reglab/statecodes huggingface dataset:
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.44 - Health Care Services. › 48.44.325 - Mammograms—Insurance coverage.

RCW 48.44.325
Mammograms—Insurance coverage.
Each health care service contract issued or renewed after January 1, 1990, that provides benefits for hospital or medical care shall provide benefits for screening or diagnostic mammography services, provided that such services are delivered upon the recommendation of the patient's physician or advanced registered nurse practitioner as authorized by the *nursing care quality assurance commission pursuant to chapter 18.79 RCW or physician assistant pursuant to chapter 18.71A RCW.
This section shall not be construed to prevent the application of standard contract 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 a contractor 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 § 5; 1994 sp.s. c 9 § 734; 1989 c 338 § 3.]
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 48.44 - Health Care Services. › 48.44.327 - Prostate cancer screening.

RCW 48.44.327
Prostate cancer screening.
(1) Each health care service contract 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 a contractor 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 § 4.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.44 - Health Care Services. › 48.44.330 - Reconstructive breast surgery.

RCW 48.44.330
Reconstructive breast surgery.
(1) Each contract for health care entered into or renewed after July 24, 1983, between a health care services contractor and the person or persons to receive the care shall provide coverage for reconstructive breast surgery resulting from a mastectomy which resulted from disease, illness, or injury.
(2) Each contract for health care entered into or renewed after January 1, 1986, between a health care services contractor and the person or persons to receive the care 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 § 7; 1983 c 113 § 3.]
NOTES:
Effective date—1985 c 54: See note following RCW 48.20.397.
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.44 - Health Care Services. › 48.44.335 - Mastectomy, lumpectomy.

RCW 48.44.335
Mastectomy, lumpectomy.
No health care service contractor under this chapter may refuse to issue any contract 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 § 3.]
NOTES:
Effective date—1985 c 54: See note following RCW 48.20.397.
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.44 - Health Care Services. › 48.44.342 - Mental health treatment—Waiver of preauthorization for persons involuntarily committed.

RCW 48.44.342
Mental health treatment—Waiver of preauthorization for persons involuntarily committed.
A health care service contractor providing hospital or medical services or benefits in this state shall waive a preauthorization from the contractor before an insured or an insured's covered dependents receive mental health treatment rendered by a state hospital as defined in RCW 72.23.010 if the insured or the insured's covered dependents are involuntarily committed to a state hospital as defined in RCW 72.23.010.
[ 1993 c 272 § 4.]
NOTES:
Savings—Severability—1993 c 272: See notes following RCW 43.20B.347.
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.44 - Health Care Services. › 48.44.344 - Benefits for prenatal diagnosis of congenital disorders—Contracts entered into or renewed on or after January 1, 1990.

RCW 48.44.344
Benefits for prenatal diagnosis of congenital disorders—Contracts entered into or renewed on or after January 1, 1990.
On or after January 1, 1990, every group health care services contract entered into or renewed that covers hospital, medical, or surgical expenses on a group basis, and which provides benefits for pregnancy, childbirth, or related medical conditions to enrollees of such groups, shall offer benefits for prenatal diagnosis of congenital disorders of the fetus by means of screening and diagnostic procedures during pregnancy to such enrollees when those services are determined to be medically necessary by the health care service contractor in accord with standards set in rule by the board of health. Every group health care services contractor shall communicate the availability of such coverage to all group health care service contract holders and to all groups with whom they are negotiating.
[ 1988 c 276 § 7.]
NOTES:
Prenatal testing—Limitation on changes to coverage: RCW 48.42.090.
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.44 - Health Care Services. › 48.44.350 - Financial interests of health care service contractors, restricted—Exceptions, regulations.

