reglab/statecodes huggingface dataset:
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.46 - Health Maintenance Organizations. › 48.46.375 - Benefits for prenatal diagnosis of congenital disorders—Agreements entered into or renewed on or after January 1, 1990.

RCW 48.46.375
Benefits for prenatal diagnosis of congenital disorders—Agreements entered into or renewed on or after January 1, 1990.
On or after January 1, 1990, every group health maintenance agreement entered into or renewed that covers hospital, medical, or surgical expenses 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 maintenance organization in accord with standards set in rule by the board of health: PROVIDED, That such procedures shall be covered only if rendered directly by the health maintenance organization or upon referral by the health maintenance organization. Every group health maintenance organization shall communicate the availability of such coverage to all groups covered and to all groups with whom they are negotiating.
[ 1988 c 276 § 8.]
NOTES:
Prenatal testing—Limitation on changes to coverage: RCW 48.42.090.
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.46 - Health Maintenance Organizations. › 48.46.380 - Notice of reason for cancellation, denial, or refusal to renew agreement.

RCW 48.46.380
Notice of reason for cancellation, denial, or refusal to renew agreement.
Every authorized health maintenance organization, upon canceling, denying, or refusing to renew any individual health maintenance agreement, shall, upon written request, directly notify in writing the applicant or enrolled participant as appropriate, of the reasons for the action by the health maintenance organization. Any benefits, terms, rates, or conditions of such agreement which are restricted, excluded, modified, increased, or reduced shall, upon written request, be set forth in writing and supplied to the individual. The written communications required by this section shall be phrased in simple language which is readily understandable to a person of average intelligence, education, and reading ability.
[ 1993 c 492 § 291; 1983 c 106 § 16.]
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.
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.46 - Health Maintenance Organizations. › 48.46.390 - Providing information on cancellation or refusal—No liability for insurance commissioner or health maintenance organization.

RCW 48.46.390
Providing information on cancellation or refusal—No liability for insurance commissioner or health maintenance organization.
With respect to the provisions of health maintenance agreements as set forth in RCW 48.46.380, there shall be no liability on the part of, and no cause of action of any nature shall arise against, the insurance commissioner, the commissioner's agents, or members of the commissioner's staff, or against any health maintenance organization, its authorized representative, its agents, its employees, for providing to the health maintenance organization information as to reasons for cancellation or refusal to issue or renew, for libel or slander on the basis of any statement made by any of them in any written notice of cancellation or refusal to issue or renew, or in any other communications, oral or written, specifying the reasons for cancellation or refusal to issue or renew or the providing of information pertaining thereto, or for statements made or evidence submitted in any hearing conducted in connection therewith.
[ 1983 c 106 § 17.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.46 - Health Maintenance Organizations. › 48.46.400 - False or misleading advertising prohibited.

RCW 48.46.400
False or misleading advertising prohibited.
No person may knowingly make, publish, or disseminate any false, deceptive, or misleading representation or advertising in the conduct of the business of a health maintenance organization, or relative to the business of a health maintenance organization or to any person engaged therein.
[ 1983 c 106 § 18.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.46 - Health Maintenance Organizations. › 48.46.410 - Misrepresentations to induce termination or retention of agreement prohibited.

RCW 48.46.410
Misrepresentations to induce termination or retention of agreement prohibited.
No health maintenance organization nor any person representing a health maintenance organization may by misrepresentation or misleading comparisons induce or attempt to induce any member of a health maintenance organization to terminate or retain an agreement or membership in the organization.
[ 1983 c 106 § 19.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.46 - Health Maintenance Organizations. › 48.46.420 - Penalty for violations.

