pool;
(5) Establish procedures for the collection of assessments from all members to provide for claims paid under the plan and for administrative expenses incurred or estimated to be incurred during the period for which the assessment is made;
(6) Establish the amount of assessment pursuant to RCW 48.41.060, which shall occur after March 1st of each calendar year, and which shall be due and payable within thirty days of the receipt of the assessment notice;
(7) Select an administrator in accordance with RCW 48.41.080;
(8) Develop and implement a program to publicize the existence of the plan, the eligibility requirements and procedures for enrollment, and to maintain public awareness of the plan; and
(9) Establish procedures under which applicants and participants may have grievances reviewed by an impartial body and reported to the board.
[ 1987 c 431 § 5.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.41 - Health Insurance Coverage Access Act. › 48.41.070 - Examination and report.

RCW 48.41.070
Examination and report.
The pool shall be subject to examination by the commissioner as provided under chapter 48.03 RCW. The board of directors shall submit to the commissioner, not later than one hundred twenty days after the end of each accounting year, a financial report for the year in a form approved by the commissioner.
[ 1998 c 245 § 98; 1989 c 121 § 4; 1987 c 431 § 7.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.41 - Health Insurance Coverage Access Act. › 48.41.080 - Pool administrator—Selection, term, duties, pay.

RCW 48.41.080
Pool administrator—Selection, term, duties, pay.
The board shall select an administrator through a competitive bidding process to administer the pool.
(1) The board shall evaluate bids based upon criteria established by the board, which shall include:
(a) The administrator's proven ability to handle health coverage;
(b) The efficiency of the administrator's claim-paying procedures;
(c) An estimate of the total charges for administering the plan; and
(d) The administrator's ability to administer the pool in a cost-effective manner.
(2) The administrator shall serve for a period of three years subject to removal for cause. At least six months prior to the expiration of each three-year period of service by the administrator, the board shall invite all interested parties, including the current administrator, to submit bids to serve as the administrator for the succeeding three-year period. Selection of the administrator for this succeeding period shall be made at least three months prior to the end of the current three-year period, unless at the time required for submission of bids pursuant to this subsection to the pool will be discontinued before the end of the succeeding thirty-six month period.
(3) The administrator shall perform such duties as may be assigned by the board including:
(a) Administering eligibility and administrative claim payment functions relating to the pool;
(b) Establishing a premium billing procedure for collection of premiums from covered persons. Billings shall be made on a periodic basis as determined by the board, which shall not be more frequent than a monthly billing;
(c) Performing all necessary functions to assure timely payment of benefits to covered persons under the pool including:
(i) Making available information relating to the proper manner of submitting a claim for benefits to the pool, and distributing forms upon which submission shall be made;
(ii) Taking steps necessary to offer and administer managed care benefit plans; and
(iii) Evaluating the eligibility of each claim for payment by the pool;
(d) Submission of regular reports to the board regarding the operation of the pool. The frequency, content, and form of the report shall be as determined by the board;
(e) Following the close of each accounting year, determination of net paid and earned premiums, the expense of administration, and the paid and incurred losses for the year and reporting this information to the board and the commissioner on a form as prescribed by the commissioner.
(4) The administrator shall be paid as provided in the contract between the board and the administrator for its expenses incurred in the performance of its services.
[ 2011 c 314 § 14; 2000 c 79 § 10; 1997 c 231 § 212; 1989 c 121 § 5; 1987 c 431 § 8.]
NOTES:
Effective date—Severability—2000 c 79: See notes following RCW 48.04.010.
Short title—Part headings and captions not law—Severability—Effective dates—1997 c 231: See notes following RCW 48.43.005.
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.41 - Health Insurance Coverage Access Act. › 48.41.120 - Comprehensive pool policy—Deductibles—Coinsurance—Carryover.