RCW 48.44.350
Financial interests of health care service contractors, restricted—Exceptions, regulations.
(1) No person having any authority in the investment or disposition of the funds of a health care service contractor and no officer or director of a health care service contractor shall accept, except for the health care service contractor, or be the beneficiary of any fee, brokerage, gift, commission, or other emolument because of any sale of health care service agreements or any investment, loan, deposit, purchase, sale, payment, or exchange made by or for the health care service contractor, or be pecuniarily interested therein in any capacity; except, that such a person may procure a loan from the health care service contractor directly upon approval by two-thirds of its directors and upon the pledge of securities eligible for the investment of the health care service contractor's funds under this title.
(2) The commissioner may, by regulations, from time to time, define and permit additional exceptions to the prohibition contained in subsection (1) of this section solely to enable payment of reasonable compensation to a director who is not otherwise an officer or employee of the health care service contractor, or to a corporation or firm in which the director is interested, for necessary services performed or sales or purchases made to or for the health care service contractor in the ordinary course of the health care service contractor's business and in the usual private professional or business capacity of the director or the corporation or firm.
[ 1986 c 223 § 9; 1983 c 202 § 6.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.44 - Health Care Services. › 48.44.360 - Continuation option to be offered.

RCW 48.44.360
Continuation option to be offered.
Every health care service contractor that issues group contracts providing group coverage for hospital or medical expense shall offer the contract holder an option to include a contract provision granting a person who becomes ineligible for coverage under the group contract, the right to continue the group benefits for a period of time and at a rate agreed upon. The contract provision shall provide that when such coverage terminates, the covered person may convert to a contract as provided in RCW 48.44.370.
[ 1984 c 190 § 5.]
NOTES:
Legislative intent—Severability—1984 c 190: See notes following RCW 48.21.250.
Application—1984 c 190 §§ 2, 5, and 8: See note following RCW 48.21.250.
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.44 - Health Care Services. › 48.44.370 - Conversion contract to be offered—Exceptions, conditions.

RCW 48.44.370
Conversion contract to be offered—Exceptions, conditions.
(1) Except as otherwise provided by this section, any group health care service contract that provides benefits for hospital or medical expenses must contain a provision granting a person covered by the group contract the right to obtain a conversion contract from the contractor upon termination of the person's eligibility for coverage under the group contract.
(2) A contractor need not offer a conversion contract to:
(a) A person whose coverage under the group contract ended when the person's employment or membership was terminated for misconduct: PROVIDED, That when a person's employment or membership is terminated for misconduct, a conversion policy shall be offered to the spouse and/or dependents of the terminated employee or member. The policy shall include in the conversion provisions the same conversion rights and conditions which are available to employees or members and their spouses and/or dependents who are terminated for reasons other than misconduct;
(b) A person who is eligible for federal medicare coverage; or
(c) A person who is covered under another group plan, policy, contract, or agreement providing benefits for hospital or medical care.
(3) To obtain the conversion contract, a person must submit a written application and the first premium payment for the conversion contract not later than thirty-one days after the date the person's eligibility for group coverage terminates or thirty-one days after the date the person received notice of termination of coverage, whichever is later. The conversion contract shall become effective, without lapse of coverage, immediately following termination of coverage under the group contract.
(4) If a health care service contractor or group contract holder does not renew, cancels, or otherwise terminates the group contract, the health care service contractor must offer a conversion contract to any person who was covered under the terminated contract unless the person is eligible to obtain group hospital or medical expense coverage within thirty-one days after such nonrenewal, cancellation, or termination of the group contract or thirty-one days after the date the person received notice of termination of coverage, whichever is later.
(5) The health care service contractor shall determine the premium for the conversion contract in accordance with the contractor's table of premium rates applicable to the age and class of risk of each person to be covered under the contract and the type and amount of benefits provided.
[ 2010 c 110 § 2; 1984 c 190 § 6.]
NOTES:
Application—2010 c 110: See note following RCW 48.21.260.
Legislative intent—Severability—1984 c 190: See notes following RCW 48.21.250.
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.44 - Health Care Services. › 48.44.380 - Conversion contract—Restrictions and requirements—Rules.

