reglab/statecodes huggingface dataset:
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.43 - Insurance Reform. › 48.43.200 - Disclosure of certain material transactions—Report—Information is confidential.

RCW 48.43.200
Disclosure of certain material transactions—Report—Information is confidential.
(1) Every certified health plan 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 48.43.205 through 48.43.225 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 certified health plan to which it pertains unless the commissioner, after giving the certified health plan 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 § 7.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.43 - Insurance Reform. › 48.43.205 - Material acquisitions or dispositions.

RCW 48.43.205
Material acquisitions or dispositions.
No acquisitions or dispositions of assets need be reported pursuant to RCW 48.43.200 if the acquisitions or dispositions are not material. For purposes of RCW 48.43.200 through 48.43.225, 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 certified health plan's total assets as reported in its most recent statutory statement filed with the commissioner.
[ 1995 c 86 § 8.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.43 - Insurance Reform. › 48.43.210 - Asset acquisitions—Asset dispositions.

RCW 48.43.210
Asset acquisitions—Asset dispositions.
(1) Asset acquisitions subject to RCW 48.43.200 through 48.43.225 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 certified health plan or the acquisition of materials for such purpose.
(2) Asset dispositions subject to RCW 48.43.200 through 48.43.225 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 § 9.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.43 - Insurance Reform. › 48.43.215 - Report of a material acquisition or disposition of assets—Information required.

RCW 48.43.215
Report of a material acquisition or disposition of assets—Information required.
(1) The following information is required to be disclosed in any report of a material acquisition or disposition of assets:
(a) Date of the transaction;
(b) Manner of acquisition or disposition;
(c) Description of the assets involved;
(d) Nature and amount of the consideration given or received;
(e) Purpose of or reason for the transaction;
(f) Manner by which the amount of consideration was determined;
(g) Gain or loss recognized or realized as a result of the transaction; and
(h) Names of the persons from whom the assets were acquired or to whom they were disposed.
(2) Certified health plans are required to report material acquisitions and dispositions on a nonconsolidated basis unless the certified health plan is part of a consolidated group of insurers that utilizes a pooling arrangement or one hundred percent reinsurance agreement that affects the solvency and integrity of the certified health plan's reserves and such certified health plan ceded substantially all of its direct and assumed business to the pool. A certified health plan has ceded substantially all of its direct and assumed business to a pool if the certified health plan has less than one million dollars total direct plus assumed written premiums during a calendar year that are not subject to a pooling arrangement and the net income of the business not subject to the pooling arrangement represents less than five percent of the certified health plan's net worth.
[ 1995 c 86 § 10.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.43 - Insurance Reform. › 48.43.220 - Material nonrenewals, cancellations, or revisions of ceded reinsurance agreements.

RCW 48.43.220
Material nonrenewals, cancellations, or revisions of ceded reinsurance agreements.
(1) No nonrenewals, cancellations, or revisions of ceded reinsurance agreements need be reported under RCW 48.43.200 if the nonrenewals, cancellations, or revisions are not material. For purposes of RCW 48.43.200 through 48.43.225, a material nonrenewal, cancellation, or revision is one that affects:
(a) More than fifty percent of a certified health plan's total reserve credit taken for business ceded, on an annualized basis, as indicated in the certified health plan's most recent annual statement;
(b) More than ten percent of a certified health plan'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 the certified health plan'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 § 11.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.43 - Insurance Reform. › 48.43.225 - Report of a material nonrenewal, cancellation, or revision of ceded reinsurance agreements—Information required.

RCW 48.43.225
Report of a material nonrenewal, cancellation, or revision of ceded reinsurance agreements—Information required.
(1) The following is required to be disclosed in any report of a material nonrenewal, cancellation, or revision of ceded reinsurance agreements:
(a) The effective date of the nonrenewal, cancellation, or revision;
(b) The description of the transaction with an identification of the initiator;
(c) The purpose of or reason for the transaction; and
(d) If applicable, the identity of the replacement reinsurers.
(2) Certified health plans are required to report all material nonrenewals, cancellations, or revisions of ceded reinsurance agreements on a nonconsolidated basis unless the certified health plan is part of a consolidated group of insurers which utilizes a pooling arrangement or one hundred percent reinsurance agreement that affects the solvency and integrity of the certified health plan's reserves and the certified health plan ceded substantially all of its direct and assumed business to the pool. A certified health plan has ceded substantially all of its direct and assumed business to a pool if the certified health plan has less than one million dollars total direct plus assumed written premiums during a calendar year that are not subject to a pooling arrangement and the net income of the business not subject to the pooling arrangement represents less than five percent of the certified health plan's net worth.
[ 1995 c 86 § 12.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.43 - Insurance Reform. › 48.43.290 - Coverage for prescribed durable medical equipment and mobility enhancing equipment—Sales and use taxes—Definitions.