RCW 48.46.420
Penalty for violations.
(1) Except as otherwise provided in this chapter, any health maintenance organization which, or person who, violates any provision of this chapter is guilty of a gross misdemeanor.
(2) A health maintenance organization that fails to comply with the net worth requirements of this chapter must cure that defect in compliance with an order of the commissioner rendered in conformity with rules adopted pursuant to chapter 34.05 RCW. The commissioner is authorized to take appropriate action to assure that the continued operation of the health maintenance organization will not be hazardous to its enrolled participants.
[ 2003 c 250 § 12; 1990 c 119 § 10; 1983 c 106 § 20.]
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. › 48.46.430 - Enforcement authority of commissioner.

RCW 48.46.430
Enforcement authority of commissioner.
For the purposes of this chapter, the insurance commissioner shall have the same powers and duties of enforcement as are provided in RCW 48.02.080.
[ 1983 c 106 § 21.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.46 - Health Maintenance Organizations. › 48.46.440 - Continuation option to be offered.

RCW 48.46.440
Continuation option to be offered.
Every health maintenance organization that issues agreements providing group coverage for hospital or medical care shall offer the agreement holder an option to include an agreement provision granting a person who becomes ineligible for coverage under the group agreement, the right to continue the group benefits for a period of time and at a rate agreed upon. The agreement provision shall provide that when such coverage terminates the covered person may convert to an agreement as provided in RCW 48.46.450.
[ 1984 c 190 § 8.]
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 48.46 - Health Maintenance Organizations. › 48.46.450 - Conversion agreement to be offered—Exceptions, conditions.

RCW 48.46.450
Conversion agreement to be offered—Exceptions, conditions.
(1) Except as otherwise provided by this section, any group health maintenance agreement that provides benefits for hospital or medical care must contain a provision granting a person covered by the group agreement the right to obtain a conversion agreement from the health maintenance organization upon termination of the person's eligibility for coverage under the group agreement.
(2) A health maintenance organization need not offer a conversion agreement to:
(a) A person whose coverage under the group agreement 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 agreement, a person must submit a written application and the first premium payment for the conversion agreement 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 agreement shall become effective without lapse of coverage, immediately following termination of coverage under the group agreement.
(4) If a health maintenance organization or group agreement holder does not renew, cancels, or otherwise terminates the group agreement, the health maintenance organization must offer a conversion agreement to any person who was covered under the terminated agreement unless the person is eligible to obtain group benefits for hospital or medical care within thirty-one days after such nonrenewal, cancellation, or termination of the group agreement or thirty-one days after the date the person received notice of termination of coverage, whichever is later.
(5) The health maintenance organization shall determine the premium for the conversion agreement in accordance with the organization's table of premium rates applicable to the age and class of risk of each person to be covered under the agreement and the type and amount of benefits provided.
[ 2010 c 110 § 3; 1984 c 190 § 9.]
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 48.46 - Health Maintenance Organizations. › 48.46.460 - Conversion agreement—Restrictions and requirements—Rules.

RCW 48.46.460
Conversion agreement—Restrictions and requirements—Rules.
(1) A health maintenance organization must offer a conversion agreement for comprehensive health care services and shall not require proof of insurability as a condition for issuance of the conversion agreement.
(2) A conversion agreement may not contain an exclusion for preexisting conditions for an applicant.
(3) A conversion agreement need not provide benefits identical to those provided under the group agreement. The conversion agreement may contain provisions requiring the person covered by the conversion agreement to pay reasonable deductibles and copayments, except for preventive service benefits as defined in 45 C.F.R. 147.130 (2010), implementing sections 2701 through 2763, 2791, and 2792 of the public health service act (42 U.S.C. 300gg through 300gg-63, 300gg-91, and 300gg-92), as amended.
(4) The insurance commissioner shall adopt rules to establish minimum benefit standards for conversion agreements.
(5) The commissioner shall adopt rules to establish specific standards for conversion agreement 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 § 6; 2011 c 314 § 9; 1984 c 190 § 10.]
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 48.46 - Health Maintenance Organizations. › 48.46.470 - Endorsement of modifications.