RCW 48.44.380
Conversion contract—Restrictions and requirements—Rules.
(1) A health care service contractor shall not require proof of insurability as a condition for issuance of the conversion contract.
(2) A conversion contract may not contain an exclusion for preexisting conditions for any applicant.
(3) A health care service contractor must offer at least three contract benefit plans that comply with the following:
(a) A major medical plan with a five thousand dollar deductible per person;
(b) A comprehensive medical plan with a five hundred dollar deductible per person; and
(c) A basic medical plan with a one thousand dollar deductible per person.
(4) The insurance commissioner may revise the deductible amounts in subsection (3) of this section from time to time to reflect changing health care costs.
(5) The insurance commissioner shall adopt rules to establish minimum benefit standards for conversion contracts.
(6) The commissioner shall adopt rules to establish specific standards for conversion contract provisions. These rules may include but are not limited to:
(a) Terms of renewability;
(b) Nonduplication of coverage;
(c) Benefit limitations, exceptions, and reductions; and
(d) Definitions of terms.
[ 2019 c 33 § 5; 2011 c 314 § 7; 1984 c 190 § 7.]
NOTES:
Effective date—2019 c 33: See note following RCW 48.43.005.
Legislative intent—Severability—1984 c 190: See notes following RCW 48.21.250.
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.44 - Health Care Services. › 48.44.390 - Modification of basis of agreement, endorsement required.

RCW 48.44.390
Modification of basis of agreement, endorsement required.
If an individual health care service agreement is issued on any basis other than as applied for, an endorsement setting forth such modification must accompany and be attached to the agreement. No agreement shall be effective unless the endorsement is signed by the applicant, and a signed copy thereof returned to the health care service contractor.
[ 1986 c 223 § 10.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.44 - Health Care Services. › 48.44.400 - Continuance provisions for former family members.

RCW 48.44.400
Continuance provisions for former family members.
After July 1, 1986, or on the next renewal date of the agreement, whichever is later, every health care service agreement issued, amended, or renewed for an individual and his or 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 enrollee, shall have the right to continue the health care service agreement without a physical examination, statement of health, or other proof of insurability.
[ 1986 c 223 § 11.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.44 - Health Care Services. › 48.44.420 - Coverage for adopted children.

RCW 48.44.420
Coverage for adopted children.
(1) Any health care service contract under this chapter delivered or issued for delivery in this state, which provides coverage for dependent children, as defined in the contract of the subscriber, shall cover adoptive children placed with the subscriber 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 health care services contractor. The notification period shall be no less than sixty days from the date of placement.
[ 1986 c 140 § 4.]
NOTES:
Effective date, application—Severability—1986 c 140: See notes following RCW 48.01.180.
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.44 - Health Care Services. › 48.44.430 - Cancellation of rider.

RCW 48.44.430
Cancellation of rider.
Upon application by a subscriber, a rider shall be canceled if at least five years after its issuance, no health care services have been received by the subscriber 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 subscriber from that condition, such agreement not to be unreasonably withheld. The option of the subscriber 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 § 3.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.44 - Health Care Services. › 48.44.440 - Phenylketonuria.

RCW 48.44.440
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 contract for health care services delivered or issued for delivery or renewed in this state on or after September 1, 1988, shall provide coverage for the formulas necessary for the treatment of phenylketonuria.
[ 1988 c 173 § 3.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.44 - Health Care Services. › 48.44.450 - Neurodevelopmental therapies—Employer-sponsored group contracts.