RCW 48.43.290
Coverage for prescribed durable medical equipment and mobility enhancing equipment—Sales and use taxes—Definitions.
(1) Health plans issued or renewed on or after January 1, 2011, that include coverage for prescribed durable medical equipment and mobility enhancing equipment must include the sales tax or use tax calculation in plan payment, consistent with the application of sales tax in chapter 82.08 RCW or use tax in chapter 82.12 RCW.
(2) The payment for covered durable medical equipment and mobility enhancing equipment must:
(a) Reflect the negotiated provider agreement for the prescribed equipment; and
(b) Separately identify the sales tax or use tax calculation that is included in the payment if the provider submitting a claim or invoice for reimbursement submits to the health plan a claim or invoice with a separate line item for the geographically adjusted sales tax.
(3) The following definitions apply to this section unless the context clearly requires otherwise.
(a) "Durable medical equipment" means equipment, including repair and replacement parts for durable medical equipment that:
(i) Can withstand repeated use;
(ii) Is primarily and customarily used to serve a medical purpose;
(iii) Generally is not useful to a person in the absence of illness or injury; and
(iv) Is not worn in or on the body.
(b) "Mobility enhancing equipment" means equipment, including repair and replacement parts for mobility enhancing equipment that:
(i) Is primarily and customarily used to provide or increase the ability to move from one place to another and that is appropriate for use either in a home or a motor vehicle;
(ii) Is not generally used by persons with normal mobility; and
(iii) Does not include any motor vehicle or equipment on a motor vehicle normally provided by a motor vehicle manufacturer.
[ 2010 c 44 § 1.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.43 - Insurance Reform. › 48.43.605 - Overpayment recovery—Health care provider.

RCW 48.43.605
Overpayment recovery—Health care provider.
(1) Except in the case of fraud, or as provided in subsection (2) of this section, a health care provider may not: (a) Request additional payment from a carrier to satisfy a claim unless he or she does so in writing to the carrier within twenty-four months after the date that the claim was denied or payment intended to satisfy the claim was made; or (b) request that the additional payment be made any sooner than six months after receipt of the request. Any such request must specify why the provider believes the carrier owes the additional payment.
(2) A health care provider may not, if doing so for reasons related to coordination of benefits with another carrier or entity responsible for payment of a claim: (a) Request additional payment from a carrier to satisfy a claim unless he or she does so in writing to the carrier within thirty months after the date the claim was denied or payment intended to satisfy the claim was made; or (b) request that the additional payment be made any sooner than six months after receipt of the request. Any such request must specify why the provider believes the carrier owes the additional payment, and include the name and mailing address of any entity that has disclaimed responsibility for payment of the claim.
(3) If a contract between a carrier and a health care provider conflicts with this section, this section shall prevail. However, nothing in this section prohibits a carrier from choosing at any time to make additional payments to a provider to satisfy a claim.
(4) This section does not apply to claims for health care services provided through dental only health carriers, health care services provided under Title XVIII (medicare) of the social security act, or medicare supplemental plans regulated under chapter 48.66 RCW.
[ 2005 c 278 § 2.]
NOTES:
Application—2005 c 278: See note following RCW 48.43.600.
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.43 - Insurance Reform. › 48.43.650 - Fixed payment insurance products—Commissioner's annual report.

RCW 48.43.650
Fixed payment insurance products—Commissioner's annual report.
The commissioner shall collect information from insurers offering fixed payment insurance products, and report aggregated data for each calendar year, including the number of groups purchasing the products, the number of enrollees, and the number of consumer complaints filed. The reports shall be provided to the legislature annually to reflect the calendar year experience, and the initial report shall reflect calendar year 2008 and be due no later than June 1, 2009, and each June thereafter.
[ 2007 c 296 § 6.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.43 - Insurance Reform. › 48.43.670 - Plan or contract renewal—Modification of wellness program.

RCW 48.43.670
Plan or contract renewal—Modification of wellness program.
Upon the renewal date of an individual or group health benefit plan or contract containing health benefits, the modification of a wellness program, as defined in 45 C.F.R. 146.121(f), included in such a plan or contract shall not be considered a cancellation or nonrenewal of such plan or contract.
[ 2009 c 329 § 3.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.43 - Insurance Reform. › 48.43.680 - Lifetime limit on transplants—Definition.