RCW 48.46.470
Endorsement of modifications.
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 maintenance organization.
[ 1985 c 320 § 7.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.46 - Health Maintenance Organizations. › 48.46.480 - Continuation of coverage of former family members.

RCW 48.46.480
Continuation of coverage of former family members.
Every health care service agreement issued, amended, or renewed after January 1, 1986, 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 maintenance agreement without a physical examination, statement of health, or other proof of insurability.
[ 1985 c 320 § 8.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.46 - Health Maintenance Organizations. › 48.46.490 - Coverage for adopted children.

RCW 48.46.490
Coverage for adopted children.
(1) Any health maintenance agreement under this chapter which provides coverage for dependent children, as defined in the agreement of the enrolled participant, shall cover adoptive children placed with the enrolled participant 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 agreement may require that notification of placement of a child for adoption and payment of the required premium must be furnished to the health maintenance organization. The notification period shall be no less than sixty days from the date of placement.
[ 1986 c 140 § 5.]
NOTES:
Effective date, application—Severability—1986 c 140: See notes following RCW 48.01.180.
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.46 - Health Maintenance Organizations. › 48.46.500 - Cancellation of rider.

RCW 48.46.500
Cancellation of rider.
Upon application by an enrollee, a rider shall be canceled if at least five years after its issuance, no health care services have been received by the enrollee 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 enrollee from that condition, such agreement not to be unreasonably withheld. The option of the enrollee 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 § 4.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.46 - Health Maintenance Organizations. › 48.46.510 - Phenylketonuria.

RCW 48.46.510
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 agreement 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. Such formulas shall be covered when deemed medically necessary by the medical director or his or her designee of the health maintenance organization and if provided by the health maintenance organization or upon the health maintenance organization's referral. Formulas shall be covered at the usual and customary rates for such formulas, subject to contract provisions with respect to deductible amounts or copayments.
[ 1988 c 173 § 4.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.46 - Health Maintenance Organizations. › 48.46.520 - Neurodevelopmental therapies—Employer-sponsored group contracts.

RCW 48.46.520
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. Covered benefits and treatment must be rendered or referred by the health maintenance organization, and 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 treatment is rendered by such licensee. Nothing in this section shall prohibit a health maintenance organization from negotiating rates with qualified providers.
(3) Benefits provided under this section shall be for medically necessary services as determined by the health maintenance organization. Benefits shall be provided for the maintenance of a covered enrollee in cases where significant deterioration in the patient's condition would result without the service. Benefits shall be provided 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 maintenance organization, retain authority to design and employ utilization and cost controls. Therefore, benefits provided under this section may be subject to contractual provisions regarding deductible amounts and/or copayments established by the employer purchasing coverage and the health maintenance organization. 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 maintenance organization.
[ 1989 c 345 § 3.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.46 - Health Maintenance Organizations. › 48.46.530 - Temporomandibular joint disorders—Insurance coverage.

RCW 48.46.530
Temporomandibular joint disorders—Insurance coverage.
(1) Except as provided in this section, a health maintenance agreement entered into or renewed after December 31, 1989, shall offer optional coverage for the treatment of temporomandibular joint disorders.
(a) Health maintenance organizations offering medical coverage only may limit benefits in such coverages to medical services related to treatment of temporomandibular joint disorders. No health maintenance organizations offering medical and dental coverage may limit benefits in such coverage to dental services related to treatment of temporomandibular joint disorders. No health maintenance organization offering medical coverage only may define all temporomandibular joint disorders as purely dental in nature.
(b) Health maintenance organizations 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 health maintenance organization 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 § 4.]
NOTES:
Legislative finding—Effective date—1989 c 331: See notes following RCW 48.21.320.
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.46 - Health Maintenance Organizations. › 48.46.535 - Prescriptions—Preapproval of individual claims—Subsequent rejection prohibited—Written record required.