RCW 48.44.450
Neurodevelopmental therapies—Employer-sponsored group contracts.
(1) Each employer-sponsored group contract for comprehensive health care service which is entered into, or renewed, on or after twelve months after July 23, 1989, shall include coverage for neurodevelopmental therapies for covered individuals age six and under.
(2) Benefits provided under this section shall cover the services of those authorized to deliver occupational therapy, speech therapy, and physical therapy. Benefits shall be payable only where the services have been delivered pursuant to the referral and periodic review of a holder of a license issued pursuant to chapter 18.71 or 18.57 RCW or where covered services have been rendered by such licensee. Nothing in this section shall prohibit a health care service contractor from requiring that covered services be delivered by a provider who participates by contract with the health care service contractor unless no participating provider is available to deliver covered services. Nothing in this section shall prohibit a health care service contractor from negotiating rates with qualified providers.
(3) Benefits provided under this section shall be for medically necessary services as determined by the health care service contractor. Benefits shall be payable for services for the maintenance of a covered individual in cases where significant deterioration in the patient's condition would result without the service. Benefits shall be payable to restore and improve function.
(4) It is the intent of this section that employers purchasing comprehensive group coverage including the benefits required by this section, together with the health care service contractor, retain authority to design and employ utilization and cost controls. Therefore, benefits delivered under this section may be subject to contractual provisions regarding deductible amounts and/or copayments established by the employer purchasing coverage and the health care service contractor. Benefits provided under this section may be subject to standard waiting periods for preexisting conditions, and may be subject to the submission of written treatment plans.
(5) In recognition of the intent expressed in subsection (4) of this section, benefits provided under this section may be subject to contractual provisions establishing annual and/or lifetime benefit limits. Such limits may define the total dollar benefits available or may limit the number of services delivered as agreed by the employer purchasing coverage and the health care service contractor.
[ 1989 c 345 § 1.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.44 - Health Care Services. › 48.44.460 - Temporomandibular joint disorders—Insurance coverage.

RCW 48.44.460
Temporomandibular joint disorders—Insurance coverage.
(1) Except as provided in this section, a group health care service contract entered into or renewed after December 31, 1989, shall offer optional coverage for the treatment of temporomandibular joint disorders.
(a) Health care service contractors offering medical coverage only may limit benefits in such coverages to medical services related to treatment of temporomandibular joint disorders. Health care service contractors offering dental coverage only may limit benefits in such coverage to dental services related to treatment of temporomandibular joint disorders. No health care service contractor offering medical coverage only may define all temporomandibular joint disorders as purely dental in nature, and no health care service contractor offering dental coverage only may define all temporomandibular joint disorders as purely medical in nature.
(b) Health care contractors offering optional temporomandibular joint disorder coverage as provided in this section may, but are not required to, offer lesser or no temporomandibular joint disorder coverage as part of their basic group disability contract.
(c) Benefits and coverage offered under this section may be subject to negotiation to promote broad flexibility in potential benefit coverage. This flexibility shall apply to services to be reimbursed, determination of treatments to be considered medically necessary, systems through which services are to be provided, including referral systems and use of other providers, and related issues.
(2) Unless otherwise directed by law, the insurance commissioner shall adopt rules, to be implemented on January 1, 1993, establishing minimum benefits, terms, definitions, conditions, limitations, and provisions for the use of reasonable deductibles and copayments.
(3) A contractor need not make the offer of coverage required by this section to an employer or other group that offers to its eligible enrollees a self-insured health plan not subject to mandated benefit statutes under Title 48 RCW that does not provide coverage for temporomandibular joint disorders.
[ 1989 c 331 § 3.]
NOTES:
Legislative finding—Effective date—1989 c 331: See notes following RCW 48.21.320.
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.44 - Health Care Services. › 48.44.465 - Prescriptions—Preapproval of individual claims—Subsequent rejection prohibited—Written record required.

RCW 48.44.465
Prescriptions—Preapproval of individual claims—Subsequent rejection prohibited—Written record required.
Health care service contractors 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 § 4.]
NOTES:
Findings—Effective date—1993 c 253: See notes following RCW 48.20.525.
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.44 - Health Care Services. › 48.44.470 - Nonresident pharmacies.

RCW 48.44.470
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, a health care service contractor providing coverage of prescription drugs from nonresident pharmacies may only provide coverage from licensed nonresident pharmacies. The health care service contractors 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 may request from the health care service contractor the proof of current licensure for all nonresident pharmacies through which the insurer is providing coverage for prescription drugs for 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 § 314; 1991 c 87 § 9.]
NOTES:
Effective date—1991 c 87: See note following RCW 18.64.350.
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.44 - Health Care Services. › 48.44.495 - Dental services that are not subject to contract or provider agreement.