RCW 48.43.680
Lifetime limit on transplants—Definition.
(1) A health benefit plan that is issued or renewed on or after January 1, 2010, and that provides coverage for organ and tissue transplants, may not permit a separate lifetime limit on transplants of any less than three hundred fifty thousand dollars. The lifetime limit on transplants shall apply from one day prior to the date of the transplant or the date of hospital admission, for a patient who receives a transplant during the course of a longer hospital stay, through one hundred days after the transplant. Donor-related services may apply to the lifetime limit on transplants any time. The major medical lifetime limit shall apply to health care services provided before and after this time period. Benefits provided are subject to all other terms and conditions of the health benefit plan, including but not limited to any applicable coinsurances, deductibles, and copayments.
(2) "Organ and tissue transplant" means the same as defined under the applicable health benefit plan.
[ 2009 c 487 § 1.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.43 - Insurance Reform. › 48.43.690 - Assessments under RCW 70.290.040 considered medical expenses.

RCW 48.43.690
Assessments under RCW 70.290.040 considered medical expenses.
Assessments paid by carriers under RCW 70.290.040 may be considered medical expenses for purposes of rate setting and regulatory filings.
[ 2010 c 174 § 15.]
NOTES:
Effective date—2010 c 174: See RCW 70.290.900.
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.43 - Insurance Reform. › 48.43.700 - Exchange—Plans that a carrier must offer—Review—Rules.

RCW 48.43.700
Exchange—Plans that a carrier must offer—Review—Rules.
(1) For plan or policy years beginning January 1, 2014, a carrier offering a health benefit plan that meets the definition of bronze level in section 1302 of P.L. 111-148 of 2010, as amended, in the individual market outside of the exchange must also offer plans that meet the definition of silver and gold level plans in section 1302 of P.L. 111-148 of 2010, as amended, in the individual market outside of the exchange.
(2) For plan or policy years beginning January 1, 2014, a carrier offering a health benefit plan that meets the definition of bronze level in section 1302 of P.L. 111-148 of 2010, as amended, in the small group market outside of the exchange must also offer plans that meet the definition of silver and gold level plans in section 1302 of P.L. 111-148 of 2010, as amended, in the small group market outside of the exchange.
(3) A health benefit plan meeting the definition of a catastrophic plan in *RCW 48.43.005(8)(c)(i) may only be sold through the exchange.
(4) By December 1, 2016, the exchange board, in consultation with the commissioner, must complete a review of the impact of this section on the health and viability of the markets inside and outside the exchange and submit the recommendations to the legislature on whether to maintain the market rules or let them expire.
(5) The commissioner shall evaluate plans offered at each actuarial value defined in section 1302 of P.L. 111-148 of 2010, as amended, and determine whether variation in prescription drug benefit cost-sharing, both inside and outside the exchange in both the individual and small group markets results in adverse selection. If so, the commissioner may adopt rules to assure substantial equivalence of prescription drug cost-sharing.
[ 2014 c 31 § 1; 2012 c 87 § 6.]
NOTES:
*Reviser's note: RCW 48.43.005 was alphabetized pursuant to RCW 1.08.015(2)(k), changing subsection (8) to subsection (10). RCW 48.43.005 was alphabetized pursuant to RCW 1.08.015(2)(k), changing subsection (10) to subsection (12).
Spiritual care services—2012 c 87: See RCW 43.71.901.
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.43 - Insurance Reform. › 48.43.705 - Plans offered outside of exchange.

RCW 48.43.705
Plans offered outside of exchange.
All nongrandfathered individual and small group health plans, other than catastrophic health plans, offered outside of the exchange must conform with the actuarial value tiers specified in section 1302 of P.L. 111-148 of 2010, as amended, as bronze, silver, gold, or platinum.
[ 2014 c 31 § 2; 2012 c 87 § 7.]
NOTES:
Spiritual care services—2012 c 87: See RCW 43.71.901.
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.43 - Insurance Reform. › 48.43.710 - Certification as qualified health plan not an exemption.