RCW 48.41.120
Comprehensive pool policy—Deductibles—Coinsurance—Carryover.
(1) Subject to the limitation provided in subsection (3) of this section, the comprehensive pool policy offered under RCW 48.41.110(4) shall impose a deductible as provided in this subsection. Deductibles of five hundred dollars and one thousand dollars on a per person per calendar year basis shall initially be offered. The board may authorize deductibles in other amounts. The deductible shall be applied to the first five hundred dollars, one thousand dollars, or other authorized amount of eligible expenses incurred by the covered person.
(2) Subject to the limitations provided in subsection (3) of this section, a mandatory coinsurance requirement shall be imposed at a rate not to exceed twenty percent of eligible expenses in excess of the mandatory deductible and which supports the efficient delivery of high quality health care services for the medical conditions of pool enrollees.
(3) The maximum aggregate out-of-pocket payments for eligible expenses by the insured in the form of deductibles and coinsurance under the comprehensive pool policy offered under RCW 48.41.110(4) shall not exceed in a calendar year:
(a) One thousand five hundred dollars per individual, or three thousand dollars per family, per calendar year for the five hundred dollar deductible policy;
(b) Two thousand five hundred dollars per individual, or five thousand dollars per family per calendar year for the one thousand dollar deductible policy; or
(c) An amount authorized by the board for any other deductible policy.
(4) Except for those enrolled in a high deductible health plan qualified under federal law for use with a health savings account, eligible expenses incurred by a covered person in the last three months of a calendar year, and applied toward a deductible, shall also be applied toward the deductible amount in the next calendar year.
(5) The board may modify cost-sharing as an incentive for enrollees to participate in care management services and other cost-effective programs and policies.
[ 2007 c 259 § 31; 2000 c 79 § 14; 1989 c 121 § 8; 1987 c 431 § 12.]
NOTES:
Subheadings not law—2007 c 259: See note following RCW 7.70.060.
Effective date—Severability—2000 c 79: See notes following RCW 48.04.010.
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.41 - Health Insurance Coverage Access Act. › 48.41.130 - Policy forms—Approval required.

RCW 48.41.130
Policy forms—Approval required.
All policy forms issued by the pool shall conform in substance to prototype forms developed by the pool, and shall in all other respects conform to the requirements of this chapter, and shall be filed with and approved by the commissioner before they are issued.
[ 2000 c 79 § 15; 1997 c 231 § 215; 1987 c 431 § 13.]
NOTES:
Effective date—Severability—2000 c 79: See notes following RCW 48.04.010.
Short title—Part headings and captions not law—Severability—Effective dates—1997 c 231: See notes following RCW 48.43.005.
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.41 - Health Insurance Coverage Access Act. › 48.41.140 - Coverage for children, dependents.

RCW 48.41.140
Coverage for children, dependents.
(1) Coverage shall provide that health insurance benefits are applicable to children of the person in whose name the policy is issued including adopted and newly born natural children. Coverage shall also include necessary care and treatment of medically diagnosed congenital defects and birth abnormalities. If payment of a specific premium is required to provide coverage for the child, the policy may require that notification of the birth or adoption of a child and payment of the required premium must be furnished to the pool within thirty-one days after the date of birth or adoption in order to have the coverage continued beyond the thirty-one day period. For purposes of this subsection, a child is deemed to be adopted, and benefits are payable, when the child is physically placed for purposes of adoption under the laws of this state with the person in whose name the policy is issued; and, when the person in whose name the policy is issued assumes financial responsibility for the medical expenses of the child. For purposes of this subsection, "newly born" means, and benefits are payable, from the moment of birth.
(2) A pool policy shall provide that coverage of a dependent person shall terminate when the person becomes twenty-six years of age: PROVIDED, That coverage of such person shall not terminate at age twenty-six while he or she is and continues to be both (a) incapable of self-sustaining employment by reason of developmental or physical disability and (b) chiefly dependent upon the person in whose name the policy is issued for support and maintenance, provided proof of such incapacity and dependency is furnished to the pool by the policyholder within thirty-one days of the dependent's attainment of age twenty-six and subsequently as may be required by the pool but not more frequently than annually after the two-year period following the dependent's attainment of age twenty-six.
[ 2020 c 274 § 34; 2011 c 314 § 16; 2000 c 79 § 16; 1987 c 431 § 14.]
NOTES:
Effective date—Severability—2000 c 79: See notes following RCW 48.04.010.
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.41 - Health Insurance Coverage Access Act. › 48.41.150 - Medical supplement policy.

RCW 48.41.150
Medical supplement policy.
(1) The board shall offer a medical supplement policy for persons receiving medicare parts A and B. The supplement policy shall provide benefits of one hundred percent of the deductible and copayment required under medicare and eighty percent of the charges for covered services under this chapter that are not paid by medicare. The coverage shall include a limitation of one thousand dollars per person on total annual out-of-pocket expenses for the covered services.
(2) If federal law is adopted that addresses this subject, the board shall offer a policy that is consistent with that federal law.
[ 1989 c 121 § 9; 1987 c 431 § 15.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.41 - Health Insurance Coverage Access Act. › 48.41.170 - Required rule making.