RCW 48.46.535
Prescriptions—Preapproval of individual claims—Subsequent rejection prohibited—Written record required.
Health maintenance organizations 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 § 5.]
NOTES:
Findings—Effective date—1993 c 253: See notes following RCW 48.20.525.
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.46 - Health Maintenance Organizations. › 48.46.540 - Nonresident pharmacies.

RCW 48.46.540
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 maintenance organization providing coverage of prescription drugs from nonresident pharmacies may only provide coverage from licensed nonresident pharmacies. The health maintenance organizations 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 maintenance organization 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 § 315; 1991 c 87 § 10.]
NOTES:
Effective date—1991 c 87: See note following RCW 18.64.350.
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.46 - Health Maintenance Organizations. › 48.46.565 - Foot care services.

RCW 48.46.565
Foot care services.
Except to the extent that a health maintenance organization contracts with a group medical practice which only treats that organization's patients, a health maintenance organization may not discriminate in the terms and conditions, including reimbursement, for the provision of foot care services between physicians and surgeons licensed under chapters 18.22, 18.57, and 18.71 RCW.
[ 1999 c 64 § 1.]
NOTES:
Intent—1999 c 64: "This act is intended to be procedural and not to impair the obligation of any existing contract." [ 1999 c 64 § 2.]
Severability—1999 c 64: "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." [ 1999 c 64 § 3.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.46 - Health Maintenance Organizations. › 48.46.570 - Denturist services.

RCW 48.46.570
Denturist services.
Notwithstanding any provision of any health maintenance organization agreement 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 agreement would have provided benefits if such service had been performed by a dentist licensed under chapter 18.32 RCW.
[ 1995 c 1 § 25 (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 48.46 - Health Maintenance Organizations. › 48.46.575 - Doctor of osteopathic medicine and surgery—Discrimination based on board certification is prohibited.

RCW 48.46.575
Doctor of osteopathic medicine and surgery—Discrimination based on board certification is prohibited.
A health maintenance organization that provides health care services to the general public may not discriminate against a qualified doctor of osteopathic medicine and surgery licensed under chapter 18.57 RCW, who has applied to practice with the health maintenance organization, solely because that practitioner was board certified or eligible under an approved osteopathic certifying board instead of board certified or eligible respectively under an approved medical certifying board.
[ 1995 c 64 § 1.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.46 - Health Maintenance Organizations. › 48.46.580 - When injury caused by intoxication or use of narcotics.

RCW 48.46.580
When injury caused by intoxication or use of narcotics.
A health maintenance organization may not deny coverage for the treatment of an injury solely because the injury was sustained as a consequence of the enrolled participant's being intoxicated or under the influence of a narcotic.
[ 2004 c 112 § 5.]
NOTES:
Finding—Application—2004 c 112: See notes following RCW 48.20.385.
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.46 - Health Maintenance Organizations. › 48.46.600 - Disclosure of certain material transactions—Report—Information is confidential.

RCW 48.46.600
Disclosure of certain material transactions—Report—Information is confidential.
(1) Every health maintenance organization 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 48.46.605 through 48.46.625 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 maintenance organization to which it pertains unless the commissioner, after giving the health maintenance organization 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 § 19.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.46 - Health Maintenance Organizations. › 48.46.605 - Material acquisitions or dispositions.

RCW 48.46.605
Material acquisitions or dispositions.
No acquisitions or dispositions of assets need be reported pursuant to RCW 48.46.600 if the acquisitions or dispositions are not material. For purposes of RCW 48.46.600 through 48.46.625, 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 maintenance organization's total assets as reported in its most recent statutory statement filed with the commissioner.
[ 1995 c 86 § 20.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.46 - Health Maintenance Organizations. › 48.46.610 - Asset acquisitions—Asset dispositions.