RCW 48.44.495
Dental services that are not subject to contract or provider agreement.
(1) Notwithstanding any other provisions of law, no contract of any health care service contractor 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 an enrolled participant at a fee set by, or at a fee subject to the approval of, the health care service contractor 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 group contract or individual contract; nor
(b) Prohibit, directly or indirectly, a dentist who is a participating provider from offering or providing to an enrolled participant dental services that are not covered services on any terms or conditions acceptable to the dentist and the enrolled participant.
(2) For the purposes of this section, "covered services" means dental services that are reimbursable under the applicable 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 § 3.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.44 - Health Care Services. › 48.44.500 - Denturist services.

RCW 48.44.500
Denturist services.
Notwithstanding any provision of any health care service 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 § 24 (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 48.44 - Health Care Services. › 48.44.530 - Disclosure of certain material transactions—Report—Information is confidential.

RCW 48.44.530
Disclosure of certain material transactions—Report—Information is confidential.
(1) Every health care service contractor domiciled in this state shall file a report with the commissioner disclosing material acquisitions and dispositions of assets or material nonrenewals, cancellations, or revisions of ceded reinsurance agreements unless these acquisitions and dispositions of assets or material nonrenewals, cancellations, or revisions of ceded reinsurance agreements have been submitted to the commissioner for review, approval, or information purposes under other provisions of this title or other requirements.
(2) The report required in subsection (1) of this section is due within fifteen days after the end of the calendar month in which any of the transactions occur.
(3) One complete copy of the report, including any exhibits or other attachments filed as part of the report, shall be filed with the:
(a) Commissioner; and
(b) National association of insurance commissioners.
(4) All reports obtained by or disclosed to the commissioner under this section and RCW 48.44.535 through 48.44.555 are exempt from public inspection and copying and shall not be subject to subpoena. These reports shall not be made public by the commissioner, the national association of insurance commissioners, or any other person, except to insurance departments of other states, without the prior written consent of the health care service contractor to which it pertains unless the commissioner, after giving the health care service contractor that would be affected by disclosure notice and a hearing under chapter 48.04 RCW, determines that the interest of policyholders, subscribers, shareholders, or the public will be served by the publication, in which event the commissioner may publish all or any part of the report in the manner he or she deems appropriate.
[ 1995 c 86 § 13.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.44 - Health Care Services. › 48.44.535 - Material acquisitions or dispositions.

RCW 48.44.535
Material acquisitions or dispositions.
No acquisitions or dispositions of assets need be reported pursuant to RCW 48.44.530 if the acquisitions or dispositions are not material. For purposes of RCW 48.44.530 through 48.44.555, a material acquisition, or the aggregate of any series of related acquisitions during any thirty-day period; or disposition, or the aggregate of any series of related dispositions during any thirty-day period is an acquisition or disposition that is nonrecurring and not in the ordinary course of business and involves more than five percent of the reporting health care service contractor's total assets as reported in its most recent statutory statement filed with the commissioner.
[ 1995 c 86 § 14.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.44 - Health Care Services. › 48.44.540 - Asset acquisitions—Asset dispositions.

RCW 48.44.540
Asset acquisitions—Asset dispositions.
(1) Asset acquisitions subject to RCW 48.44.530 through 48.44.555 include every purchase, lease, exchange, merger, consolidation, succession, or other acquisition other than the construction or development of real property by or for the reporting health care service contractor or the acquisition of materials for such purpose.
(2) Asset dispositions subject to RCW 48.44.530 through 48.44.555 include every sale, lease, exchange, merger, consolidation, mortgage, hypothecation, abandonment, destruction, other disposition, or assignment, whether for the benefit of creditors or otherwise.
[ 1995 c 86 § 15.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.44 - Health Care Services. › 48.44.545 - Report of a material acquisition or disposition of assets—Information required.