RCW 48.43.710
Certification as qualified health plan not an exemption.
Certification by the Washington health benefit exchange of a plan as a qualified health plan, or of a carrier as a qualified issuer, does not exempt the plan or carrier from any of the requirements of this title or rules adopted by the commissioner pursuant to chapter 34.05 RCW to implement this title.
[ 2012 c 87 § 12.]
NOTES:
Spiritual care services—2012 c 87: See RCW 43.71.901.
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.43 - Insurance Reform. › 48.43.720 - Reinsurance and risk adjustment programs—Affordable care act—Rules.

RCW 48.43.720
Reinsurance and risk adjustment programs—Affordable care act—Rules.
(1)(a) The commissioner, in consultation with the board, shall adopt rules establishing the reinsurance and risk adjustment programs required by P.L. 111-148 of 2010, as amended.
(b) The commissioner must include in deliberations related to reinsurance rule making an analysis of an invisible high risk pool option, in which the full premium and risk associated with certain high-risk or high-cost enrollees would be ceded to the transitional reinsurance program. The analysis must include a determination as to whether that option is authorized under the federal reinsurance program regulations, whether the option would provide sufficiently comprehensive coverage for current nonmedicare high risk pool enrollees, and how an invisible high risk pool option could be designed to ensure that carriers ceding risk provide effective care management to high-risk or high-cost enrollees.
(2) Consistent with federal law, the rules for the reinsurance program must, at a minimum, establish:
(a) A mechanism to collect reinsurance contribution funds;
(b) A reinsurance payment formula; and
(c) A mechanism to disburse reinsurance payments.
(3)(a) The commissioner may adjust the rules adopted under this section as needed to preserve a healthy market both inside and outside of the exchange.
(b) The rules adopted under this section must identify and may require submission of the data needed to support operation of the reinsurance and risk adjustment programs established under this section. The commissioner must identify by rule the sources of the data, and other requirements related to the collection, validation, correction, interpretation, transmission or exchange, and retention of the data.
(4) The commissioner shall contract with one or more nonprofit entities to administer the risk adjustment and reinsurance programs.
(5) Contribution amounts for the transitional reinsurance program under section 1341 of P.L. 111-148 of 2010, as amended, may be increased to include amounts sufficient to cover the costs of administration of the reinsurance program including reasonable costs incurred for preoperational and planning activities related to the reinsurance program.
[ 2012 c 87 § 16.]
NOTES:
Effective date—2012 c 87 §§ 4, 16, 18, and 19-23: See note following RCW 43.71.030.
Spiritual care services—2012 c 87: See RCW 43.71.901.
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.43 - Insurance Reform. › 48.43.725 - Exclusion of mandated benefits from health plan—Carrier requirements—Notice—Fees—Commissioner's duties.

RCW 48.43.725
Exclusion of mandated benefits from health plan—Carrier requirements—Notice—Fees—Commissioner's duties.
(1) A health carrier that excludes, under state or federal law, any benefit required or mandated by this title or rules adopted by the commissioner from any health plan or student health plan shall:
(a) Notify each enrollee in writing of the following:
(i) Which benefits the health plan or student health plan does not cover; and
(ii) Alternate ways in which the enrollees may access excluded benefits in a timely manner;
(b) Ensure that enrollees have prompt access to the information required under this subsection; and
(c) Clearly and legibly include the information specified in (a)(i) and (ii) of this subsection in any of its marketing materials that include a list of benefits covered under the plan. The information must also be listed in the benefit booklet and posted on the carrier's health plan or student health plan website.
(2) For the purpose of mitigating inequity in the health insurance market, unless waived by the commissioner pursuant to (c) of this subsection, the commissioner must assess a fee on any health carrier offering a health plan or student health plan if the health plan or student health plan excludes, under state or federal law, any essential health benefit or coverage that is otherwise required or mandated by this title or rules adopted by the commissioner.
(a) The commissioner shall set the fee in an amount that is the actuarial equivalent of costs attributed to the provision and administration of the excluded benefit. As part of its rate filing, a health carrier subject to this subsection (2) must submit to the commissioner an estimate of the amount of the fee, including supporting documentation of its methods for estimating the fee. The carrier must include in its supporting documentation a certification by a member of the American academy of actuaries that the estimated fee is the actuarial equivalent of costs attributed to the provision and administration of the excluded benefit.
(b) Fees paid under this section must be deposited into the general fund.
(c) The commissioner may waive the fee assessed under this subsection (2) if he or she finds that the carrier excluding a mandated benefit for a health plan or student health plan provides health plan enrollees or student health plan enrollees alternative access to all excluded mandated benefits.
(3) Beginning July 1, 2021, the commissioner shall provide on its website written notice of the carrier requirements in this section and information on alternate ways in which enrollees may access excluded benefits in a timely manner.
(4) Nothing in this section limits the authority of the commissioner to take enforcement action if a health carrier unlawfully fails to comply with the provisions of this title.
(5) The commissioner shall adopt any rules necessary to implement this section.
[ 2020 c 283 § 1.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.43 - Insurance Reform. › 48.43.731 - Health care benefit management contracts—Carrier filing requirements—Notice to enrollees—Confidentiality of filings.