RCW 48.41.170
Required rule making.
The commissioner shall adopt rules pursuant to chapter 34.05 RCW that:
(1) Provide for disclosure by the member of the availability of insurance coverage from the pool; and
(2) Implement this chapter.
[ 1987 c 431 § 17.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.41 - Health Insurance Coverage Access Act. › 48.41.190 - Civil and criminal immunity.

RCW 48.41.190
Civil and criminal immunity.
The pool, members of the pool, board directors of the pool, officers of the pool, employees of the pool, the commissioner, the commissioner's representatives, and the commissioner's employees shall not be civilly or criminally liable and shall not have any penalty or cause of action of any nature arise against them for any action taken or not taken, including any discretionary decision or failure to make a discretionary decision, when the action or inaction is done in good faith and in the performance of the powers and duties under this chapter. Nothing in this section prohibits legal actions against the pool to enforce the pool's statutory or contractual duties or obligations.
[ 2007 c 259 § 33; 1989 c 121 § 10; 1987 c 431 § 19.]
NOTES:
Subheadings not law—2007 c 259: See note following RCW 7.70.060.
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.41 - Health Insurance Coverage Access Act. › 48.41.210 - Last payor of benefits.

RCW 48.41.210
Last payor of benefits.
It is the express intent of this chapter that the pool be the last payor of benefits whenever any other benefit is available.
(1) Benefits otherwise payable under pool coverage shall be reduced by all amounts paid or payable through any other health insurance, or health benefit plans, including but not limited to self-insured plans and by all hospital and medical expense benefits paid or payable under any worker's compensation coverage, automobile medical payment or liability insurance whether provided on the basis of fault or nonfault, and by any hospital or medical benefits paid or payable under or provided pursuant to any state or federal law or program.
(2) The administrator or the pool shall have a cause of action against an eligible person for the recovery of the amount of benefits paid which are not for covered expenses. Benefits due from the pool may be reduced or refused as a set-off against any amount recoverable under this subsection.
[ 1987 c 431 § 21.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.41 - Health Insurance Coverage Access Act. › 48.41.240 - Review of populations needing coverage through pool—Analysis and recommendations—Report.

RCW 48.41.240
Review of populations needing coverage through pool—Analysis and recommendations—Report.
(1) The board shall review populations that may need ongoing access to coverage through the pool, with specific attention to those persons who may be excluded from or may receive inadequate coverage beginning January 1, 2014, such as persons with end-stage renal disease or HIV/AIDS, or persons not eligible for coverage in the exchange.
(2) If the review under subsection (1) of this section indicates a continued need for coverage through the pool after December 31, 2013, the board shall submit recommendations regarding any modifications to pool eligibility requirements for new and ongoing enrollment after December 31, 2013. The recommendations must address any needed modifications to the standard health questionnaire or other eligibility screening tool that could be used in a manner consistent with federal law to determine eligibility for enrollment in the pool.
(3) The board shall complete an analysis of current pool assessment requirements in relation to assessments that will fund the reinsurance program and recommend changes to pool assessments or any credits against assessments that may be considered for the reinsurance program. The analysis shall recommend whether the categories of members paying assessments should be adjusted to make the assessment fair and equitable among all payers.
(4) The board shall report its recommendations to the governor and the legislature by December 1, 2012.
(5) The board shall revisit the study of eligibility completed in 2012 with another review of the populations that may need ongoing access to coverage through the pool, to be submitted to the governor and legislature by November 1, 2015. The eligibility study shall include the nonmedicare populations scheduled to lose coverage and medicare populations, and consider whether the enrollees have access to comprehensive coverage alternatives that include appropriate pharmacy coverage. The study shall include recommendations to address any barriers in eligibility that remain in accessing other coverage such as medicare supplemental coverage or comprehensive pharmacy coverage, as well as suggestions for financing changes and recommendations on a future expiration of the pool.
[ 2013 c 279 § 5; 2012 c 87 § 17.]
NOTES:
Finding—Intent—2013 c 279: See note following RCW 48.41.060.
Spiritual care services—2012 c 87: See RCW 43.71.901.
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.41 - Health Insurance Coverage Access Act. › 48.41.250 - Administration of risk management functions—Contract with commissioner authorized—Recommendations—Report to legislature.

