reglab/statecodes huggingface dataset:
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.21 - Group and Blanket Disability Insurance. › 48.21.070 - Payment of premiums.

RCW 48.21.070
Payment of premiums.
There shall be a provision that all premiums due under the policy shall be remitted by the employer or employers of the persons insured, by the policyholder, or by some other designated person acting on behalf of the association or group insured, to the insurer on or before the due date thereof with such period of grace as may be specified therein.
[1947 c 79 § .21.07; Rem. Supp. 1947 § 45.21.07.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.21 - Group and Blanket Disability Insurance. › 48.21.075 - Payment of premiums by employee in event of suspension of compensation due to labor dispute.

RCW 48.21.075
Payment of premiums by employee in event of suspension of compensation due to labor dispute.
Any employee whose compensation includes group disability or blanket disability insurance providing health care services, the premiums for which are paid in full or in part by an employer including the state of Washington, its political subdivisions, or municipal corporations, or paid by payroll deduction, may pay the premiums as they become due directly to the policyholder whenever the employee's compensation is suspended or terminated directly or indirectly as the result of a strike, lockout, or other labor dispute, for a period not exceeding six months and at the rate and coverages as the policy provides. During that period of time the policy may not be altered or changed. Nothing in this section shall be deemed to impair the right of the insurer to make normal decreases or increases of the premium rate upon expiration and renewal of the policy, in accordance with the provisions of the policy. Thereafter, if such insurance coverage is no longer available, then the employee shall be given the opportunity to purchase an individual policy at a rate consistent with rates filed by the insurer with the commissioner. When the employee's compensation is so suspended or terminated, the employee shall be notified immediately by the policyholder in writing, by mail addressed to the address last on record with the policyholder, that the employee may pay the premiums to the policyholder as they become due as provided in this section.
Payment of the premiums must be made when due or the insurance coverage may be terminated by the insurer.
The provisions of any insurance policy contrary to provisions of this section are void and unenforceable after May 29, 1975.
[ 1975 1st ex.s. c 117 § 1.]
NOTES:
Severability—1975 1st ex.s. c 117: "If any provision of this 1975 act, or its application to any person or circumstance is held invalid, the remainder of the act, or the application of the provision to other persons or circumstances is not affected." [ 1975 1st ex.s. c 117 § 4.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.21 - Group and Blanket Disability Insurance. › 48.21.080 - Certificates of coverage.

RCW 48.21.080
Certificates of coverage.
In group disability insurance policies there shall be a provision that the insurer shall issue to the employer, the policyholder, or other person or association in whose name such policy is issued, for delivery to each insured employee or member, a certificate setting forth in summary form a statement of the essential features of the insurance coverage, and to whom the benefits thereunder are payable described by name, relationship, or reference to the insurance records of the policyholder or insurer. If family members are insured, only one certificate need be issued for each family. This section shall not apply to blanket disability insurance policies.
[ 1961 c 194 § 6; 1947 c 79 § .21.08; Rem. Supp. 1947 § 45.21.08.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.21 - Group and Blanket Disability Insurance. › 48.21.090 - Age limitations.

RCW 48.21.090
Age limitations.
There shall be a provision specifying the ages, if any there be, to which the insurance provided therein shall be limited; and the ages, if any there be, for which additional restrictions are placed on benefits, and the additional restrictions placed on the benefits at such ages.
[1947 c 79 § .21.09; Rem. Supp. 1947 § 45.21.09.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.21 - Group and Blanket Disability Insurance. › 48.21.100 - Examination and autopsy.

RCW 48.21.100
Examination and autopsy.
There may be a provision that the insurer shall have the right and opportunity to examine the person of the insured employee, member or dependent when and so often as it may reasonably require during the pendency of claim under the policy and also the right and opportunity to make an autopsy in case of death where it is not prohibited by law.
[1947 c 79 § .21.10; Rem. Supp. 1947 § 45.21.10.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.21 - Group and Blanket Disability Insurance. › 48.21.110 - Payment of benefits.

RCW 48.21.110
Payment of benefits.
The benefits payable under any policy or contract of group or blanket disability insurance shall be payable to the employee or other insured member of the group or to the beneficiary designated by him or her, other than the policyholder, employer or the association or any officer thereof as such, subject to provisions of the policy in the event there is no designated beneficiary as to all or any part of any sum payable at the death of the individual insured.
The policy may provide that any hospital, medical, or surgical benefits thereunder may be made payable jointly to the insured employee or member and the person furnishing such hospital, medical, or surgical services.
[ 2009 c 549 § 7103; 1955 c 303 § 17; 1947 c 79 § .21.11; Rem. Supp. 1947 § 45.21.11.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.21 - Group and Blanket Disability Insurance. › 48.21.120 - Readjustment of premiums—Dividends.