RCW 48.43.731
Health care benefit management contracts—Carrier filing requirements—Notice to enrollees—Confidentiality of filings.
(1) A carrier must file with the commissioner in the form and manner prescribed by the commissioner every contract and contract amendment between the carrier and any health care benefit manager registered under RCW 48.200.030, within thirty days following the effective date of the contract or contract amendment.
(2) For health plans issued or renewed on or after January 1, 2022, carriers must notify health plan enrollees in writing of each health care benefit manager contracted with the carrier to provide any benefit management services in the administration of the health plan.
(3) Contracts filed under this section are confidential and not subject to public inspection under RCW 48.02.120(2), or public disclosure under chapter 42.56 RCW, if filed in accordance with the procedures for submitting confidential filings through the system for electronic rate and form filings and the general filing instructions as set forth by the commissioner. In the event the referenced filing fails to comply with the filing instructions setting forth the process to withhold the contract from public inspection, and the carrier indicates that the contract is to be withheld from public inspection, the commissioner must reject the filing and notify the carrier through the system for electronic rate and form filings to amend its filing to comply with the confidentiality filing instructions.
(4) For purposes of this section, "health care benefit manager" has the same meaning as in RCW 48.200.020.
[ 2020 c 240 § 6.]
NOTES:
Rule making—Effective date—2020 c 240: See RCW 48.200.900 and 48.200.901.
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.43 - Insurance Reform. › 48.43.734 - Health carrier rate filings—Review of surplus, capital, and profit levels.

RCW 48.43.734
Health carrier rate filings—Review of surplus, capital, and profit levels.
(1) For individual and small group rate filings with an effective date on or after January 1, 2021, submitted by a health carrier for either the individual or small group markets, the commissioner may review the carrier's surplus, capital, or profit levels as an element in determining the reasonableness of the proposed rate.
(2) In reviewing the surplus, capital, or profit levels, the commissioner must take into consideration the current capital facility needs for carriers, including those maintaining and operating hospital and clinical facilities.
(3) Except as provided in subsection (1) of this section, this section does not affect the rate review authority granted to the commissioner by chapter 48.19, 48.44, or 48.46 RCW.
(4) Nothing in this section affects the requirement that all approved individual and small group rates be actuarially sound according to chapter 48.19, 48.44, or 48.46 RCW.
(5) The commissioner may adopt rules to implement this section.
[ 2020 c 247 § 1.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.43 - Insurance Reform. › 48.43.740 - Dental only plan—Emergency dental conditions—Definitions.

RCW 48.43.740
Dental only plan—Emergency dental conditions—Definitions.
(1) A health carrier offering a dental only plan may not deny coverage for treatment of emergency dental conditions that would otherwise be considered a covered service of an existing benefit contract on the basis that the services were provided on the same day the covered person was examined and diagnosed for the emergency dental condition.
(2) For purposes of this section:
(a) "Emergency dental condition" means a dental condition manifesting itself by acute symptoms of sufficient severity, including severe pain or infection such that a prudent layperson, who possesses an average knowledge of health and dentistry, could reasonably expect the absence of immediate dental attention to result in:
(i) Placing the health of the individual, or with respect to a pregnant woman the health of the woman or her unborn child, in serious jeopardy;
(ii) Serious impairment to bodily functions; or
(iii) Serious dysfunction of any bodily organ or part.
(b) "Health carrier," in addition to the definition in RCW 48.43.005, also includes health care service contractors, limited health care service contractors, and disability insurers offering dental only coverage.
[ 2015 c 9 § 1.]
NOTES:
Effective date—2015 c 9: "This act takes effect January 1, 2017." [ 2015 c 9 § 3.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.43 - Insurance Reform. › 48.43.743 - Dental only plan—Annual data statement—Contents—Public use—Definition.