RCW 48.46.610
Asset acquisitions—Asset dispositions.
(1) Asset acquisitions subject to RCW 48.46.600 through 48.46.625 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 maintenance organization or the acquisition of materials for such purpose.
(2) Asset dispositions subject to RCW 48.46.600 through 48.46.625 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 § 21.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.46 - Health Maintenance Organizations. › 48.46.615 - Report of a material acquisition or disposition of assets—Information required.

RCW 48.46.615
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 § 22.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.46 - Health Maintenance Organizations. › 48.46.620 - Material nonrenewals, cancellations, or revisions of ceded reinsurance agreements.

RCW 48.46.620
Material nonrenewals, cancellations, or revisions of ceded reinsurance agreements.
(1) No nonrenewals, cancellations, or revisions of ceded reinsurance agreements need be reported under RCW 48.46.600 if the nonrenewals, cancellations, or revisions are not material. For purposes of RCW 48.46.600 through 48.46.625, a material nonrenewal, cancellation, or revision is one that affects:
(a) More than fifty percent of a health maintenance organization's total reserve credit taken for business ceded, on an annualized basis, as indicated in the health maintenance organization's most recent annual statement;
(b) More than ten percent of a health maintenance organization'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 maintenance organization'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 § 23.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.46 - Health Maintenance Organizations. › 48.46.625 - Report of a material nonrenewal, cancellation, or revision of ceded reinsurance agreements—Information required.

RCW 48.46.625
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 § 24.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.46 - Health Maintenance Organizations. › 48.46.900 - Liberal construction.

RCW 48.46.900
Liberal construction.
It is intended that the provisions of this chapter shall be liberally construed to accomplish the purposes provided for and authorized herein.
[ 1975 1st ex.s. c 290 § 24.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.46 - Health Maintenance Organizations. › 48.46.920 - Short title.

RCW 48.46.920
Short title.
This 1975 amendatory act may be known and cited as "The Washington Health Maintenance Organization Act of 1975".
[ 1975 1st ex.s. c 290 § 27.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.46 - Health Maintenance Organizations. › 48.46.930 - Construction—Chapter applicable to state registered domestic partnerships—2009 c 521.

RCW 48.46.930
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 § 127.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.47 - Mandated Health Benefits. › 48.47.005 - Legislative findings—Purpose.

RCW 48.47.005
Legislative findings—Purpose.
The legislature finds that there is a continued interest in mandating certain health coverages or offering of health coverages by health carriers; and that improved access to these health care services to segments of the population which desire them can provide beneficial social and health consequences which may be in the public interest.
The legislature finds further, however, that the cost ramifications of expanding health coverages is of continuing concern; and that the merits of a particular mandated benefit must be balanced against a variety of consequences which may go far beyond the immediate impact upon the cost of insurance coverage. The legislature hereby finds and declares that a systematic review of proposed mandated benefits, which explores all the ramifications of such proposed legislation, will assist the legislature in determining whether mandating a particular coverage or offering is in the public interest. The purpose of this chapter is to establish a procedure for the proposal, review, and determination of mandated benefit necessity.
[ 1997 c 412 § 1; 1984 c 56 § 1. Formerly RCW 48.42.060.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.47 - Mandated Health Benefits. › 48.47.020 - Submission of mandated health benefit proposal—Review—Benefit must be authorized by law.

RCW 48.47.020
Submission of mandated health benefit proposal—Review—Benefit must be authorized by law.
Mandated health benefits shall be established as follows:
(1) Every person who, or organization that, seeks to establish a mandated benefit shall, at least ninety days prior to a regular legislative session, submit a mandated benefit proposal to the appropriate committees of the legislature, assessing the social impact, financial impact, and evidence of health care service efficacy of the benefit in strict adherence to the criteria enumerated in RCW 48.47.030.
(2) The chair of a committee may request that the department examine the proposal using the criteria set forth in RCW 48.47.030, however, such request must be made no later than nine months prior to a subsequent regular legislative session.
(3) To the extent that funds are appropriated for this purpose, the department shall report to the appropriate committees of the legislature on the appropriateness of adoption no later than thirty days prior to the legislative session during which the proposal is to be considered.
(4) Mandated benefits must be authorized by law.
[ 1997 c 412 § 3; 1989 1st ex.s. c 9 § 221; 1987 c 150 § 79; 1984 c 56 § 2. Formerly RCW 48.42.070.]
NOTES:
Effective date—Severability—1989 1st ex.s. c 9: See RCW 43.70.910 and 43.70.920.
Severability—1987 c 150: See RCW 18.122.901.
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.49 - Balance Billing Protection Act. › 48.49.003 - Findings—Intent—2019 c 427.