RCW 48.41.250
Administration of risk management functions—Contract with commissioner authorized—Recommendations—Report to legislature.
(1) The pool is authorized to contract with the commissioner to administer risk management functions if necessary, consistent with RCW 48.43.720, and consistent with P.L. 111-148 of 2010, as amended. Prior to entering into a contract, the pool may conduct preoperational and planning activities related to these programs, including defining and implementing an appropriate legal structure or structures to administer and coordinate the reinsurance or risk adjustment programs.
(2) The reasonable costs incurred by the pool for preoperational and planning activities related to the reinsurance program may be reimbursed from federal funds or from the additional contributions authorized under RCW 48.43.720 to pay the administrative costs of the reinsurance program.
(3) If the pool contracts to administer and coordinate the reinsurance or risk adjustment program, the board must submit recommendations to the legislature with suggestions for additional consumer representatives or other representative members to the board.
(4) The pool shall report on these activities to the appropriate committees of the senate and house of representatives by December 15, 2012, and December 15, 2013.
[ 2012 c 87 § 18.]
NOTES:
Effective date—2012 c 87 §§ 4, 16, 18, and 19-23: See note following RCW 43.71.030.
Spiritual care services—2012 c 87: See RCW 43.71.901.
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.41 - Health Insurance Coverage Access Act. › 48.41.900 - Federal supremacy.

RCW 48.41.900
Federal supremacy.
If any part of this chapter is found to be in conflict with federal requirements which are a prescribed condition to the allocation of federal funds to the state, the conflicting part of this chapter is hereby declared to be inoperative solely to the extent of the conflict and with respect to the agencies directly affected, and such finding or determination shall not affect the operation of the remainder of this chapter in its application to the agencies concerned. The rules under this chapter shall meet federal requirements which are a necessary condition to the receipt of federal funds by the state.
[ 1987 c 431 § 22.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.41 - Health Insurance Coverage Access Act. › 48.41.920 - Construction—Chapter applicable to state registered domestic partnerships—2009 c 521.

RCW 48.41.920
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 § 124.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.42 - Personal Coverage, General Authority. › 48.42.010 - Personal coverage, authority of commissioner—Definition.

RCW 48.42.010
Personal coverage, authority of commissioner—Definition.
(1) Notwithstanding any other provision of law, and except as provided in this chapter, any person or other entity which provides coverage in this state for life insurance, annuities, loss of time, medical, surgical, chiropractic, physical therapy, speech pathology, audiology, professional mental health, dental, hospital, or optometric expenses, whether the coverage is by direct payment, reimbursement, the providing of services, or otherwise, shall be subject to the authority of the state insurance commissioner, unless the person or other entity shows that while providing the services it is subject to the jurisdiction and regulation of another agency of this state, any subdivisions thereof, or the federal government.
(2) "Another agency of this state, any subdivision thereof, or the federal government" does not include the Washington health benefit exchange under chapter 43.71 RCW or P.L. 111-148 of 2010, as amended.
[ 2012 c 87 § 10; 1985 c 264 § 15; 1983 c 36 § 1.]
NOTES:
Spiritual care services—2012 c 87: See RCW 43.71.901.
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.42 - Personal Coverage, General Authority. › 48.42.020 - Showing regulation by other agency, how done—Definition.

RCW 48.42.020
Showing regulation by other agency, how done—Definition.
(1) A person or entity may show that it is subject to the jurisdiction and regulation of another agency of this state, any subdivision thereof, or the federal government, by providing to the insurance commissioner the appropriate certificate, license, or other document issued by the other governmental agency which permits or qualifies it to provide the coverage as defined in RCW 48.42.010.
(2) "Another agency of this state, any subdivision thereof, or the federal government" does not include the Washington health benefit exchange under chapter 43.71 RCW or P.L. 111-148 of 2010, as amended.
[ 2012 c 87 § 11; 1983 c 36 § 2.]
NOTES:
Spiritual care services—2012 c 87: See RCW 43.71.901.
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.42 - Personal Coverage, General Authority. › 48.42.030 - Examination by commissioner—When required, scope of.

RCW 48.42.030
Examination by commissioner—When required, scope of.
Any person or entity which is unable to show under RCW 48.42.020 that it is subject to the jurisdiction and regulation of another agency of this state, any subdivision thereof, or the federal government, shall submit to an examination by the insurance commissioner to determine the organization and solvency of the person or the entity, and to determine whether or not such person or entity complies with the applicable provisions of this title.
[ 1983 c 36 § 3.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.42 - Personal Coverage, General Authority. › 48.42.040 - Application of this title to otherwise unregulated entities.