RCW 48.43.743
Dental only plan—Annual data statement—Contents—Public use—Definition.
(1) Each health carrier offering a dental only plan shall submit to the commissioner on or before April 1st of each year as part of the additional data statement or as a supplemental data statement the following information for the preceding year that is derived from the carrier's annual statement, including the exhibit of premiums, enrollments, and utilization for the company at an aggregate level and the additional data to the annual statement:
(a) The total number of dental members;
(b) The total amount of dental revenue;
(c) The total amount of dental payments;
(d) The dental loss ratio that is computed by dividing the total amount of dental payments by the total amount of dental revenues;
(e) The average amount of premiums per member per month; and
(f) The percentage change in the average premium per member per month, measured from the previous year.
(2) A carrier shall electronically submit the information described in subsection (1) of this section in a format and according to instructions prescribed by the commissioner.
(3) The commissioner shall make the information reported under this section available to the public in a format that allows comparison among carriers through a searchable public website on the internet.
(4) For the purposes of licensed disability insurers and health care service contractors, the commissioner shall work collaboratively with insurers to develop an additional or supplemental data statement that utilizes to the maximum extent possible information from the annual statement forms that are currently filed by these entities.
(5) For purposes of this section, "health carrier," in addition to the definition in RCW 48.43.005, also includes health care service contractors, limited health care service contractors, and disability insurers offering dental only coverage.
(6) Nothing in this section is intended to establish a minimum dental loss ratio.
[ 2015 c 9 § 2.]
NOTES:
Effective date—2015 c 9: See note following RCW 48.43.740.
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.43 - Insurance Reform. › 48.43.745 - Dental only plan—Denturist services.

RCW 48.43.745
Dental only plan—Denturist services.
(1) Every health carrier offering dental only coverage and every health carrier offering dental only coverage in addition to a health plan delivered, issued for delivery, or renewed by a health carrier on and after January 1, 2024, shall permit denturists licensed under chapter 18.30 RCW to provide dental services or care included in their benefits package, to the extent that:
(a) The provision of such dental services or care is within the health care providers' permitted scope of practice; and
(b) The providers agree to abide by standards related to:
(i) Provision, utilization review, and cost containment of dental services;
(ii) Management and administrative procedures; and
(iii) Provision of cost-effective and clinically efficacious dental services.
(2) The requirements of subsection (1) of this section do not apply to a licensed health care profession regulated under Title 18 RCW when the licensing statute for the profession states that such requirements do not apply.
(3) For purposes of this section, "health carrier," in addition to the definition in RCW 48.43.005, also includes health care service contractors, limited health care service contractors, and disability insurers offering dental only coverage.
(4) Chapter 216, Laws of 2023 does not apply to a plan that offers dental only coverage when the plan relies solely on employees of the health carrier for provision of the benefits.
[ 2023 c 216 § 1.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.43 - Insurance Reform. › 48.43.750 - Health care provider credentialing applications—Use of electronic database by health carriers.

RCW 48.43.750
Health care provider credentialing applications—Use of electronic database by health carriers.
(1)(a) A health carrier must use the database selected pursuant to RCW 48.165.035 to accept and manage credentialing applications from health care providers. A health carrier may not require a health care provider to submit credentialing information in any format other than through the database selected pursuant to RCW 48.165.035.
(b) Effective June 1, 2018, a health carrier shall make a determination approving or denying a credentialing application submitted to the carrier no later than ninety days after receiving a complete application from a health care provider.
(c) Effective June 1, 2020, a health carrier shall make a determination approving or denying a credentialing application submitted to the carrier no later than ninety days after receiving a complete application from a health care provider. All determinations made by a health carrier in approving or denying credentialing applications must average no more than sixty days.
(d) This section does not require health carriers to approve a credentialing application or to place providers into a network.
(2) This section does not apply to health care entities that utilize credentialing delegation arrangements in the credentialing of their health care providers with health carriers.
(3) For purposes of this section, "credentialing" means the collection, verification, and assessment of whether a health care provider meets relevant licensing, education, and training requirements.
(4) Nothing in this section creates an oversight or enforcement duty on behalf of the office of the insurance commissioner against a health carrier for failure to comply with the terms of this section.
[ 2020 c 4 § 1; 2016 c 123 § 1.]
NOTES:
Effective date—2016 c 123: "This act takes effect June 1, 2018." [ 2016 c 123 § 3.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.43 - Insurance Reform. › 48.43.755 - Health care provider credentialing applications—Use of electronic database by providers.