RCW 48.49.003
Findings—Intent—2019 c 427.
(1) The legislature finds that:
(a) Consumers receive surprise bills or balance bills for services provided at nonparticipating facilities or by nonparticipating health care providers at in-network facilities;
(b) Consumers must not be placed in the middle of contractual disputes between providers and health insurance carriers; and
(c) Facilities, providers, and health insurance carriers all share responsibility to ensure consumers have transparent information on network providers and benefit coverage, and the insurance commissioner is responsible for ensuring that provider networks include sufficient numbers and types of contracted providers to reasonably ensure consumers have in-network access for covered benefits.
(2) It is the intent of the legislature to:
(a) Ban balance billing of consumers enrolled in fully insured, regulated insurance plans and plans offered to public employees under chapter 41.05 RCW for the services described in RCW 48.49.020, and to provide self-funded group health plans with an option to elect to be subject to the provisions of this chapter;
(b) Remove consumers from balance billing disputes and require that nonparticipating providers and carriers negotiate nonparticipating provider payments in good faith under the terms of this chapter;
(c) Align Washington state law with the federal balance billing prohibitions and transparency protections in sections 2799A-1 et seq. of the public health service act (P.L. 116-260) and implementing federal regulations in effect on March 31, 2022, while maintaining provisions of this chapter that provide greater protection for consumers; and
(d) Provide an environment that encourages self-funded groups to negotiate payments in good faith with nonparticipating providers and facilities in return for balance billing protections.
[ 2022 c 263 § 6; 2019 c 427 § 1.]
NOTES:
Effective date—2022 c 263: See note following RCW 43.371.100.
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.49 - Balance Billing Protection Act. › 48.49.030 - Enrollee's obligation to pay for services.

RCW 48.49.030
Enrollee's obligation to pay for services.
(1) If an enrollee receives emergency services from a behavioral health emergency services provider under the circumstances described in RCW 48.49.020(3):
(a) The enrollee satisfies his or her obligation to pay for the health care services if he or she pays the in-network cost-sharing amount specified in the enrollee's or applicable group's health plan contract. The enrollee's obligation must be determined using the methodology for calculating the qualifying payment amount as described in 45 C.F.R. Sec. 149.140 as in effect on March 31, 2022. The carrier must provide an explanation of benefits to the enrollee and the nonparticipating provider that reflects the cost-sharing amount determined under this subsection.
(b) The carrier, nonparticipating behavioral health emergency services provider, and an agent, trustee, or assignee of the carrier or nonparticipating behavioral health emergency services provider must ensure that the enrollee incurs no greater cost than the amount determined under (a) of this subsection.
(c) The nonparticipating behavioral health emergency services provider and an agent, trustee, or assignee of the nonparticipating behavioral health emergency services provider may not balance bill or otherwise attempt to collect from the enrollee any amount greater than the amount determined under (a) of this subsection. This does not impact the behavioral health emergency services provider's ability to collect a past due balance for that cost-sharing amount with interest.
(d) The carrier must treat any cost-sharing amounts determined under (a) of this subsection paid by the enrollee for a nonparticipating behavioral health emergency services provider's services in the same manner as cost-sharing for health care services provided by an in-network behavioral health emergency services provider and must apply any cost-sharing amounts paid by the enrollee for such services toward the enrollee's maximum out-of-pocket payment obligation.
(e) If the enrollee pays the nonparticipating behavioral health emergency services provider an amount that exceeds the in-network cost-sharing amount determined under (a) of this subsection, the behavioral health emergency services provider must refund any amount in excess of the in-network cost-sharing amount to the enrollee within thirty business days of receipt. Interest must be paid to the enrollee for any unrefunded payments at a rate of twelve percent beginning on the first calendar day after the thirty business days.
(2) This section shall only apply to health care providers, facilities, or behavioral health emergency services providers providing services to members of entities administering a self-funded group health plan and its plan members if the entity has elected to participate in this section and RCW 48.49.020, 48.49.160, and 48.49.040 as provided in RCW 48.49.130.
[ 2022 c 263 § 8; 2019 c 427 § 7.]
NOTES:
Effective date—2022 c 263: See note following RCW 43.371.100.
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.49 - Balance Billing Protection Act. › 48.49.060 - Notice of consumer rights—Development of standard template language by commissioner.