RCW 48.42.040
Application of this title to otherwise unregulated entities.
Any person or entity unable to show that it is subject to the jurisdiction and regulation of another agency of this state, any subdivision thereof, or the federal government, shall be subject to all appropriate provisions of this title regarding the conduct of its business including, but not limited to, RCW 48.43.300 through 48.43.370.
[ 1998 c 241 § 16; 1983 c 36 § 4.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.42 - Personal Coverage, General Authority. › 48.42.050 - Notice to purchasers by uninsured production agency—Notice to production agency by administrator of coverage.

RCW 48.42.050
Notice to purchasers by uninsured production agency—Notice to production agency by administrator of coverage.
Any production agency or administrator which advertises, sells, transacts, or administers the coverage in this state described in RCW 48.42.010 and which is required to submit to an examination by the insurance commissioner under RCW 48.42.030, shall, if the coverage is not fully insured or otherwise fully covered by an admitted life or disability insurer or health care service contractor or health maintenance organization agreement, advise every purchaser, prospective purchaser, and covered person of the lack of insurance or other coverage.
Any administrator which advertises or administers the coverage in this state described in RCW 48.42.010 and which is subject to an examination by the insurance commissioner under RCW 48.42.030 shall advise any production agency of the elements of the coverage, including the amount of "stop-loss" insurance in effect.
[ 1983 c 36 § 5.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.42 - Personal Coverage, General Authority. › 48.42.090 - Prenatal testing—Limitation on changes to coverage.

RCW 48.42.090
Prenatal testing—Limitation on changes to coverage.
The carrier or provider of any group disability contract, health care services contract or health maintenance agreement shall not cancel, reduce, limit or otherwise alter or change the coverage provided solely on the basis of the result of any prenatal test.
[ 1988 c 276 § 9.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.42 - Personal Coverage, General Authority. › 48.42.100 - Women's health care services—Duties of health care carriers.

RCW 48.42.100
Women's health care services—Duties of health care carriers.
(1) For purposes of this section, health care carriers includes disability insurers regulated under chapter 48.20 or 48.21 RCW, health care services contractors regulated under chapter 48.44 RCW, health maintenance organizations regulated under chapter 48.46 RCW, plans operating under the health care authority under chapter 41.05 RCW, the state health insurance pool operating under chapter 48.41 RCW, and insuring entities regulated under chapter 48.43 RCW.
(2) For purposes of this section and consistent with their lawful scopes of practice, types of health care practitioners that provide women's health care services shall include, but need not be limited by a health care carrier to, the following: Any generally recognized medical specialty of practitioners licensed under chapter 18.57 or 18.71 RCW who provides women's health care services; practitioners licensed under chapter 18.71A RCW when providing women's health care services; midwives licensed under chapter 18.50 RCW; and advanced registered nurse practitioner specialists in women's health and midwifery under chapter 18.79 RCW.
(3) For purposes of this section, women's health care services shall include, but need not be limited by a health care carrier to, the following: Maternity care; reproductive health services; gynecological care; general examination; and preventive care as medically appropriate and medically appropriate follow-up visits for the services listed in this subsection.
(4) Health care carriers shall ensure that enrolled female patients have direct access to timely and appropriate covered women's health care services from the type of health care practitioner of their choice in accordance with subsection (5) of this section.
(5)(a) Health care carrier policies, plans, and programs written, amended, or renewed after July 23, 1995, shall provide women patients with direct access to the type of health care practitioner of their choice for appropriate covered women's health care services without the necessity of prior referral from another type of health care practitioner.
(b) Health care carriers may comply with this section by including all the types of health care practitioners listed in this section for women's health care services for women patients.
(c) Nothing in this section shall prevent health care carriers from restricting women patients to seeing only health care practitioners who have signed participating provider agreements with the health care carrier.
[ 2020 c 80 § 35; 2000 c 7 § 1; 1995 c 389 § 1.]
NOTES:
Effective date—2020 c 80 §§ 12-59: See note following RCW 7.68.030.
Intent—2020 c 80: See note following RCW 18.71A.010.
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.43 - Insurance Reform. › 48.43.001 - Intent.