RCW 48.43.755
Health care provider credentialing applications—Use of electronic database by providers.
(1) When submitting a credentialing application to a health carrier, a health care provider shall submit the application to health carriers using the database selected pursuant to RCW 48.165.035.
(2) A health care provider shall update credentialing information as necessary to provide for the purposes of recredentialing.
(3) This section does not apply to providers practicing at entities that utilize credentialing delegation arrangements in the credentialing of their health care providers with health carriers.
(4) The definitions in this subsection apply throughout this section unless the context clearly requires otherwise.
(a) "Credentialing" has the same meaning as in RCW 48.43.750.
(b) "Health care provider" has the same meaning as in *RCW 48.43.005(23)(a).
(c) "Health carrier" has the same meaning as in RCW 48.43.005.
[ 2016 c 123 § 2.]
NOTES:
*Reviser's note: RCW 48.43.005 was alphabetized pursuant to RCW 1.08.015(2)(k), changing subsection (23) to subsection (24), and effective January 1, 2020, changing subsection (23) to subsection (26). RCW 48.43.005 was alphabetized pursuant to RCW 1.08.015(2)(k), changing subsection (26) to subsection (28).
Effective date—2016 c 123: See note following RCW 48.43.750.
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.43 - Insurance Reform. › 48.43.757 - Health care provider credentialing applications—Reimbursement requirements.

RCW 48.43.757
Health care provider credentialing applications—Reimbursement requirements.
(1) If a carrier approves a health care provider's credentialing application, upon completion of the credentialing process, the carrier must reimburse a health care provider under the following circumstances:
(a) When credentialing a new health care provider through a new provider contract, the carrier must reimburse the health care provider for covered services provided to the carrier's enrollee retroactively to the date of contract effectiveness if the credentialing process extends beyond the effective date of the new contract.
(b) When credentialing a provider to be added to an approved and in-use provider contract where a relationship existed between the carrier and the health care provider or the entity for whom the health care provider is employed or engaged at the time the health care provider submitted the completed credentialing application, the carrier must reimburse the health care provider for covered health care services provided to the carrier's enrollees during the credentialing process beginning when the health care provider submitted a completed credentialing application to the carrier.
(2) The health carrier must reimburse the health care provider at the contracted rate for the applicable health benefit plan that the health care provider would have been paid at the time the services were provided if the health care provider were fully credentialed by the carrier.
(3) Nothing in this section requires reimbursement of health care provider-rendered services that are not benefits or services covered by the health carrier's health benefit plan.
(4) Nothing in this section requires a health carrier to pay reimbursement for any covered medical services provided by a health care provider applicant if the health care provider's credentialing application is not approved or if the carrier and health care provider do not enter into a contractual relationship.
[ 2020 c 4 § 2.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.43 - Insurance Reform. › 48.43.760 - Opioid use disorder—Coverage without prior authorization.

RCW 48.43.760
Opioid use disorder—Coverage without prior authorization.
For health plans issued or renewed on or after January 1, 2020, a health carrier shall provide coverage without prior authorization of at least one federal food and drug administration approved product for the treatment of opioid use disorder in the drug classes opioid agonists, opioid antagonists, and opioid partial agonists.
[ 2019 c 314 § 37.]
NOTES:
Declaration—2019 c 314: See note following RCW 18.22.810.
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.43 - Insurance Reform. › 48.43.762 - Opioid overdose reversal medication bulk purchasing and distribution program.

RCW 48.43.762
Opioid overdose reversal medication bulk purchasing and distribution program.
For health plans issued or renewed on or after January 1, 2023, health carriers must participate in the opioid overdose reversal medication bulk purchasing and distribution program established in RCW 70.14.170 once the program is operational. A health plan may not impose enrollee cost sharing related to opioid overdose reversal medication provided through the bulk purchasing and distribution program established in RCW 70.14.170.
[ 2021 c 273 § 11.]
NOTES:
Rules—2021 c 273 §§ 7-12: See note following RCW 70.14.170.
Findings—Intent—2021 c 273: See note following RCW 70.41.480.
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.43 - Insurance Reform. › 48.43.765 - Health carrier network adequacy—Mental health and substance abuse treatment.