RCW 48.21.120
Readjustment of premiums—Dividends.
Any contract of group disability insurance may provide for the readjustment of the rate of premium based on the experience thereunder at the end of the first year or of any subsequent year of insurance thereunder, and such readjustment may be made retroactive only for such policy year. Any refund under any plan for readjustment of the rate of premium based on the experience under group policies heretofore or hereafter issued, and any dividend paid under such policies may be used to reduce the employer's share of the cost of the coverage, except that if the aggregate refunds or dividends under such group policy and any other group policy or contract issued to the policyholder exceed the aggregate contributions of the employer toward the cost of the coverages, such excess shall be applied by the policyholder for the sole benefit of insured employees.
[1947 c 79 § .21.12; Rem. Supp. 1947 § 45.21.12.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.21 - Group and Blanket Disability Insurance. › 48.21.125 - When injury caused by intoxication or use of narcotics.

RCW 48.21.125
When injury caused by intoxication or use of narcotics.
An insurer may not deny coverage for the treatment of an injury solely because the injury was sustained as a consequence of the insured's being intoxicated or under the influence of a narcotic.
[ 2004 c 112 § 3.]
NOTES:
Finding—Application—2004 c 112: See notes following RCW 48.20.385.
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.21 - Group and Blanket Disability Insurance. › 48.21.130 - Podiatric medicine and surgery.

RCW 48.21.130
Podiatric medicine and surgery.
Notwithstanding any provision of any group disability insurance contract or blanket disability insurance contract, benefits shall not be denied thereunder for any medical or surgical service performed by a holder of a license issued pursuant to chapter 18.22 RCW provided that (1) the service performed was within the lawful scope of such person's license, and (2) such contract would have provided benefits if such service had been performed by a holder of a license issued pursuant to chapter 18.71 RCW.
[ 1963 c 87 § 2.]
NOTES:
Application—1963 c 87: Nonapplicability to prior contracts and certain renewals, see note following RCW 48.20.390.
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.21 - Group and Blanket Disability Insurance. › 48.21.140 - Optometry.

RCW 48.21.140
Optometry.
Notwithstanding any provision of any group disability insurance contract or blanket disability insurance contract, benefits shall not be denied thereunder for any eye care service rendered by a holder of a license issued pursuant to chapter 18.53 RCW, provided, that (1) the service rendered was within the lawful scope of such person's license, and (2) such contract would have provided the benefits for such service if rendered by a holder of a license issued pursuant to chapter 18.71 RCW.
[ 1965 c 149 § 3.]
NOTES:
Construction—1965 c 149: Nonapplicability to prior contracts and certain renewals, see note following RCW 48.20.410.
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.21 - Group and Blanket Disability Insurance. › 48.21.141 - Registered nurses or advanced registered nurses.

RCW 48.21.141
Registered nurses or advanced registered nurses.
Notwithstanding any provision of any group disability insurance contract or blanket disability insurance contract as provided for in this chapter, benefits shall not be denied thereunder for any health service performed by a holder of a license for registered nursing practice or advanced registered nursing practice issued pursuant to chapter 18.79 RCW if (1) the service performed was within the lawful scope of such person's license, and (2) such contract would have provided benefits if such service had been performed by a holder of a license issued pursuant to chapter 18.71 RCW: PROVIDED, HOWEVER, That no provision of chapter 18.71 RCW shall be asserted to deny benefits under this section.
The provisions of this section are intended to be remedial and procedural to the extent they do not impair the obligation of any existing contract.
[ 1994 sp.s. c 9 § 730; 1973 1st ex.s. c 188 § 4.]
NOTES:
Severability—Headings and captions not law—Effective date—1994 sp.s. c 9: See RCW 18.79.900 through 18.79.902.
Severability—1973 1st ex.s. c 188: See note following RCW 48.18.298.
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.21 - Group and Blanket Disability Insurance. › 48.21.142 - Chiropractic.

