reglab/statecodes huggingface dataset:
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.180 - Nonprofit Corporations—Joint Self-Insurance Programs. › 48.180.050 - Prohibition on receiving anything of value for services rendered.

RCW 48.180.050
Prohibition on receiving anything of value for services rendered.
(1) An employee or official of a participating nonprofit corporation in a joint self-insurance program may not directly or indirectly receive anything of value for services rendered in connection with the operation and management of a self-insurance program other than the salary and benefits provided by his or her employer or the reimbursement of expenses reasonably incurred in furtherance of the operation or management of the program. An employee or official of a participating nonprofit corporation in a joint self-insurance program may not accept or solicit anything of value for personal benefit or for the benefit of others under circumstances in which it can be reasonably inferred that the employee's or official's independence of judgment is impaired with respect to the management and operation of the program.
(2) RCW 48.30.140, 48.30.150, and 48.30.157 apply to the use of insurance producers and surplus line brokers by a joint self-insurance program.
[ 2015 c 109 § 14.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.180 - Nonprofit Corporations—Joint Self-Insurance Programs. › 48.180.055 - Program exempt from certain taxes and fees.

RCW 48.180.055
Program exempt from certain taxes and fees.
A joint self-insurance program approved in accordance with this chapter is exempt from insurance premium taxes, fees assessed under chapters 48.02, 48.32, and 48.32A RCW, business and occupation taxes imposed under chapter 82.04 RCW, and any assigned risk plan or joint underwriting association otherwise required by law. This section does not apply to or provide exemptions for insurance companies issuing policies to cover program risks and third-party administrators or insurance producers serving the joint self-insurance program.
[ 2015 c 109 § 15.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.180 - Nonprofit Corporations—Joint Self-Insurance Programs. › 48.180.060 - Investigation fee—Use—Failure to pay.

RCW 48.180.060
Investigation fee—Use—Failure to pay.
(1) The state risk manager shall establish and charge an investigation fee in an amount necessary to cover the costs for the initial review and approval of a joint self-insurance program. The fee must accompany the initial submission of the plan of operation and management.
(2) The costs of subsequent reviews and investigations must be charged to the joint self-insurance program being reviewed or investigated in accordance with the actual time and expenses incurred in the review or investigation.
(3) Any program failing to remit its assessment when due is subject to denial of permission to operate or to a cease and desist order until the assessment is paid.
[ 2015 c 109 § 16.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.180 - Nonprofit Corporations—Joint Self-Insurance Programs. › 48.180.065 - Immunity from liability—Person who files, reports, or furnishes information—State risk manager and agents or employees.

RCW 48.180.065
Immunity from liability—Person who files, reports, or furnishes information—State risk manager and agents or employees.
(1) Any person who files, reports, or furnishes other information required under this title, required by the state risk manager under the authority granted under this title, or which is useful to the state risk manager in the administration of this title is immune from liability in any civil action or suit arising from the filing of any such report or furnishing such information to the state risk manager, unless actual malice, fraud, or bad faith is shown.
(2) The state risk manager and his or her agents and employees are immune from liability in any civil action or suit arising from the publication of any report or bulletin or from dissemination of information related to the official activities of the state risk manager unless actual malice, fraud, or bad faith is shown.
(3) The immunity granted under this section is in addition to any common law or statutory privilege or immunity enjoyed by such person. This section is not intended to abrogate or modify in any way such common law or statutory privilege or immunity.
[ 2015 c 109 § 17.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.185 - Electronic Notices and Document Delivery. › 48.185.010 - Certain property and casualty insurance information—May be mailed, delivered, or posted on website—Requirements to post on website.

RCW 48.185.010
Certain property and casualty insurance information—May be mailed, delivered, or posted on website—Requirements to post on website.
(1) Notwithstanding any other provisions of this chapter, standard property and casualty insurance policy forms and endorsements that do not contain personally identifiable information may be mailed, delivered, or posted on the insurer's website. If the insurer elects to post insurance policy forms and endorsements on its website in lieu of mailing or delivering them to the insured, it must comply with all of the following conditions:
(a) The policy forms and endorsements must be accessible to the insured and the producer of record and remain that way for as long as the policy is in force;
(b) After the expiration of the policy, the insurer must archive its expired policy forms and endorsements for a period of six years or other period required by law, and make them available upon request;
(c) The policy forms and endorsements must be posted in a manner that enables the insured and producer of record to print and save the policy form and endorsements using programs or applications that are widely available on the internet and free to use;
(d) The insurer must provide the following information in, or simultaneous with, each declarations page provided at the time of issuance of the initial policy and any renewals of that policy:
(i) A description of the exact policy and endorsement forms purchased by the insured;
(ii) A description of the insured's right to receive, upon request and without charge, a paper copy of the policy and endorsements by mail;
(iii) The internet address where their policy and endorsements are posted;
(iv) The insurer, upon request and without charge, mails a paper copy of the insured's policy and endorsements to the insured; and
(v) Notice, in the manner in which the insurer customarily communicates with the insured, of any changes to the forms or endorsements, the insured's right to obtain, upon request and without charge, a paper copy of such forms or endorsements, and the internet address where such forms or endorsements are posted.
(2) Nothing in this section affects the timing or content of any disclosure or other document required to be provided or made available to any insured under applicable law.
[ 2015 c 263 § 2.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.190 - Public Benefit Hospital Entities—Joint Self-Insurance Programs. › 48.190.005 - Intent.