RCW 48.44.545
Report of a material acquisition or disposition of assets—Information required.
The following information is required to be disclosed in any report of a material acquisition or disposition of assets:
(1) Date of the transaction;
(2) Manner of acquisition or disposition;
(3) Description of the assets involved;
(4) Nature and amount of the consideration given or received;
(5) Purpose of or reason for the transaction;
(6) Manner by which the amount of consideration was determined;
(7) Gain or loss recognized or realized as a result of the transaction; and
(8) Names of the persons from whom the assets were acquired or to whom they were disposed.
[ 1995 c 86 § 16.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.44 - Health Care Services. › 48.44.550 - Material nonrenewals, cancellations, or revisions of ceded reinsurance agreements.

RCW 48.44.550
Material nonrenewals, cancellations, or revisions of ceded reinsurance agreements.
(1) No nonrenewals, cancellations, or revisions of ceded reinsurance agreements need be reported under RCW 48.44.530 if the nonrenewals, cancellations, or revisions are not material. For purposes of RCW 48.44.530 through 48.44.555, a material nonrenewal, cancellation, or revision is one that affects:
(a) More than fifty percent of a health care service contractor's total reserve credit taken for business ceded, on an annualized basis, as indicated in the health care service contractor's most recent annual statement;
(b) More than ten percent of a health care service contractor's total cession when it is replaced by one or more unauthorized reinsurers; or
(c) Previously established collateral requirements, when they have been reduced or waived as respects one or more unauthorized reinsurers representing collectively more than ten percent of a total cession.
(2) However, a filing is not required if a health care service contractor's total reserve credit taken for business ceded represents, on an annualized basis, less than ten percent of the statutory reserve requirement prior to any cession.
[ 1995 c 86 § 17.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.44 - Health Care Services. › 48.44.555 - Report of a material nonrenewal, cancellation, or revision of ceded reinsurance agreements—Information required.

RCW 48.44.555
Report of a material nonrenewal, cancellation, or revision of ceded reinsurance agreements—Information required.
The following is required to be disclosed in any report of a material nonrenewal, cancellation, or revision of ceded reinsurance agreements:
(1) The effective date of the nonrenewal, cancellation, or revision;
(2) The description of the transaction with an identification of the initiator;
(3) The purpose of or reason for the transaction; and
(4) If applicable, the identity of the replacement reinsurers.
[ 1995 c 86 § 18.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.44 - Health Care Services. › 48.44.900 - Construction—Chapter applicable to state registered domestic partnerships—2009 c 521.

RCW 48.44.900
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 § 126.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.45 - Rural Health Care. › 48.45.005 - Findings.

RCW 48.45.005
Findings.
The legislature finds that the residents of rural communities are having difficulties in locating and purchasing affordable health insurance. The legislature further finds that many rural communities have sufficient funds to pay for needed services, but those funds are being expended elsewhere causing insufficient funding of local health services. As part of the solution to this problem, rural communities need to be able to structure the financing of local health services to better serve local residents. The legislature further finds that as rural communities need well financed and organized health care, it is in the interest of residents of rural communities that existing unauthorized entities comply with appropriate fiscal solvency standards and consumer safeguards, and that those entities be given an opportunity to come into compliance with existing state laws.
[ 1990 c 271 § 20.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.45 - Rural Health Care. › 48.45.010 - Definitions.

RCW 48.45.010
Definitions.
Unless the context clearly requires otherwise, the definitions in this section apply throughout this chapter.
(1) "Rural community" means any grouping of consumers, seventy-five percent of whom reside in areas outside of a standard metropolitan statistical area as defined by the United States bureau of census.
(2) "Consumer" means any person enrolled and eligible to receive benefits in the rural health care arrangement.
(3) "Rural health care service arrangement" or "arrangement" means any arrangement which is established or maintained for the purpose of offering or providing through the purchase of insurance or otherwise, medical, surgical, or hospital care or benefits in the event of sickness, accident, or disability in a rural community, as defined in this section, that is subject to the jurisdiction of the insurance commissioner but is not now a currently authorized carrier.
[ 1990 c 271 § 22.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.45 - Rural Health Care. › 48.45.020 - Rural health care service arrangements.