RCW 48.21.142
Chiropractic.
Notwithstanding any provision of any group disability insurance contract or blanket disability insurance contract as provided for in this chapter, benefits shall not be denied thereunder for any health service performed by a holder of a license issued pursuant to chapter 18.25 RCW if (1) the service performed was within the lawful scope of such person's license, and (2) such contract would have provided benefits if such service had been performed by a holder of a license issued pursuant to chapter 18.71 RCW: PROVIDED, HOWEVER, That no provision of chapter 18.71 RCW shall be asserted to deny benefits under this section.
The provisions of this section are intended to be remedial and procedural to the extent they do not impair the obligation of any existing contract.
[ 1971 ex.s. c 13 § 2.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.21 - Group and Blanket Disability Insurance. › 48.21.144 - Psychological services.

RCW 48.21.144
Psychological services.
Notwithstanding any provision of any group disability insurance contract or blanket disability insurance contract, benefits shall not be denied thereunder for any psychological service rendered by a holder of a license issued pursuant to chapter 18.83 RCW: PROVIDED, That (1) the service rendered was within the lawful scope of such person's license, and (2) such contract would have provided the benefits for such service if rendered by a holder of a license issued pursuant to chapter 18.71 RCW.
[ 1971 ex.s. c 197 § 2.]
NOTES:
Application—1971 ex.s. c 197: See note following RCW 48.20.414.
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.21 - Group and Blanket Disability Insurance. › 48.21.146 - Dentistry.

RCW 48.21.146
Dentistry.
Notwithstanding any provision of any group disability insurance contract or blanket disability insurance contract as provided for in this chapter, benefits shall not be denied thereunder for any health service performed by a holder of a license issued pursuant to chapter 18.32 RCW if (1) the service performed was within the lawful scope of such person's license, and (2) such contract would have provided benefits if such service had been performed by a holder of a license issued pursuant to chapter 18.71 RCW: PROVIDED, HOWEVER, That no provision of chapter 18.71 RCW shall be asserted to deny benefits under this section.
The provisions of this section are intended to be remedial and procedural to the extent they do not impair the obligation of any existing contract.
[ 1974 ex.s. c 42 § 2.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.21 - Group and Blanket Disability Insurance. › 48.21.147 - Dental services that are not subject to contract or provider agreement.

RCW 48.21.147
Dental services that are not subject to contract or provider agreement.
(1) Notwithstanding any other provisions of law, no group disability insurance contract or blanket disability insurance contract of any disability insurer as provided for in this chapter subject to the jurisdiction of the state of Washington that covers any dental services, and no contract or participating provider agreement with a dentist may:
(a) Require, directly or indirectly, that a dentist who is a participating provider provide services to a subscriber at a fee set by, or at a fee subject to the approval of, the disability insurer unless the dental services are covered services, including services that would be reimbursable but for the application of contractual limitations such as benefit maximums, deductibles, coinsurance, waiting periods, or frequency limitations, under the applicable group plan or disability insurance policy; nor
(b) Prohibit, directly or indirectly, a dentist who is a participating provider from offering or providing to a subscriber dental services that are not covered services on any terms or conditions acceptable to the dentist and the subscriber.
(2) For the purposes of this section, "covered services" means dental services that are reimbursable under the applicable insurance policy, group plan, or subscriber agreement or would be reimbursable but for the application of contractual limitations such as benefit maximums, deductibles, coinsurance, waiting periods or frequency limitations.
[ 2010 c 228 § 2.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.21 - Group and Blanket Disability Insurance. › 48.21.148 - Denturist services.

RCW 48.21.148
Denturist services.
Notwithstanding any provision of any group disability insurance contract or blanket disability insurance contract covering dental care as provided for in this chapter, effective January 1, 1995, benefits shall not be denied thereunder for any service performed by a denturist licensed under chapter 18.30 RCW if (1) the service performed was within the lawful scope of such person's license, and (2) such contract would have provided benefits if such service had been performed by a dentist licensed under chapter 18.32 RCW.
[ 1995 c 1 § 22 (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 48.21 - Group and Blanket Disability Insurance. › 48.21.150 - Dependent child coverage—Continuation for incapacity.