RCW 48.190.005
Intent.
This chapter is intended to provide authority for two or more public benefit hospital entities to participate in a joint self-insurance program covering property or liability risks. This chapter provides public benefit hospital entities with the exclusive source of authority to jointly self-insure property and liability risks, jointly purchase insurance or reinsurance, and to contract for risk management, claims, and administrative services with other public benefit hospital entities, except as otherwise provided in this chapter. This chapter must be liberally construed to grant public benefit hospital entities maximum flexibility in jointly self-insuring to the extent the self-insurance programs are operated in a safe and sound manner. This chapter is intended to require prior approval for the establishment of every joint self-insurance program. In addition, this chapter is intended to require every joint self-insurance program for public benefit hospital entities established under this chapter to notify the state of the existence of the program and to comply with the regulatory and statutory standards governing the management and operation of the programs as provided in this chapter. This chapter is not intended to authorize or regulate self-insurance of unemployment compensation under chapter 50.44 RCW or industrial insurance under chapter 51.14 RCW.
[ 2017 c 221 § 1.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.190 - Public Benefit Hospital Entities—Joint Self-Insurance Programs. › 48.190.010 - Definitions.

RCW 48.190.010
Definitions.
The definitions in this section apply throughout this chapter unless the context clearly requires otherwise.
(1) "Hospital services" means clinically related (i.e., preventive, diagnostic, curative, rehabilitative, or palliative) services provided in a hospital setting.
(2) "Property and liability risks" include the risk of property damage or loss sustained by a public benefit hospital entity and the risk of claims arising from the tortious or negligent conduct or any error or omission of the entity, its officers, employees, agents, or volunteers as a result of which a claim may be made against the entity.
(3) "Public benefit hospital entity" means any of the following:
(a) A public hospital district organized under the laws of this state or another state and any agency or instrumentality of a public hospital district including, but not limited to, a legal entity created to conduct a joint self-insurance program for public hospital districts that is operating in accordance with chapter 48.62 RCW; or
(b) A nonprofit corporation, whether organized under the laws of this state or another state, that meets the following requirements:
(i) The nonprofit corporation operates one or more hospitals each of which is licensed for three hundred sixty or fewer beds by the department of health pursuant to chapter 70.41 RCW; and
(ii) The nonprofit corporation is engaged in providing hospital services.
(4) "Self-insurance" means a formal program of advance funding and management of entity financial exposure to a risk of loss that is not transferred through the purchase of an insurance policy or contract.
(5) "State risk manager" means the risk manager of the office of risk management within the department of enterprise services.
[ 2017 c 221 § 2.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.190 - Public Benefit Hospital Entities—Joint Self-Insurance Programs. › 48.190.030 - Applicability of chapter.

RCW 48.190.030
Applicability of chapter.
This chapter does not apply to a public benefit hospital entity that:
(1) Individually self-insures for property and liability risks; or
(2) Participates in a risk pooling arrangement, including a risk retention group or a risk purchasing group, regulated under chapter 48.92 RCW, is a captive insurer authorized in its state of domicile, or participates in a local government risk pool formed under chapter 48.62 RCW.
[ 2017 c 221 § 4.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.190 - Public Benefit Hospital Entities—Joint Self-Insurance Programs. › 48.190.040 - State risk manager—Rules.