RCW 48.43.001
Intent.
It is the intent of the legislature to ensure that all enrollees in managed care settings have access to adequate information regarding health care services covered by health carriers' health plans, and provided by health care providers and health care facilities. It is only through such disclosure that Washington state citizens can be fully informed as to the extent of health insurance coverage, availability of health care service options, and necessary treatment. With such information, citizens are able to make knowledgeable decisions regarding their health care.
[ 1996 c 312 § 1.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.43 - Insurance Reform. › 48.43.008 - Enrollment in employer-sponsored health plan—Person eligible for medical assistance.

RCW 48.43.008
Enrollment in employer-sponsored health plan—Person eligible for medical assistance.
When the health care authority determines that it is cost-effective to enroll a person eligible for medical assistance under chapter 74.09 RCW in an employer-sponsored health plan, a carrier shall permit the enrollment of the person in the health plan for which he or she is otherwise eligible without regard to any open enrollment period restrictions.
[ 2011 1st sp.s. c 15 § 77; 2007 c 259 § 24.]
NOTES:
Effective date—Findings—Intent—Report—Agency transfer—References to head of health care authority—Draft legislation—2011 1st sp.s. c 15: See notes following RCW 74.09.010.
Subheadings not law—2007 c 259: See note following RCW 7.70.060.
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.43 - Insurance Reform. › 48.43.009 - Health care sharing ministries.

RCW 48.43.009
Health care sharing ministries.
Health care sharing ministries are not health carriers as defined in RCW 48.43.005 or insurers as defined in RCW 48.01.050. For purposes of this section, "health care sharing ministry" has the same meaning as in 26 U.S.C. Sec. 5000A.
[ 2011 c 314 § 18.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.43 - Insurance Reform. › 48.43.012 - Health plans—Preexisting conditions—Rules.

RCW 48.43.012
Health plans—Preexisting conditions—Rules.
(1) No carrier may reject an individual for an individual or group health benefit plan based upon preexisting conditions of the individual.
(2) No carrier may deny, exclude, or otherwise limit coverage for an individual's preexisting health conditions including, but not limited to, preexisting condition exclusions or waiting periods.
(3) No carrier may avoid the requirements of this section through the creation of a new rate classification or the modification of an existing rate classification. A new or changed rate classification will be deemed an attempt to avoid the provisions of this section if the new or changed classification would substantially discourage applications for coverage from individuals who are higher than average health risks. These provisions apply only to individuals who are Washington residents.
(4) Unless preempted by federal law, the commissioner shall adopt any rules necessary to implement this section, consistent with federal rules and guidance in effect on January 1, 2017, implementing the patient protection and affordable care act.
[ 2019 c 33 § 2; 2011 c 315 § 3; 2001 c 196 § 6; 2000 c 79 § 19.]
NOTES:
Effective date—2019 c 33: See note following RCW 48.43.005.
Intent—2011 c 315: See note following RCW 48.43.005.
Effective date—2001 c 196: See note following RCW 48.20.025.
Effective date—Severability—2000 c 79: See notes following RCW 48.04.010.
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.43 - Insurance Reform. › 48.43.01211 - Health plans—Eligibility—Health status-related factors—Rules.

RCW 48.43.01211
Health plans—Eligibility—Health status-related factors—Rules.
(1) A health carrier or health plan may not establish rules for eligibility, including continued eligibility, of any individual to enroll under the terms of the plan or coverage based on any of the following health status-related factors in relation to the individual or a dependent of the individual:
(a) Health status;
(b) Medical condition, including both physical and mental illnesses;
(c) Claims experience;
(d) Receipt of health care;
(e) Medical history;
(f) Genetic information;
(g) Evidence of insurability, including conditions arising out of acts of domestic violence;
(h) Disability; or
(i) Any other health status-related factor determined appropriate by the commissioner.
(2) Unless preempted by federal law, the commissioner shall adopt any rules necessary to implement this section, consistent with federal rules and guidance in effect on January 1, 2017, implementing the patient protection and affordable care act.
[ 2019 c 33 § 3.]
NOTES:
Effective date—2019 c 33: See note following RCW 48.43.005.
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.43 - Insurance Reform. › 48.43.0122 - Individual health benefit plans—Open enrollment and special enrollment periods—Rules—Enforcement.