RCW 48.21.150
Dependent child coverage—Continuation for incapacity.
Any group disability insurance contract or blanket disability insurance contract, providing health care services, delivered or issued for delivery in this state more than one hundred twenty days after August 11, 1969, which provides that coverage of a dependent child of an employee or other member of the covered group shall terminate upon attainment of the limiting age for dependent children specified in the contract shall also provide in substance that attainment of such limiting age shall not operate to terminate the coverage of such child while the child is and continues to be both (1) incapable of self-sustaining employment by reason of developmental or physical disability and (2) chiefly dependent upon the employee or member for support and maintenance, provided proof of such incapacity and dependency is furnished to the insurer by the employee or member within thirty-one days of the child's attainment of the limiting age and subsequently as may be required by the insurer, but not more frequently than annually after the two year period following the child's attainment of the limiting age.
[ 2020 c 274 § 31; 1977 ex.s. c 80 § 32; 1969 ex.s. c 128 § 4.]
NOTES:
Purpose—Intent—Severability—1977 ex.s. c 80: See notes following RCW 4.16.190.
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.21 - Group and Blanket Disability Insurance. › 48.21.155 - Dependent child coverage—From moment of birth—Congenital anomalies—Notification of birth.

RCW 48.21.155
Dependent child coverage—From moment of birth—Congenital anomalies—Notification of birth.
(1) Any group disability insurance contract except blanket disability insurance contract, providing hospital and medical expenses and health care services, renewed, delivered or issued for delivery in this state more than one hundred twenty days after February 16, 1974, which provides coverage for the dependent children of persons in the insured group, shall provide coverage for newborn infant children of persons in the insured group from and after the moment of birth. Coverage provided in accord with this section shall include, but not be limited to, coverage for congenital anomalies of such infant children from the moment of birth.
(2) If payment of an additional premium is required to provide coverage for a child, the contract may require that notification of birth of a newly born child and payment of the required premium must be furnished to the insurer. The notification period shall be no less than sixty days from the date of birth. This subsection applies to policies issued or renewed on or after January 1, 1984.
[ 1983 1st ex.s. c 32 § 20; 1974 ex.s. c 139 § 2.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.21 - Group and Blanket Disability Insurance. › 48.21.157 - Option to cover dependents under age twenty-six.

RCW 48.21.157
Option to cover dependents under age twenty-six.
Any group disability insurance contract or blanket disability insurance contract that provides coverage for a participating member's dependent must offer each participating member the option of covering any dependent under the age of twenty-six.
[ 2011 c 314 § 17; 2007 c 259 § 20.]
NOTES:
Effective date—2007 c 259 §§ 18-22: See note following RCW 41.05.095.
Subheadings not law—2007 c 259: See note following RCW 7.70.060.
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.21 - Group and Blanket Disability Insurance. › 48.21.160 - Chemical dependency benefits—Legislative declaration.

RCW 48.21.160
Chemical dependency benefits—Legislative declaration.
The legislature recognizes that chemical dependency is a disease and, as such, warrants the same attention from the health care industry as other similarly serious diseases warrant; the legislature further recognizes that health insurance contracts and contracts for health care services include inconsistent provisions providing benefits for the treatment of chemical dependency. In order to assist the many citizens of this state who suffer from the disease of chemical dependency, and who are presently effectively precluded from obtaining adequate coverage for medical assistance under the terms of their health insurance contract or health care service contract, the legislature hereby declares that provisions providing benefits for the treatment of chemical dependency shall be included in new contracts and that this section, RCW 48.21.180, 48.21.190, 48.44.240, 48.46.350, and RCW 48.21.195, 48.44.245, and 48.46.355 are necessary for the protection of the public health and safety. Nothing in this section, RCW 48.21.180, 48.21.190, 48.44.240, 48.46.350, and RCW 48.21.195, 48.44.245, and 48.46.355 shall be construed to relieve any person of any civil or criminal liability for any act or omission that is the result of a chemical dependency or to grant any person with a chemical dependency any special right, privilege, or status under the law against discrimination, chapter 49.60 RCW.
[ 1987 c 458 § 13; 1974 ex.s. c 119 § 1.]
NOTES:
Effective date—1987 c 458 §§ 13-20: "Sections 13 through 20 of this act shall take effect on January 1, 1988." [ 1987 c 458 § 24.]
Severability—1987 c 458: "If any provision of this act or its application to any person or circumstance is held invalid, the remainder of the act or the application of the provision to other persons or circumstances is not affected." [ 1987 c 458 § 25.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.21 - Group and Blanket Disability Insurance. › 48.21.180 - Chemical dependency benefits—Contracts issued or renewed after January 1, 1988.