RCW 48.190.040
State risk manager—Rules.
The state risk manager shall adopt rules governing the management and operation of joint self-insurance programs for public benefit hospital entities that cover property or liability risks. All rules must be appropriate for the type of program and class of risk covered. The state risk manager's rules must include:
(1) Standards for the management, operation, and solvency of joint self-insurance programs, including the necessity and frequency of actuarial analyses and claims audits;
(2) Standards for claims management procedures;
(3) Standards for contracts between joint self-insurance programs and private businesses, including standards for contracts between third-party administrators and programs; and
(4) Standards that preclude public hospital districts or other public entities participating in the joint self-insurance program from subsidizing, regardless of the form of subsidy, public benefit hospital entities that are not public hospital districts or public entities. These standards do not apply to the consideration attributable to the ownership interest of a public hospital district or other public entity in a separate legal or administrative entity organized with respect to the program.
[ 2017 c 221 § 5.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.190 - Public Benefit Hospital Entities—Joint Self-Insurance Programs. › 48.190.050 - State risk manager—Approval of program creation—Required submissions.

RCW 48.190.050
State risk manager—Approval of program creation—Required submissions.
Before the establishment of a joint self-insurance program covering property or liability risks by public benefit hospital entities, the entities must obtain the approval of the state risk manager. The entities proposing the creation of a joint self-insurance program requiring prior approval shall submit a plan of management and operation to the state risk manager that provides at least the following information:
(1) The risk or risks to be covered, including any coverage definitions, terms, conditions, and limitations;
(2) The amount and method of funding the covered risks, including the initial capital and proposed rates and projected premiums;
(3) The proposed claim reserving practices;
(4) The proposed purchase and maintenance of insurance or reinsurance in excess of the amounts retained by the joint self-insurance program;
(5) The legal form of the program including, but not limited to, any articles of incorporation, bylaws, charter, or trust agreement or other agreement among the participating entities;
(6) The agreements with participants in the program defining the responsibilities and benefits of each participant and management;
(7) The proposed accounting, depositing, and investment practices of the program;
(8) The proposed time when actuarial analysis will be first conducted and the frequency of future actuarial analysis;
(9) A designation of the individual to whom service of process must be forwarded by the state risk manager on behalf of the program;
(10) All contracts between the program and private persons providing risk management, claims, or other administrative services;
(11) A professional analysis of the feasibility of the creation and maintenance of the program;
(12) A legal determination of the potential federal and state tax liabilities of the program; and
(13) Any other information required by rule of the state risk manager that is necessary to determine the probable financial and management success of the program or that is necessary to determine compliance with this chapter.
[ 2017 c 221 § 6.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.190 - Public Benefit Hospital Entities—Joint Self-Insurance Programs. › 48.190.070 - Participation with entities from other states.

RCW 48.190.070
Participation with entities from other states.
A public benefit hospital entity may participate in a joint self-insurance program covering property or liability risks with similar public benefit hospital entities from other states if the program satisfies the following requirements:
(1) An ownership interest in the program is limited to some or all of the public benefit hospital entities of this state and public benefit hospital entities of other states that are provided insurance by the program;
(2) The participating public benefit hospital entities of this state and other states shall elect a board of directors to manage the program, a majority of whom must be affiliated with one or more of the participating public benefit hospital entities;
(3) The program must provide coverage through the delivery to each participating public benefit hospital entity of one or more written policies affecting insurance of covered risks;
(4) The program must be financed, including the payment of premiums and the contribution of initial capital, in accordance with the plan of management and operation submitted to the state risk manager in accordance with this chapter;
(5) The financial statements of the program must be audited annually by the certified public accountants for the program, and these audited financial statements must be delivered to the state risk manager not more than one hundred twenty days after the end of each fiscal year of the program;
(6) The investments of the program must be initiated only with financial institutions or broker-dealers, or both, doing business in those states in which participating public benefit hospital entities are located, and these investments must be audited annually by the certified public accountants for the program;
(7) The treasurer of a multistate joint self-insurance program must be designated by resolution of the program and the treasurer must be located in the state of one of the participating entities;
(8) The participating entities may have no contingent liabilities for covered claims, other than liabilities for unpaid premiums, retrospective premiums, or assessments, if assets of the program are insufficient to cover the program's liabilities; and
(9) The program must obtain approval from the state risk manager in accordance with this chapter and must remain in compliance with this chapter, except if provided otherwise under this section.
[ 2017 c 221 § 7.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.190 - Public Benefit Hospital Entities—Joint Self-Insurance Programs. › 48.190.080 - Designation of treasurer—Interest and earnings.