RCW 48.45.020
Rural health care service arrangements.
Rural health care service arrangements existing on March 29, 1990, may continue in full operation only so long as they comply with all of the following:
(1) Within ten days following March 29, 1990, all rural health care service arrangements shall inform the insurance commissioner of their intent to apply for approval to operate as an entity authorized under chapter 48.44 RCW or intend to merge with an entity authorized under Title 48 RCW or merge with an entity defined in this section;
(2) The arrangement submits an application for approval as an entity authorized under chapter 48.44 RCW by May 1, 1990;
(3) The arrangement has one hundred thousand dollars on deposit with the insurance commissioner by July 1, 1990;
(4) The arrangement has one hundred fifty thousand dollars on deposit with the insurance commissioner by September 1, 1990; and
(5) The arrangement complies with all reasonable requirements of the insurance commissioner excluding the deposit requirement, except as outlined in this section.
If such rural health care service arrangements fail to comply with any of the above requirements, or if during the application process an entity engages in any activities which the insurance commissioner reasonably determines may cause imminent harm to consumers, the entity may be subject to appropriate legal action by the insurance commissioner pursuant to the authority provided in Title 48 RCW.
A rural health care service arrangement which comes into compliance with Title 48 RCW through the method outlined in this chapter shall be subject to all applicable requirements of Title 48 RCW except that the deposit requirements shall not be increased until May 1, 1991.
[ 1990 c 271 § 23.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.45 - Rural Health Care. › 48.45.030 - Rule making.

RCW 48.45.030
Rule making.
The insurance commissioner, pursuant to chapter 34.05 RCW, may promulgate rules to implement RCW 48.45.010 and 48.45.020.
[ 1990 c 271 § 24.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.46 - Health Maintenance Organizations. › 48.46.010 - Legislative declaration—Purpose.

RCW 48.46.010
Legislative declaration—Purpose.
In affirmation of the declared principle that health care is a right of every citizen of the state, the legislature expresses its concern that the present high costs of health care in Washington may be preventing or inhibiting a large segment of the people from obtaining access to quality health care services.
The legislature declares that the establishment of qualified prepaid group and individual practice health care delivery systems should be encouraged in order to provide all citizens of the state with the freedom of choice between competitive, alternative health care delivery systems necessary to realize their right to health. It is the purpose and policy of this chapter to provide for the development and registration of prepaid group and individual practice health care plans as health maintenance organizations, which the legislature declares to be in the interest of the health, safety and welfare of the people.
[ 1975 1st ex.s. c 290 § 2.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.46 - Health Maintenance Organizations. › 48.46.012 - Filings with secretary of state—Copy for commissioner.

RCW 48.46.012
Filings with secretary of state—Copy for commissioner.
Health maintenance organizations shall send a copy specifically for the office of the insurance commissioner to the secretary of state of any corporate document required to be filed in the office of the secretary of state, including articles of incorporation and bylaws, and any amendments thereto. The copy specifically provided for the office of the insurance commissioner shall be in addition to the copies required by the secretary of state and shall clearly indicate on the copy that it is for delivery to the office of the insurance commissioner.
[ 1998 c 23 § 17.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.46 - Health Maintenance Organizations. › 48.46.023 - Insurance producer—Definition—License required—Application, issuance, renewal, fees—Penalties involving license.