RCW 48.21.180
Chemical dependency benefits—Contracts issued or renewed after January 1, 1988.
Each group disability insurance contract which is delivered or issued for delivery or renewed, on or after January 1, 1988, and which insures for hospital or medical care must contain provisions providing benefits for the treatment of chemical dependency rendered to the insured by a provider which is an "approved substance use disorder treatment program" under *RCW 70.96A.020(2).
[ 2018 c 201 § 8011; 2003 c 248 § 9; 1990 1st ex.s. c 3 § 7; 1987 c 458 § 14; 1974 ex.s. c 119 § 3.]
NOTES:
*Reviser's note: RCW 70.96A.020 was repealed by 2016 sp.s. c 29 § 301.
Findings—Intent—Effective date—2018 c 201: See notes following RCW 41.05.018.
Effective date—Severability—1987 c 458: See notes following RCW 48.21.160.
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.21 - Group and Blanket Disability Insurance. › 48.21.190 - Chemical dependency benefits—RCW 48.21.160 through 48.21.190, 48.44.240 inapplicable, when.

RCW 48.21.190
Chemical dependency benefits—RCW 48.21.160 through 48.21.190, 48.44.240 inapplicable, when.
RCW 48.21.160 through 48.21.190 and 48.44.240 as now or hereafter amended shall not apply to the renewal of a contract in force prior to the pertinent date provided for such contract under RCW 48.21.160 through 48.21.190 and 48.44.240 as now or hereafter amended where there exists a right of renewal on the part of the insured or subscriber without any change in any provision of the contract: PROVIDED FURTHER, That RCW 48.21.160 through 48.21.190 and 48.44.240 as now or hereafter amended shall not apply to contracts which provide only accident coverage, nor to any contract written as supplemental coverage to any federal or state programs of health care including, but not limited to, Title XVIII health insurance for the aged (commonly referred to as Medicare, Parts A and B), and amendments thereto.
[ 1975 1st ex.s. c 266 § 10; 1974 ex.s. c 119 § 5.]
NOTES:
Severability—1975 1st ex.s. c 266: See note following RCW 48.01.010.
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.21 - Group and Blanket Disability Insurance. › 48.21.195 - "Chemical dependency" defined.

RCW 48.21.195
"Chemical dependency" defined.
For the purposes of RCW 48.21.160 and 48.21.180 "chemical dependency" means an illness characterized by a physiological or psychological dependency, or both, on a controlled substance regulated under chapter 69.50 RCW and/or alcoholic beverages. It is further characterized by a frequent or intense pattern of pathological use to the extent the user exhibits a loss of self-control over the amount and circumstances of use; develops symptoms of tolerance or physiological and/or psychological withdrawal if use of the controlled substance or alcoholic beverage is reduced or discontinued; and the user's health is substantially impaired or endangered or his or her social or economic function is substantially disrupted.
[ 1987 c 458 § 15.]
NOTES:
Effective date—Severability—1987 c 458: See notes following RCW 48.21.160.
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.21 - Group and Blanket Disability Insurance. › 48.21.197 - Chemical dependency benefits—Rules.

RCW 48.21.197
Chemical dependency benefits—Rules.
By September 1, 1987, the insurance commissioner shall adopt rules governing benefits for treatment of chemical dependency under medical plans issued under chapters 48.21, 48.44, and 48.46 RCW. These rules shall recognize that many persons are dependent on both alcohol and drugs; they shall prohibit the stacking of benefits and shall require that benefits for chemical dependency be equivalent to benefits previously required for alcoholism.
[ 1987 c 458 § 21.]
NOTES:
Severability—1987 c 458: See note following RCW 48.21.160.
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.21 - Group and Blanket Disability Insurance. › 48.21.200 - Individual or group disability, health care service contract, health maintenance agreement—Reduction of benefits on basis of other existing coverages.

RCW 48.21.200
Individual or group disability, health care service contract, health maintenance agreement—Reduction of benefits on basis of other existing coverages.
(1) No individual or group disability insurance policy, health care service contract, or health maintenance agreement providing hospital, medical or surgical expense benefits and which contains a provision for the reduction of benefits otherwise payable or available thereunder on the basis of other existing coverages, shall provide that such reduction will operate to reduce total benefits payable below an amount equal to one hundred percent of total allowable expenses.
(2) The commissioner shall by rule establish guidelines for the application of this section, including:
(a) The procedures by which persons covered under such policies, contracts, and agreements are to be made aware of the existence of such a provision;
(b) The benefits which may be subject to such a provision;
(c) The effect of such a provision on the benefits provided;
(d) Establishment of the order of benefit determination;
(e) Exceptions necessary to preserve policy, contract, or agreement requirements for use of particular health care facilities or providers; and
(f) Reasonable claim administration procedures to expedite claim payments and prevent duplication of payments or benefits under such a provision.
[ 2007 c 80 § 3; 1993 c 492 § 282. Prior: 1983 c 202 § 16; 1983 c 106 § 24; 1975 1st ex.s. c 266 § 20.]
NOTES:
Findings—Intent—1993 c 492: See notes following RCW 43.20.050.
Short title—Savings—Reservation of legislative power—Effective dates—1993 c 492: See RCW 43.72.910 through 43.72.915.
Severability—1975 1st ex.s. c 266: See note following RCW 48.01.010.
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.21 - Group and Blanket Disability Insurance. › 48.21.223 - Prescribed, self-administered anticancer medication.