RCW 48.190.080
Designation of treasurer—Interest and earnings.
(1) A joint self-insurance program may by resolution of the program designate a person having experience with investments or financial matters as treasurer of the program. The program must require a bond obtained from a surety company in an amount and under the terms and conditions that the program finds will protect against loss arising from mismanagement or malfeasance in investing and managing program funds. The program may pay the premium on the bond.
(2) All interest and earnings collected on joint self-insurance program funds belong to the program and must be deposited to the program's credit in the proper program account.
[ 2017 c 221 § 9.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.190 - Public Benefit Hospital Entities—Joint Self-Insurance Programs. › 48.190.090 - Receiving or soliciting anything of value—Inducement.

RCW 48.190.090
Receiving or soliciting anything of value—Inducement.
(1) An employee or official of a participating public benefit hospital entity in a joint self-insurance program may not directly or indirectly receive anything of value for services rendered in connection with the operation and management of a self-insurance program other than the salary and benefits provided by his or her employer or the reimbursement of expenses reasonably incurred in furtherance of the operation or management of the program. An employee or official of a participating public benefit hospital entity in a joint self-insurance program may not accept or solicit anything of value for personal benefit or for the benefit of others under circumstances in which it can be reasonably inferred that the employee's or official's independence of judgment is impaired with respect to the management and operation of the program.
(2) RCW 48.30.140, 48.30.150, and 48.30.157 apply to the use of insurance producers by a joint self-insurance program.
[ 2017 c 221 § 10.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.190 - Public Benefit Hospital Entities—Joint Self-Insurance Programs. › 48.190.100 - Tax exemptions.

RCW 48.190.100
Tax exemptions.
A joint self-insurance program approved in accordance with this chapter is exempt from insurance premium taxes, fees assessed under chapter 48.02 RCW, chapters 48.32 and 48.32A RCW, business and occupation taxes imposed under chapter 82.04 RCW, and any assigned risk plan or joint underwriting association otherwise required by law. This section does not apply to, and no exemption is provided for, insurance companies issuing policies to cover program risks, and does not apply to or provide an exemption for third-party administrators or insurance producers serving the joint self-insurance program.
[ 2017 c 221 § 11.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.190 - Public Benefit Hospital Entities—Joint Self-Insurance Programs. › 48.190.110 - Fees.

RCW 48.190.110
Fees.
(1) The state risk manager shall establish and charge an investigation fee in an amount necessary to cover the costs for the initial review and approval of a joint self-insurance program. The fee must accompany the initial submission of the plan of operation and management.
(2) The costs of subsequent reviews and investigations must be charged to the joint self-insurance program being reviewed or investigated in accordance with the actual time and expenses incurred in the review or investigation.
(3) Any program failing to remit its assessment when due is subject to denial of permission to operate or to a cease and desist order until the assessment is paid.
[ 2017 c 221 § 12.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.190 - Public Benefit Hospital Entities—Joint Self-Insurance Programs. › 48.190.120 - Civil immunity—Filings and publications.

RCW 48.190.120
Civil immunity—Filings and publications.
(1) Any person who files reports or furnishes other information required under this title, required by the state risk manager under the authority granted under this title, or which is useful to the state risk manager in the administration of this title, is immune from liability in any civil action or suit arising from the filing of any such report or furnishing such information to the state risk manager, unless actual malice, fraud, or bad faith is shown.
(2) The state risk manager and his or her agents and employees are immune from liability in any civil action or suit arising from the publication of any report or bulletins or arising from dissemination of information related to the official activities of the state risk manager unless actual malice, fraud, or bad faith is shown.
(3) The immunity granted under this section is in addition to any common law or statutory privilege or immunity enjoyed by such person. This section is not intended to abrogate or modify in any way such common law or statutory privilege or immunity.
[ 2017 c 221 § 13.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.195 - Corporate Governance Annual Disclosure. › 48.195.005 - Purpose—Application.

RCW 48.195.005
Purpose—Application.
(1) The purpose of this chapter is to:
(a) Provide the insurance commissioner a summary of an insurer or insurance group's corporate governance structure, policies, and practices to permit the commissioner to gain and maintain an understanding of the insurer's corporate governance framework;
(b) Outline the requirements for completing a corporate governance annual disclosure with the commissioner; and
(c) Provide for the confidential treatment of the corporate governance annual disclosure and related information that will contain confidential and sensitive information related to an insurer or insurance group's internal operations and proprietary and trade secret information which, if made public, could potentially cause the insurer or insurance group competitive harm or disadvantage.
(2) This chapter does not prescribe or impose corporate governance standards and internal procedures beyond that which is required under applicable corporate law. This chapter does not limit the commissioner's authority, or the rights or obligations of third parties, under chapter 48.03 RCW.
(3) This chapter applies to all insurers domiciled in this state.
[ 2018 c 30 § 1.]
NOTES:
Effective date—2018 c 30: "(1) The first filing of the corporate governance annual disclosure is 2019.
(2) This act takes effect January 1, 2019." [ 2018 c 30 § 11.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.195 - Corporate Governance Annual Disclosure. › 48.195.010 - Definitions.