RCW 48.43.0122
Individual health benefit plans—Open enrollment and special enrollment periods—Rules—Enforcement.
(1) The commissioner shall adopt rules establishing and implementing requirements for the open enrollment periods and special enrollment periods that carriers must follow for individual health benefit plans.
(2) The commissioner shall monitor the sale of individual health benefit plans and if a carrier refuses to sell guaranteed issue policies to persons in compliance with rules adopted by the commissioner pursuant to subsection (1) of this section, the commissioner may levy fines or suspend or revoke a certificate of authority as provided in chapter 48.05 RCW.
[ 2019 c 33 § 11; 2011 c 315 § 4.]
NOTES:
Effective date—2019 c 33: See note following RCW 48.43.005.
Intent—2011 c 315: See note following RCW 48.43.005.
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.43 - Insurance Reform. › 48.43.0123 - Health plans—Rescission of coverage—Rules.

RCW 48.43.0123
Health plans—Rescission of coverage—Rules.
(1) A health plan or health carrier offering group or individual coverage may not rescind such coverage with respect to an enrollee once the enrollee is covered under the plan or coverage involved, except that this section does not apply to a covered person who has performed an act or practice that constitutes fraud or makes an intentional misrepresentation of material fact as prohibited by the terms of the plan or coverage. The plan or coverage may not be canceled except as permitted under RCW 48.43.035 or 48.43.038.
(2) The commissioner shall adopt any rules necessary to implement this section, consistent with federal rules and guidance in effect on January 1, 2017, implementing the patient protection and affordable care act.
[ 2019 c 33 § 8.]
NOTES:
Effective date—2019 c 33: See note following RCW 48.43.005.
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.43 - Insurance Reform. › 48.43.0124 - Health plans—Cost sharing for essential health benefits—Rules.

RCW 48.43.0124
Health plans—Cost sharing for essential health benefits—Rules.
(1) For plan years beginning in 2020, the cost sharing incurred under a health plan for the essential health benefits may not exceed the following amounts:
(a) For self-only coverage:
(i) The amount required under federal law for the calendar year; or
(ii) If there are no cost-sharing requirements under federal law, eight thousand two hundred dollars increased by the premium adjustment percentage for the calendar year.
(b) For coverage other than self-only coverage:
(i) The amount required under federal law for the calendar year; or
(ii) If there are no cost-sharing requirements under federal law, sixteen thousand four hundred dollars increased by the premium adjustment percentage for the calendar year.
(2) Regardless of whether an enrollee is covered by a self-only plan or a plan that is other than self-only, the enrollee's cost sharing for the essential health benefits may not exceed the self-only annual limitation on cost sharing.
(3) For purposes of this section, "the premium adjustment percentage for the calendar year" means the percentage, if any, by which the average per capita premium for health insurance in Washington for the preceding year, as estimated by the commissioner no later than April 1st of such preceding year, exceeds such average per capita premium for 2020 as determined by the commissioner.
(4) Unless preempted by federal law, the commissioner shall adopt any rules necessary to implement this section, consistent with federal rules and guidance in effect on January 1, 2017, implementing the patient protection and affordable care act.
[ 2019 c 33 § 10.]
NOTES:
Effective date—2019 c 33: See note following RCW 48.43.005.
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.43 - Insurance Reform. › 48.43.0125 - Essential health benefits—Annual or lifetime dollar limits.

RCW 48.43.0125
Essential health benefits—Annual or lifetime dollar limits.
A health carrier may not impose annual or lifetime dollar limits on an essential health benefit, other than those permitted as reference-based limitations under rules adopted by the commissioner.
[ 2019 c 33 § 12.]
NOTES:
Effective date—2019 c 33: See note following RCW 48.43.005.
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.43 - Insurance Reform. › 48.43.0127 - Group health plans—Waiting period—Rules.

RCW 48.43.0127
Group health plans—Waiting period—Rules.
(1) A group health plan and a health carrier offering group health coverage may not apply any waiting period that exceeds ninety days.
(2) Unless preempted by federal law, the commissioner shall adopt any rules necessary to implement this section, consistent with federal rules and guidance in effect on January 1, 2017, implementing the patient protection and affordable care act.
[ 2019 c 33 § 14.]
NOTES:
Effective date—2019 c 33: See note following RCW 48.43.005.
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.43 - Insurance Reform. › 48.43.021 - Personally identifiable health information—Restrictions on release.

RCW 48.43.021
Personally identifiable health information—Restrictions on release.
Except as otherwise required by statute or rule, a carrier and the Washington state health insurance pool, and persons acting at the direction of or on behalf of a carrier or the pool, who are in receipt of an enrollee's or applicant's personally identifiable health information included in the standard health questionnaire shall not disclose the identifiable health information unless such disclosure is explicitly authorized in writing by the person who is the subject of the information.
[ 2000 c 79 § 22.]
NOTES:
Effective date—Severability—2000 c 79: See notes following RCW 48.04.010.
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.43 - Insurance Reform. › 48.43.022 - Enrollee identification card—Social security number restriction.