RCW 48.21.223
Prescribed, self-administered anticancer medication.
(1) Each health plan issued or renewed on or after January 1, 2012, that provides coverage for cancer chemotherapy treatment must provide coverage for prescribed, self-administered anticancer medication that is used to kill or slow the growth of cancerous cells on a basis at least comparable to cancer chemotherapy medications administered by a health care provider or facility as defined in *RCW 48.43.005 (25) and (26).
(2) Nothing in this section may be interpreted to prohibit a health plan from administering a formulary or preferred drug list, requiring prior authorization, or imposing other appropriate utilization controls in approving coverage for any chemotherapy.
[ 2020 c 18 § 20; 2011 c 159 § 4.]
NOTES:
*Reviser's note: RCW 48.43.005 was alphabetized pursuant to RCW 1.08.015(2)(k), changing subsections (25) and (26) to subsections (27) and (28).
Explanatory statement—2020 c 18: See note following RCW 43.79A.040.
Findings—2011 c 159: See note following RCW 41.05.175.
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.21 - Group and Blanket Disability Insurance. › 48.21.225 - Mammograms—Insurance coverage.

RCW 48.21.225
Mammograms—Insurance coverage.
Each group disability insurance policy issued or renewed after January 1, 1990, that provides coverage for hospital or medical expenses shall provide coverage for screening or diagnostic mammography services, provided that such services are delivered upon the recommendation of the patient's physician or advanced registered nurse practitioner as authorized by the *nursing care quality assurance commission pursuant to chapter 18.79 RCW or physician assistant pursuant to chapter 18.71A RCW.
This section shall not be construed to prevent the application of standard policy provisions, other than the cost-sharing prohibition provided in RCW 48.43.076, that are applicable to other benefits. This section does not limit the authority of an insurer to negotiate rates and contract with specific providers for the delivery of mammography services. This section shall not apply to medicare supplement policies or supplemental contracts covering a specified disease or other limited benefits.
[ 2023 c 366 § 4; 1994 sp.s. c 9 § 731; 1989 c 338 § 2.]
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 48.21 - Group and Blanket Disability Insurance. › 48.21.227 - Prostate cancer screening.

RCW 48.21.227
Prostate cancer screening.
(1) Each group disability insurance policy issued or renewed after December 31, 2006, that provides coverage for hospital or medical expenses shall provide coverage for prostate cancer screening, provided that the screening is delivered upon the recommendation of the patient's physician, advanced registered nurse practitioner, or physician assistant.
(2) This section shall not be construed to prevent the application of standard policy provisions applicable to other benefits, such as deductible or copayment provisions. This section does not limit the authority of an insurer to negotiate rates and contract with specific providers for the delivery of prostate cancer screening services. This section shall not apply to medicare supplemental policies or supplemental contracts covering a specified disease or other limited benefits.
[ 2006 c 367 § 3.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.21 - Group and Blanket Disability Insurance. › 48.21.230 - Reconstructive breast surgery.

RCW 48.21.230
Reconstructive breast surgery.
(1) Each group disability insurance contract issued or renewed after July 24, 1983, which insures for hospital or medical care shall provide coverage for reconstructive breast surgery resulting from a mastectomy which resulted from disease, illness, or injury.
(2) Each group disability insurance contract issued or renewed after January 1, 1986, which insures for hospital or medical 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 § 6; 1983 c 113 § 2.]
NOTES:
Effective date—1985 c 54: See note following RCW 48.20.397.
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.21 - Group and Blanket Disability Insurance. › 48.21.235 - Mastectomy, lumpectomy.