RCW 48.195.010
Definitions.
The definitions in this section apply throughout this chapter unless the context clearly requires otherwise.
(1) "Commissioner" means the insurance commissioner of this state.
(2) "Corporate governance annual disclosure" means a confidential report filed by the insurer or insurance group under this chapter.
(3) "Insurance group" means those insurers and affiliates included within an insurance holding company system as defined in RCW 48.31B.005.
(4) "Insurer" has the same meaning as set forth in RCW 48.31B.005.
(5) "ORSA summary report" means the report filed under chapter 48.05A RCW.
[ 2018 c 30 § 2.]
NOTES:
Effective date—2018 c 30: See note following RCW 48.195.005.
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.195 - Corporate Governance Annual Disclosure. › 48.195.030 - Responses to annual disclosure inquiries—Documentation and supporting information.

RCW 48.195.030
Responses to annual disclosure inquiries—Documentation and supporting information.
(1) The insurer or insurance group has discretion over the responses to the corporate governance annual disclosure inquiries, provided the corporate governance annual disclosure contains the material information necessary to permit the commissioner to gain an understanding of the insurer's or insurance group's corporate governance structure, policies, and practices. The commissioner may request additional information that he or she deems material and necessary to provide the commissioner with a clear understanding of the corporate governance policies, the reporting or information system, or controls implementing those policies.
(2) The corporate governance annual disclosure must be prepared consistent with the national association of insurance commissioners' corporate governance annual disclosure model rule which may be adopted by the commissioner. Documentation and supporting information must be maintained and made available upon examination or upon request of the commissioner.
[ 2018 c 30 § 4.]
NOTES:
Effective date—2018 c 30: See note following RCW 48.195.005.
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.195 - Corporate Governance Annual Disclosure. › 48.195.060 - Failure to timely file—Penalties.

RCW 48.195.060
Failure to timely file—Penalties.
Any insurer failing, without just cause, to timely file the corporate governance annual disclosure as required by this chapter is required, after notice and hearing under chapters 48.04 and 34.05 RCW, to pay a penalty of five hundred dollars for each day's delay, to be recovered by the commissioner and the penalty must be paid to the general fund of this state. The maximum penalty under this section is one hundred thousand dollars. The commissioner may reduce the penalty if the insurer demonstrates to the commissioner that the imposition of the penalty would constitute a financial hardship to the insurer.
[ 2018 c 30 § 7.]
NOTES:
Effective date—2018 c 30: See note following RCW 48.195.005.
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.195 - Corporate Governance Annual Disclosure. › 48.195.100 - Rules.

RCW 48.195.100
Rules.
The commissioner may, under chapter 34.05 RCW, adopt rules to implement and administer this chapter, including the national association of insurance commissioners' corporate governance annual disclosure model rule.
[ 2018 c 30 § 8.]
NOTES:
Effective date—2018 c 30: See note following RCW 48.195.005.
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.200 - Health Care Benefit Managers. › 48.200.010 - Findings—Intent.

RCW 48.200.010
Findings—Intent.
(1) The legislature finds that growth in managed health care systems has shifted substantial authority over health care decisions from providers and patients to health carriers and health care benefit managers. Health care benefit managers acting as intermediaries between carriers, health care providers, and patients exercise broad discretion to affect health care services recommended and delivered by providers and the health care choices of patients. Regularly, these health care benefit managers are making health care decisions on behalf of carriers. However, unlike carriers, health care benefit managers are not currently regulated.
(2) Therefore, the legislature finds that it is in the best interest of the public to create a separate chapter in this title for health care benefit managers.
(3) The legislature intends to protect and promote the health, safety, and welfare of Washington residents by establishing standards for regulatory oversight of health care benefit managers.
[ 2020 c 240 § 1.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.200 - Health Care Benefit Managers. › 48.200.030 - Registration requirements—Application—Fees—Retention of transaction records.