RCW 48.43.022
Enrollee identification card—Social security number restriction.
After December 31, 2005, a health carrier that issues a card identifying a person as an enrollee, and requires the person to present the card to providers for purposes of claims processing, may not display on the card an identification number that includes more than a four-digit portion of the person's complete social security number.
[ 2004 c 115 § 1.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.43 - Insurance Reform. › 48.43.023 - Pharmacy identification cards—Rules.

RCW 48.43.023
Pharmacy identification cards—Rules.
(1) A health carrier that provides coverage for prescription drugs provided on an outpatient basis and issues a card or other technology for claims processing, or an administrator of a health benefit plan including, but not limited to, third-party administrators for self-insured plans, pharmacy benefits managers, and state administered plans, shall issue to its enrollees a pharmacy identification card or other technology containing all information required for proper prescription drug claims adjudication.
(2) Upon renewal of the health benefit plan, information on the pharmacy identification card or other technology shall be made current by the health carrier or other entity that issues the card.
(3) Nothing in this section shall be construed to require any health carrier or administrator of a health benefit plan to issue a pharmacy identification card or other technology separate from another identification card issued to an enrollee under the health benefit plan if the identification card contains all of the information required under subsection (1) of this section.
(4) This section applies to health benefit plans that are delivered, issued for delivery, or renewed on or after July 1, 2003. For the purposes of this section, renewal of a health benefit policy, contract, or plan occurs on each anniversary of the date on which coverage was first effective on the person or persons covered by the health benefit plan.
(5) The insurance commissioner may adopt rules to implement chapter 106, Laws of 2001, taking into consideration any relevant standards developed by the national council for prescription drug programs and the requirements of the federal health insurance portability and accountability act of 1996.
[ 2001 c 106 § 2.]
NOTES:
Intent—2001 c 106: "It is the intent of the legislature to improve care to patients by minimizing confusion, eliminating unnecessary paperwork, decreasing administrative burdens, and streamlining dispensing of prescription products paid for by third-party payors." [ 2001 c 106 § 1.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.43 - Insurance Reform. › 48.43.028 - Eligibility to purchase certain health benefit plans—Small employers and small groups.

RCW 48.43.028
Eligibility to purchase certain health benefit plans—Small employers and small groups.
To the extent required of the federal health insurance portability and accountability act of 1996, the eligibility of an employer or group to purchase a health benefit plan set forth in RCW 48.21.045(1)(b), 48.44.023(1)(b), and 48.46.066(1)(b) must be extended to all small employers and small groups as defined in RCW 48.43.005.
[ 2001 c 196 § 10.]
NOTES:
Effective date—2001 c 196: See note following RCW 48.20.025.
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.43 - Insurance Reform. › 48.43.041 - Individual health benefit plans—Mandatory benefits.

RCW 48.43.041
Individual health benefit plans—Mandatory benefits.
(1) All individual health benefit plans, other than catastrophic health plans, offered or renewed on or after October 1, 2000, shall include benefits described in this section. Nothing in this section shall be construed to require a carrier to offer an individual health benefit plan.
(a) Maternity services that include, with no enrollee cost-sharing requirements beyond those generally applicable cost-sharing requirements: Diagnosis of pregnancy; prenatal care; delivery; care for complications of pregnancy; physician services; hospital services; operating or other special procedure rooms; radiology and laboratory services; appropriate medications; anesthesia; and services required under RCW 48.43.115; and
(b) Prescription drug benefits with at least a two thousand dollar benefit payable by the carrier annually.
(2) If a carrier offers a health benefit plan that is not a catastrophic health plan to groups, and it chooses to offer a health benefit plan to individuals, it must offer at least one health benefit plan to individuals that is not a catastrophic health plan.
[ 2000 c 79 § 26.]
NOTES:
Effective dates—2000 c 79 §§ 26, 38, and 39: "(1) Section 38 of this act takes effect July 1, 2000.
(2) Section 39 of this act takes effect September 1, 2000.
(3) *Section 26 of this act takes effect on the first day of the month following the expiration of a one hundred eighty-day period beginning on the effective date of section 25 of this act." [ 2000 c 79 § 50.]
*Reviser's note: Section 26 of this act takes effect October 1, 2000.
Severability—2000 c 79: See note following RCW 48.04.010.