RCW 48.21.235
Mastectomy, lumpectomy.
No person engaged in the business of insurance under this chapter may refuse to issue any contract of insurance or cancel or decline to renew the contract solely because of a mastectomy or lumpectomy performed on the insured or prospective insured more than five years previously. The amount of benefits payable, or any term, rate, condition, or type of coverage shall not be restricted, modified, excluded, increased, or reduced solely on the basis of a mastectomy or lumpectomy performed on the insured or prospective insured more than five years previously.
[ 1985 c 54 § 2.]
NOTES:
Effective date—1985 c 54: See note following RCW 48.20.397.
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.21 - Group and Blanket Disability Insurance. › 48.21.242 - Mental health treatment—Waiver of preauthorization for persons involuntarily committed.

RCW 48.21.242
Mental health treatment—Waiver of preauthorization for persons involuntarily committed.
An insurer providing group disability insurance coverage for health care in this state shall waive a preauthorization requirement from the insurer before an insured or the insured's covered dependents receive mental health care and treatment rendered by a state hospital if the insured or any of the insured's covered dependents are involuntarily committed to a state hospital as defined in RCW 72.23.010.
[ 1993 c 272 § 3.]
NOTES:
Savings—Severability—1993 c 272: See notes following RCW 43.20B.347.
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.21 - Group and Blanket Disability Insurance. › 48.21.244 - Benefits for prenatal diagnosis of congenital disorders—Contracts entered into or renewed on or after January 1, 1990.

RCW 48.21.244
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 disability 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 disability contractor in accord with standards set in rule by the board of health. Every group disability contractor shall communicate the availability of such coverage to all group disability contract holders and to all groups with whom they are negotiating.
[ 1988 c 276 § 6.]
NOTES:
Prenatal testing—Limitation on changes to coverage: RCW 48.42.090.
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.21 - Group and Blanket Disability Insurance. › 48.21.250 - Continuation option to be offered.

RCW 48.21.250
Continuation option to be offered.
Every insurer that issues policies providing group coverage for hospital or medical expense shall offer the policyholder an option to include a policy provision granting a person who becomes ineligible for coverage under the group policy, the right to continue the group benefits for a period of time and at a rate agreed upon. The policy provision shall provide that when such coverage terminates, the covered person may convert to a policy as provided in RCW 48.21.260.
[ 1984 c 190 § 2.]
NOTES:
Legislative intent—1984 c 190: "The legislature recognizes that when people covered by a group health insurance policy lose their group insurance benefits because they are no longer eligible, they need time to obtain a suitable form of replacement coverage or time to complete a reasonable course of medical treatment for a health condition that existed when the group benefits ended.
Spouses and dependents can lose their group insurance and may not have any other health insurance when one spouse covered under a group policy dies, obtains a divorce, or becomes unemployed. Often the cost of an individual policy prevents these persons from obtaining any other health insurance.
The intent of this act is to require insurers, health care service contractors, and health maintenance organizations to:
(1) Offer to the contract holder the option to continue health and medical benefits for employees, members, spouses, or dependents whose eligibility for coverage under a group policy, contract, or agreement is terminated; and
(2) Provide a conversion policy, contract, or agreement to employees, members, spouses, or dependents whose eligibility for coverage under a group policy, contract, or agreement is terminated." [ 1984 c 190 § 1.]
Application—1984 c 190 §§ 2, 5, and 8: "Sections 2, 5, and 8 of this act shall apply to any policy, contract, or agreement issued, renewed, or amended on or after January 1, 1985." [ 1984 c 190 § 12.]
Severability—1984 c 190: "If any provision of this act or its application to any person or circumstance is held invalid, the remainder of the act or the application of the provision to other persons or circumstances is not affected." [ 1984 c 190 § 13.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.21 - Group and Blanket Disability Insurance. › 48.21.260 - Conversion policy to be offered—Exceptions, conditions.

RCW 48.21.260
Conversion policy to be offered—Exceptions, conditions.
(1) Except as otherwise provided by this section, any group disability insurance policy that provides benefits for hospital or medical expenses must contain a provision granting a person covered by the group policy the right to obtain a conversion policy from the insurer upon termination of the person's eligibility for coverage under the group policy.
(2) An insurer need not offer a conversion policy to:
(a) A person whose coverage under the group policy 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 policy, a person must submit a written application and the first premium payment for the conversion policy not later than thirty-one days after the date the person's group coverage terminates or thirty-one days after the date the person received notice of termination of coverage, whichever is later. The conversion policy shall become effective, without lapse of coverage, immediately following termination of coverage under the group policy.
(4) If an insurer or group policyholder does not renew, cancels, or otherwise terminates the group policy, the insurer must offer a conversion policy to any person who was covered under the terminated policy 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 policy or thirty-one days after the date the person received notice of termination of coverage, whichever is later.
(5) The insurer shall determine the premium for the conversion policy in accordance with the insurer's table of premium rates applicable to the age and class of risk of each person to be covered under the policy and the type and amount of benefits provided.
[ 2010 c 110 § 1; 1984 c 190 § 3.]
NOTES:
Application—2010 c 110: "This act applies to any group disability insurance policy, group health care service contract, and group health maintenance agreement issued, entered into, or renewed on or after January 1, 2011." [ 2010 c 110 § 4.]
Legislative intent—Severability—1984 c 190: See notes following RCW 48.21.250.
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.21 - Group and Blanket Disability Insurance. › 48.21.270 - Conversion policy—Restrictions and requirements—Rules.