RCW 48.200.030
Registration requirements—Application—Fees—Retention of transaction records.
(1) To conduct business in this state, a health care benefit manager must register with the commissioner and annually renew the registration.
(2) To apply for registration under this section, a health care benefit manager must:
(a) Submit an application on forms and in a manner prescribed by the commissioner and verified by the applicant by affidavit or declaration under chapter 5.50 RCW. Applications must contain at least the following information:
(i) The identity of the health care benefit manager and of persons with any ownership or controlling interest in the applicant including relevant business licenses and tax identification numbers, and the identity of any entity that the health care benefit manager has a controlling interest in;
(ii) The business name, address, phone number, and contact person for the health care benefit manager;
(iii) Any areas of specialty such as pharmacy benefit management, radiology benefit management, laboratory benefit management, mental health benefit management, or other specialty; and
(iv) Any other information as the commissioner may reasonably require.
(b) Pay an initial registration fee and annual renewal registration fee as established in rule by the commissioner. The fees for each registration must be set by the commissioner in an amount that ensures the registration, renewal, and oversight activities are self-supporting. If one health care benefit manager has a contract with more than one carrier, the health care benefit manager must complete only one application providing the details necessary for each contract.
(3) All receipts from fees collected by the commissioner under this section must be deposited into the insurance commissioner's regulatory account created in RCW 48.02.190.
(4) Before approving an application for or renewal of a registration, the commissioner must find that the health care benefit manager:
(a) Has not committed any act that would result in denial, suspension, or revocation of a registration;
(b) Has paid the required fees; and
(c) Has the capacity to comply with, and has designated a person responsible for, compliance with state and federal laws.
(5) Any material change in the information provided to obtain or renew a registration must be filed with the commissioner within thirty days of the change.
(6) Every registered health care benefit manager must retain a record of all transactions completed for a period of not less than seven years from the date of their creation. All such records as to any particular transaction must be kept available and open to inspection by the commissioner during the seven years after the date of completion of such transaction.
[ 2020 c 240 § 3.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.200 - Health Care Benefit Managers. › 48.200.040 - Contract requirements—Written agreement describing rights and responsibilities—Filing of contracts—Confidentiality.

RCW 48.200.040
Contract requirements—Written agreement describing rights and responsibilities—Filing of contracts—Confidentiality.
(1) A health care benefit manager may not provide health care benefit management services to a health carrier or employee benefits programs without a written agreement describing the rights and responsibilities of the parties conforming to the provisions of this chapter and any rules adopted by the commissioner to implement or enforce this chapter including rules governing contract content.
(2) A health care benefit manager must file with the commissioner in the form and manner prescribed by the commissioner, every benefit management contract and contract amendment between the health care benefit manager and a health carrier, provider, pharmacy, pharmacy services administration organization, or other health care benefit manager, entered into directly or indirectly in support of a contract with a carrier or employee benefits programs, within 30 days following the effective date of the contract or contract amendment. Contracts and contract amendments between health care benefit managers and health carriers that were executed prior to July 23, 2023, and remain in force must be filed with the commissioner no later than 60 days following July 23, 2023.
(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 health care benefit manager indicates that the contract is to be withheld from public inspection, the commissioner must reject the filing and notify the health care benefit manager through the system for electronic rate and form filings to amend its filing to comply with the confidentiality filing instructions.
[ 2023 c 107 § 1; 2020 c 240 § 4.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.200 - Health Care Benefit Managers. › 48.200.210 - Definitions applicable to RCW 48.200.220 through 48.200.290.

RCW 48.200.210
Definitions applicable to RCW 48.200.220 through 48.200.290.
The definitions in this section apply throughout this section and RCW 48.200.220 through 48.200.290 unless the context clearly requires otherwise.
(1) "Audit" means an on-site or remote review of the records of a pharmacy by or on behalf of an entity.
(2) "Claim" means a request from a pharmacy or pharmacist to be reimbursed for the cost of filling or refilling a prescription for a drug or for providing a medical supply or service.
(3) "Clerical error" means a minor error:
(a) In the keeping, recording, or transcribing of records or documents or in the handling of electronic or hard copies of correspondence;
(b) That does not result in financial harm to an entity; and
(c) That does not involve dispensing an incorrect dose, amount, or type of medication, or dispensing a prescription drug to the wrong person.
(4) "Entity" includes:
(a) A pharmacy benefit manager;
(b) An insurer;
(c) A third-party payor;
(d) A state agency; or
(e) A person that represents or is employed by one of the entities described in this subsection.
(5) "Fraud" means knowingly and willfully executing or attempting to execute a scheme, in connection with the delivery of or payment for health care benefits, items, or services, that uses false or misleading pretenses, representations, or promises to obtain any money or property owned by or under the custody or control of any person.
(6) "Pharmacist" has the same meaning as in RCW 18.64.011.
(7) "Pharmacy" has the same meaning as in RCW 18.64.011.
(8) "Third-party payor" means a person licensed under RCW 48.39.005.
[ 2020 c 240 § 10; 2014 c 213 § 3. Formerly RCW 19.340.020.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.200 - Health Care Benefit Managers. › 48.200.220 - Auditing of claims—Requirements—Prohibited practices.