RCW 48.43.765
Health carrier network adequacy—Mental health and substance abuse treatment.
(1) The commissioner shall amend his or her rules on electronic provider directories to require health carriers to include a notation when any mental health provider or substance abuse provider is closed to new patients.
(2) Beginning January 1, 2020, a health carrier shall prominently post the information listed in (a) through (e) of this subsection on its website in an easily understandable format and in a manner that any interested party may obtain the information:
(a) Whether the health carrier classifies mental health treatment and substance abuse treatment as primary care or specialty care and the number of business days within which an enrollee must have access to covered mental health treatment services and substance abuse treatment services under network access standards pertaining to primary care or specialty care, as applicable, adopted by the commissioner;
(b) Information on actions an enrollee may take if he or she is unable to access covered mental health treatment services or substance abuse treatment services within the requisite number of business days, including any tools or resources the carrier makes available to enrollees to assist them in finding available providers and information on how to file a complaint with the office of the insurance commissioner;
(c) Any instances where the commissioner has taken disciplinary action against the health carrier for failing to comply with network access standards for covered mental health treatment services or substance abuse treatment services;
(d) A link to the commissioner's report published under subsection (5) of this section; and
(e) Resources for persons who are experiencing a mental health crisis including, but not limited to, information on the national suicide prevention lifeline.
(3) The commissioner shall, by rule, specify a model format for the information required to be posted on a health carrier's website under subsection (2) of this section.
(4) The commissioner may audit the information a health carrier provides under this section for accuracy.
(5) The commissioner shall annually publish on the commissioner's website a report on the number of consumer complaints per licensed health carrier the commissioner received in the previous calendar year regarding consumers who were not able to access covered mental health treatment services or substance abuse treatment services within the time limits established by the commissioner for primary care or specialty care.
[ 2019 c 11 § 1.]
NOTES:
Short title—2019 c 11: "This act may be known and cited as Brennen's law." [ 2019 c 11 § 2.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.43 - Insurance Reform. › 48.43.767 - Behavioral health services—Network access.

RCW 48.43.767
Behavioral health services—Network access.
By July 1, 2025, every carrier shall provide access to services provided by behavioral health support specialists in a manner sufficient to meet the network access standards set forth in rules established by the office of the insurance commissioner.
[ 2023 c 270 § 12.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.43 - Insurance Reform. › 48.43.770 - Individual market health plan availability—Annual report.

RCW 48.43.770
Individual market health plan availability—Annual report.
The commissioner shall submit an annual report to the appropriate committees of the legislature on the number of health plans available per county in the individual market.
[ 2019 c 364 § 7.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.43 - Insurance Reform. › 48.43.775 - Qualified health plan participation—Reimbursement rate for other health plans.

RCW 48.43.775
Qualified health plan participation—Reimbursement rate for other health plans.
A carrier may not require a provider or facility participating in a qualified health plan under RCW 41.05.410 to, as a condition of participation in a qualified health plan under RCW 41.05.410, accept a reimbursement rate for other health plans offered by the carrier at the same rate as the provider or facility is reimbursed for a qualified health plan under RCW 41.05.410.
[ 2019 c 364 § 8.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.43 - Insurance Reform. › 48.43.780 - Insulin drugs—Cap on enrollee's required payment amount—Cost-sharing requirements.

RCW 48.43.780
Insulin drugs—Cap on enrollee's required payment amount—Cost-sharing requirements.
(1) Except as required in subsection (2) of this section, a health plan issued or renewed on or after January 1, 2023, that provides coverage for prescription insulin drugs for the treatment of diabetes must cap the total amount that an enrollee is required to pay for a covered insulin drug at an amount not to exceed $35 per 30-day supply of the drug. Prescription insulin drugs must be covered without being subject to a deductible, and any cost sharing paid by an enrollee must be applied toward the enrollee's deductible obligation.
(2) If the federal internal revenue service removes insulin from the list of preventive care services which can be covered by a qualifying health plan for a health savings account before the deductible is satisfied, for a health plan that provides coverage for prescription insulin drugs for the treatment of diabetes and is offered as a qualifying health plan for a health savings account, the carrier must establish the plan's cost sharing for the coverage of prescription insulin for diabetes at the minimum level necessary to preserve the enrollee's ability to claim tax exempt contributions from his or her health savings account under internal revenue service laws and regulations. The office of the insurance commissioner must provide written notice of the change in internal revenue service guidance to affected parties, the chief clerk of the house of representatives, the secretary of the senate, the office of the code reviser, and others as deemed appropriate by the office.
[ 2023 c 16 § 1; 2022 c 10 § 1. Prior: 2020 c 346 § 5; 2020 c 245 § 1.]
NOTES:
Effective date—2022 c 10 § 1: "Section 1 of this act takes effect January 1, 2023." [ 2022 c 10 § 3.]
Intent—2020 c 346: See note following RCW 70.14.165.