RCW 48.46.023
Insurance producer—Definition—License required—Application, issuance, renewal, fees—Penalties involving license.
(1) Insurance producer, as used in this chapter, means any person appointed or authorized by a health maintenance organization to solicit applications for health care service agreements on its behalf.
(2) No person shall act as or hold himself or herself out to be an appointed insurance producer of a health maintenance organization unless licensed as a disability insurance producer by this state and appointed or authorized by the health maintenance organization on whose behalf solicitations are to be made.
(3) Applications, appointments, and qualifications for licenses, the renewal thereof, the fees and issuance of a license, and the renewal thereof shall be in accordance with the provisions of chapter 48.17 RCW that are applicable to a disability insurance producer.
(4) The commissioner may revoke, suspend, or refuse to issue or renew any insurance producer's license, or levy a fine upon the licensee, in accordance with those provisions of chapter 48.17 RCW that are applicable to a disability insurance producer.
[ 2008 c 217 § 54; 1983 c 202 § 8.]
NOTES:
Severability—Effective date—2008 c 217: See notes following RCW 48.03.020.
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.46 - Health Maintenance Organizations. › 48.46.027 - Registration, required—Issuance of securities—Penalty.

RCW 48.46.027
Registration, required—Issuance of securities—Penalty.
(1) A person may not in this state, by mail or otherwise, act as or hold himself or herself out to be a health maintenance organization as defined in RCW 48.46.020 without first being registered with the commissioner.
(2) The issuance, sale, or offer for sale in this state of securities of its own issue by any health maintenance organization domiciled in this state other than the memberships and bonds of a nonprofit corporation is subject to the provisions of chapter 48.06 RCW relating to obtaining solicitation permits the same as if health maintenance organizations were domestic insurers.
(3) Any person violating any provision of subsection (2) of this section is guilty of a gross misdemeanor and will, upon conviction, be fined not more than one thousand dollars, or imprisoned for not more than six months, or both, for each violation.
[ 2003 c 250 § 10; 1983 c 202 § 9.]
NOTES:
Severability—2003 c 250: See note following RCW 48.01.080.
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.46 - Health Maintenance Organizations. › 48.46.033 - Unregistered activities—Acts committed in this state—Sanctions.

RCW 48.46.033
Unregistered activities—Acts committed in this state—Sanctions.
(1) As used in this section, "person" has the same meaning as in RCW 48.01.070.
(2) For the purpose of this section, an act is committed in this state if it is committed, in whole or in part, in the state of Washington, or affects persons or property within the state and relates to or involves a health maintenance agreement.
(3) Any person who knowingly violates RCW 48.46.027(1) is guilty of a class B felony punishable under chapter 9A.20 RCW.
(4) Any criminal penalty imposed under this section is in addition to, and not in lieu of, any other civil or administrative penalty or sanction otherwise authorized under state law.
(5)(a) If the commissioner has cause to believe that any person has violated the provisions of RCW 48.46.027(1), the commissioner may:
(i) Issue and enforce a cease and desist order in accordance with the provisions of RCW 48.02.080; and/or
(ii) Assess a civil penalty of not more than twenty-five thousand dollars for each violation, after providing notice and an opportunity for a hearing in accordance with chapters 34.05 and 48.04 RCW.
(b) Upon failure to pay a civil penalty when due, the attorney general may bring a civil action on behalf of the commissioner to recover the unpaid penalty. Any amounts collected by the commissioner must be paid to the state treasurer for the account of the general fund.
[ 2003 c 250 § 11.]
NOTES:
Severability—2003 c 250: See note following RCW 48.01.080.
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.46 - Health Maintenance Organizations. › 48.46.045 - Catastrophic health plans permitted.

RCW 48.46.045
Catastrophic health plans permitted.
Notwithstanding the provisions of this chapter, a health maintenance organization may offer catastrophic health plans as defined in RCW 48.43.005.
[ 2000 c 79 § 27.]
NOTES:
Effective date—Severability—2000 c 79: See notes following RCW 48.04.010.
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.46 - Health Maintenance Organizations. › 48.46.068 - Requirements for plans offered to small employers—Definitions.

RCW 48.46.068
Requirements for plans offered to small employers—Definitions.
(1) A health maintenance organization may not offer any health benefit plan to any small employer without complying with RCW 48.46.066(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 are not subject to RCW 48.46.066(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.
[ 2003 c 248 § 16; 1995 c 265 § 24.]
NOTES:
Captions not law—Effective dates—Savings—Severability—1995 c 265: See notes following RCW 70.47.015.