RCW 48.200.220
Auditing of claims—Requirements—Prohibited practices.
An entity that audits claims or an independent third party that contracts with an entity to audit claims:
(1) Must establish, in writing, a procedure for a pharmacy to appeal the entity's findings with respect to a claim and must provide a pharmacy with a notice regarding the procedure, in writing or electronically, prior to conducting an audit of the pharmacy's claims;
(2) May not conduct an audit of a claim more than twenty-four months after the date the claim was adjudicated by the entity;
(3) Must give at least fifteen days' advance written notice of an on-site audit to the pharmacy or corporate headquarters of the pharmacy;
(4) May not conduct an on-site audit during the first five days of any month without the pharmacy's consent;
(5) Must conduct the audit in consultation with a pharmacist who is licensed by this or another state if the audit involves clinical or professional judgment;
(6) May not conduct an on-site audit of more than two hundred fifty unique prescriptions of a pharmacy in any twelve-month period except in cases of alleged fraud;
(7) May not conduct more than one on-site audit of a pharmacy in any twelve-month period;
(8) Must audit each pharmacy under the same standards and parameters that the entity uses to audit other similarly situated pharmacies;
(9) Must pay any outstanding claims of a pharmacy no more than forty-five days after the earlier of the date all appeals are concluded or the date a final report is issued under RCW 48.200.260(3);
(10) May not include dispensing fees or interest in the amount of any overpayment assessed on a claim unless the overpaid claim was for a prescription that was not filled correctly;
(11) May not recoup costs associated with:
(a) Clerical errors; or
(b) Other errors that do not result in financial harm to the entity or a consumer; and
(12) May not charge a pharmacy for a denied or disputed claim until the audit and the appeals procedure established under subsection (1) of this section are final.
[ 2020 c 240 § 11; 2014 c 213 § 4. Formerly RCW 19.340.040.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.200 - Health Care Benefit Managers. › 48.200.230 - Basis of finding of claim.

RCW 48.200.230
Basis of finding of claim.
An entity's finding that a claim was incorrectly presented or paid must be based on identified transactions and not based on probability sampling, extrapolation, or other means that project an error using the number of patients served who have a similar diagnosis or the number of similar prescriptions or refills for similar drugs.
[ 2014 c 213 § 5. Formerly RCW 19.340.050.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.200 - Health Care Benefit Managers. › 48.200.240 - Contract with third party—Prohibited practices.

RCW 48.200.240
Contract with third party—Prohibited practices.
An entity that contracts with an independent third party to conduct audits may not:
(1) Agree to compensate the independent third party based on a percentage of the amount of overpayments recovered; or
(2) Disclose information obtained during an audit except to the contracting entity, the pharmacy subject to the audit, or the holder of the policy or certificate of insurance that paid the claim.
[ 2014 c 213 § 6. Formerly RCW 19.340.060.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.200 - Health Care Benefit Managers. › 48.200.250 - Evidence of validation of claim.

RCW 48.200.250
Evidence of validation of claim.
For purposes of RCW 48.200.210 through 48.200.270, an entity, or an independent third party that contracts with an entity to conduct audits, must allow as evidence of validation of a claim:
(1) An electronic or physical copy of a valid prescription if the prescribed drug was, within fourteen days of the dispensing date:
(a) Picked up by the patient or the patient's designee;
(b) Delivered by the pharmacy to the patient; or
(c) Sent by the pharmacy to the patient using the United States postal service or other common carrier;
(2) Point of sale electronic register data showing purchase of the prescribed drug, medical supply, or service by the patient or the patient's designee; or
(3) Electronic records, including electronic beneficiary signature logs, electronically scanned and stored patient records maintained at or accessible to the audited pharmacy's central operations, and any other reasonably clear and accurate electronic documentation that corresponds to a claim.
[ 2020 c 240 § 12; 2014 c 213 § 7. Formerly RCW 19.340.070.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.200 - Health Care Benefit Managers. › 48.200.260 - Preliminary audit report—Dispute or denial of claim—Final audit report—Recoupment of disputed funds.