RCW 48.21.270
Conversion policy—Restrictions and requirements—Rules.
(1) An insurer shall not require proof of insurability as a condition for issuance of the conversion policy.
(2) A conversion policy may not contain an exclusion for preexisting conditions for any applicant.
(3) An insurer must offer at least three policy 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 policies.
(6) The commissioner shall adopt rules to establish specific standards for conversion policy 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 § 4; 2011 c 314 § 2; 1984 c 190 § 4.]
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 48.21 - Group and Blanket Disability Insurance. › 48.21.280 - Coverage for adopted children.

RCW 48.21.280
Coverage for adopted children.
(1) Any group disability insurance contract, except a blanket disability insurance contract, providing hospital and medical expenses and health care services, delivered or issued for delivery in this state, which provides coverage for dependent children, as defined in the contract of the insured, shall cover adoptive children placed with the insured on the same basis as other dependents, as provided in RCW 48.01.180.
(2) If payment of an additional premium is required to provide coverage for a child, the contract may require that notification of placement of a child for adoption and payment of the required premium must be furnished to the insurer. The notification period shall be no less than sixty days from the date of placement.
[ 1986 c 140 § 3.]
NOTES:
Effective date, application—Severability—1986 c 140: See notes following RCW 48.01.180.
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.21 - Group and Blanket Disability Insurance. › 48.21.290 - Cancellation of rider.

RCW 48.21.290
Cancellation of rider.
Upon application by an insured, a rider shall be canceled if at least five years after its issuance, no health care services have been received by the insured during that time for the condition specified in the rider, and a physician, selected by the carrier for that purpose, agrees in writing to the full medical recovery of the insured from that condition, such agreement not to be unreasonably withheld. The option of the insured to apply for cancellation shall be disclosed on the face of the rider in clear and conspicuous language.
For purposes of this section, a rider is a legal document that modifies a contract to exclude, limit, or reduce coverage or benefits for specifically named or described preexisting diseases or physical conditions.
[ 1987 c 37 § 2.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.21 - Group and Blanket Disability Insurance. › 48.21.300 - Phenylketonuria.

RCW 48.21.300
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 group disability insurance contract delivered or issued for delivery or renewed in this state on or after September 1, 1988, that insures for hospital or medical expenses shall provide coverage for the formulas necessary for the treatment of phenylketonuria.
[ 1988 c 173 § 2.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.21 - Group and Blanket Disability Insurance. › 48.21.310 - Neurodevelopmental therapies—Employer-sponsored group contracts.

RCW 48.21.310
Neurodevelopmental therapies—Employer-sponsored group contracts.
(1) Each employer-sponsored group policy for comprehensive health insurance 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 an insurer from negotiating rates with qualified providers.
(3) Benefits provided under this section shall be for medically necessary services as determined by the insurer. Benefits shall be payable for services for the maintenance of an insured 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 health insurance, including the benefits required by this section, together with the insurer, 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 insurance and the insurer. 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 insurance and the insurer.
[ 1989 c 345 § 2.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.21 - Group and Blanket Disability Insurance. › 48.21.325 - Prescriptions—Preapproval of individual claims—Subsequent rejection prohibited—Written record required.

RCW 48.21.325
Prescriptions—Preapproval of individual claims—Subsequent rejection prohibited—Written record required.
Group disability insurance companies who through an authorized representative have first approved, by any means, an individual prescription claim as eligible may not reject that claim at some later date. Pharmacists or drug dispensing outlets who obtain preapproval of claims shall keep a written record of the preapproval that consists of identification by name and telephone number of the person who approved the claim.
[ 1993 c 253 § 3.]
NOTES:
Findings—Effective date—1993 c 253: See notes following RCW 48.20.525.