RCW 48.49.060
Notice of consumer rights—Development of standard template language by commissioner.
(1) The commissioner, in consultation with health carriers, health care providers, health care facilities, and consumers, must develop standard template language for a notice of consumer rights notifying consumers of their rights under this chapter, and sections 2799A-1 and 2799A-2 of the public health service act (42 U.S.C. Secs. 300gg-111 and 300gg-112) and implementing federal regulations in effect on March 31, 2022.
(2) The standard template language must include contact information for the office of the insurance commissioner so that consumers may contact the office of the insurance commissioner if they believe they have received a balance bill in violation of this chapter.
(3) The office of the insurance commissioner shall determine by rule when and in what format health carriers, health care providers, and health care facilities must provide consumers with the notice developed under this section.
[ 2022 c 263 § 13; 2019 c 427 § 10.]
NOTES:
Effective date—2022 c 263: See note following RCW 43.371.100.
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.49 - Balance Billing Protection Act. › 48.49.070 - Hospital, ambulatory surgical facility, or behavioral health emergency services provider—Requirement to provide certain information on website or upon consumer request—Requirement to provide carriers with nonemployed provider lists.

RCW 48.49.070
Hospital, ambulatory surgical facility, or behavioral health emergency services provider—Requirement to provide certain information on website or upon consumer request—Requirement to provide carriers with nonemployed provider lists.
(1)(a) A hospital, ambulatory surgical facility, or behavioral health emergency services provider must post the following information on its website, if one is available:
(i) The listing of the carrier health plan provider networks with which the hospital, ambulatory surgical facility, or behavioral health emergency services provider is an in-network provider, based upon the information provided by the carrier pursuant to RCW 48.43.730(7); and
(ii) The notice of consumer rights developed under RCW 48.49.060.
(b) If the hospital, ambulatory surgical facility, or behavioral health emergency services provider does not maintain a website, this information must be provided to consumers upon an oral or written request.
(2) Posting or otherwise providing the information required in this section does not relieve a hospital, ambulatory surgical facility, or behavioral health emergency services provider of its obligation to comply with the provisions of this chapter.
(3) Not less than thirty days prior to executing a contract with a carrier, a hospital or ambulatory surgical facility must provide the carrier with a list of the nonemployed providers or provider groups contracted to provide emergency medicine, anesthesiology, pathology, radiology, neonatology, surgery, hospitalist, intensivist[,] and diagnostic services, including radiology and laboratory services at the hospital or ambulatory surgical facility. The hospital or ambulatory surgical facility must notify the carrier within thirty days of a removal from or addition to the nonemployed provider list. A hospital or ambulatory surgical facility also must provide an updated list of these providers within fourteen calendar days of a request for an updated list by a carrier.
[ 2022 c 263 § 14; 2019 c 427 § 11.]
NOTES:
Effective date—2022 c 263: See note following RCW 43.371.100.