RCW 48.200.260
Preliminary audit report—Dispute or denial of claim—Final audit report—Recoupment of disputed funds.
(1)(a) After conducting an audit, an entity must provide the pharmacy that is the subject of the audit with a preliminary report of the audit. The preliminary report must be received by the pharmacy no later than forty-five days after the date on which the audit was completed and must be sent:
(i) By mail or common carrier with a return receipt requested; or
(ii) Electronically with electronic receipt confirmation.
(b) An entity shall provide a pharmacy receiving a preliminary report under this subsection no fewer than forty-five days after receiving the report to contest the report or any findings in the report in accordance with the appeals procedure established under RCW 48.200.220(1) and must allow the submission of additional documentation in support of the claim. The entity shall consider a reasonable request for an extension of time to submit documentation to contest the report or any findings in the report.
(2) If an audit results in the dispute or denial of a claim, the entity conducting the audit shall allow the pharmacy to resubmit the claim using any commercially reasonable method, including facsimile, mail, or email.
(3) An entity must provide a pharmacy that is the subject of an audit with a final report of the audit no later than sixty days after the later of the date the preliminary report was received or the date the pharmacy contested the report using the appeals procedure established under RCW 48.200.220(1). The final report must include a final accounting of all moneys to be recovered by the entity.
(4) Recoupment of disputed funds from a pharmacy by an entity or repayment of funds to an entity by a pharmacy, unless otherwise agreed to by the entity and the pharmacy, shall occur after the audit and the appeals procedure established under RCW 48.200.220(1) are final. If the identified discrepancy for an individual audit exceeds forty thousand dollars, any future payments to the pharmacy may be withheld by the entity until the audit and the appeals procedure established under RCW 48.200.220(1) are final.
[ 2020 c 240 § 13; 2014 c 213 § 8. Formerly RCW 19.340.080.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.200 - Health Care Benefit Managers. › 48.200.270 - Application.

RCW 48.200.270
Application.
RCW 48.200.210 through 48.200.270 do not:
(1) Preclude an entity from instituting an action for fraud against a pharmacy;
(2) Apply to an audit of pharmacy records when fraud or other intentional and willful misrepresentation is indicated by physical review, review of claims data or statements, or other investigative methods; or
(3) Apply to a state agency that is conducting audits or a person that has contracted with a state agency to conduct audits of pharmacy records for prescription drugs paid for by the state medical assistance program.
[ 2020 c 240 § 14; 2014 c 213 § 9. Formerly RCW 19.340.090.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.200 - Health Care Benefit Managers. › 48.200.290 - Enforcement—Disputes—Civil penalties.

RCW 48.200.290
Enforcement—Disputes—Civil penalties.
(1) The commissioner shall have enforcement authority over this chapter and shall have authority to render a binding decision in any dispute between a pharmacy benefit manager, or third-party administrator of prescription drug benefits, and a pharmacy arising out of an appeal under RCW 48.200.280(6) regarding drug pricing and reimbursement.
(2) Any person, corporation, third-party administrator of prescription drug benefits, pharmacy benefit manager, or business entity which violates any provision of this chapter shall be subject to a civil penalty in the amount of one thousand dollars for each act in violation of this chapter or, if the violation was knowing and willful, a civil penalty of five thousand dollars for each violation of this chapter.
[ 2020 c 240 § 16; 2016 c 210 § 2. Formerly RCW 19.340.110.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.200 - Health Care Benefit Managers. › 48.200.901 - Effective date—2020 c 240.

RCW 48.200.901
Effective date—2020 c 240.
Sections 1 through 19 of this act take effect January 1, 2022.
[ 2020 c 240 § 23.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.201 - Captive Insurance. › 48.201.010 - Findings—Intent—2021 c 281.

RCW 48.201.010
Findings—Intent—2021 c 281.
The legislature finds that creating a framework for Washington private entities and public institutions of higher education to manage their risks through captive insurers will facilitate the growth and safety of those entities and protect the public interest. The legislature further finds that captive insurance promotes prudent risk management and provides access to insurance and reinsurance markets that may not be available to these Washington entities otherwise. The legislature believes that encouraging the use of captive insurance will support those who rely upon the strength and stability of employers in this state.
The legislature does not intend by chapter 281, Laws of 2021 to make Washington a captive domicile state. Rather, the legislature is establishing a framework for registration by captive insurers that insure Washington-based entities and are licensed by the jurisdictions in which they are domiciled.
[ 2021 c 281 § 1.]
NOTES:
Effective date—2021 c 281: "This act is necessary for the immediate preservation of the public peace, health, or safety, or support of the state government and its existing public institutions, and takes effect immediately [May 12, 2021]." [ 2021 c 281 § 15.]