reglab/statecodes huggingface dataset:
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.135 - Insurance Fraud Program. › 48.135.050 - Furnishing and disclosing insurance fraud knowledge and information.

RCW 48.135.050
Furnishing and disclosing insurance fraud knowledge and information.
(1) Any insurer or licensee of the commissioner that has reasonable belief that an act of insurance fraud which is or may be a crime under Washington law has been, is being, or is about to be committed shall furnish and disclose the knowledge and information to the commissioner or the national insurance crime bureau, the national association of insurance commissioners, or similar organization, who shall disclose the information to the commissioner, and cooperate fully with any investigation conducted by the commissioner.
(2) Any person that has a reasonable belief that an act of insurance fraud which is or may be a crime under Washington law has been, is being, or is about to be committed; or any person who collects, reviews, or analyzes information concerning insurance fraud which is or may be a crime under Washington law may furnish and disclose any information in its possession concerning such an act to the commissioner or to an authorized representative of an insurer that requests the information for the purpose of detecting, prosecuting, or preventing insurance fraud.
[ 2006 c 284 § 6.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.135 - Insurance Fraud Program. › 48.135.070 - Insurance company as victim—Restitution.

RCW 48.135.070
Insurance company as victim—Restitution.
In a criminal prosecution for any crime under Washington law in which the insurance company is a victim, the insurance company is entitled to be considered as a victim in any restitution ordered by the court under RCW 9.94A.753, as part of the criminal penalty imposed against the defendant convicted for such a violation.
[ 2006 c 284 § 8.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.135 - Insurance Fraud Program. › 48.135.080 - Required statement on all insurance applications and claim forms.

RCW 48.135.080
Required statement on all insurance applications and claim forms.
No later than six months after July 1, 2006, or when the insurer has used all its existing paper application and claim forms which were in its possession on July 1, 2006, whichever is later, all applications for insurance, and all claim forms regardless of the form of transmission provided and required by an insurer or required by law as condition of payment of a claim, must contain a statement, permanently affixed to the application or claim form, that clearly states in substance the following:
"It is a crime to knowingly provide false, incomplete, or misleading information to an insurance company for the purpose of defrauding the company. Penalties include imprisonment, fines, and denial of insurance benefits."
The lack of a statement required in this section does not constitute a defense in any criminal prosecution nor any civil action.
[ 2006 c 284 § 10.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.135 - Insurance Fraud Program. › 48.135.090 - Insurance fraud advisory board—Membership.

RCW 48.135.090
Insurance fraud advisory board—Membership.
The commissioner shall appoint an insurance fraud advisory board. The board shall consist of ten members. Five members shall be representatives from the insurance industry doing business in this state, at least one of which shall be from a Washington domestic insurer, two members shall represent consumers, one member shall represent the national insurance crime bureau or successor organization, one member shall represent prosecutors, and one member shall represent other law enforcement agencies. The members of the board serve four-year terms and until their successors are appointed and qualified. Three of the original members must be appointed to serve an initial term of four years, three must be appointed to serve an initial term of three years, two must be appointed to serve an initial term of two years, and two must be appointed to serve an initial term of one year. The members of the board receive no compensation. The board shall advise the commissioner and the legislature with respect to the effectiveness, resources allocated to the fraud program, the source of the funding for the program, and before June 30, 2010, if the staffing level restriction in RCW 48.135.020(5) should be renewed.
[ 2006 c 284 § 11.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.135 - Insurance Fraud Program. › 48.135.100 - Program report—Contents.

RCW 48.135.100
Program report—Contents.
The commissioner shall prepare a periodic report of the activities of the fraud program. The report shall, at a minimum, include information as to the number of cases reported to the commissioner, the number of cases referred for prosecution, the number of convictions obtained, the amount of money recovered, and any recommendations of the insurance advisory board.
[ 2006 c 284 § 12.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.140 - Medical Malpractice Closed Claim Reporting. › 48.140.010 - Definitions.

RCW 48.140.010
Definitions.
The definitions in this section apply throughout this chapter unless the context clearly requires otherwise.
(1) "Claim" means a demand for monetary damages for injury or death caused by medical malpractice, and a voluntary indemnity payment for injury or death caused by medical malpractice made in the absence of a demand for monetary damages.
(2) "Claimant" means a person, including a decedent's estate, who is seeking or has sought monetary damages for injury or death caused by medical malpractice.
(3) "Closed claim" means a claim that has been settled or otherwise disposed of by the insuring entity, self-insurer, facility, or provider. A claim may be closed with or without an indemnity payment to a claimant.
(4) "Commissioner" means the insurance commissioner.
(5) "Economic damages" means objectively verifiable monetary losses, including medical expenses, loss of earnings, burial costs, loss of use of property, cost of replacement or repair, cost of obtaining substitute domestic services, loss of employment, and loss of business or employment opportunities.
(6) "Health care facility" or "facility" means a clinic, diagnostic center, hospital, laboratory, mental health center, nursing home, office, surgical facility, treatment facility, or similar place where a health care provider provides health care to patients, and includes entities described in RCW 7.70.020(3).
(7) "Health care provider" or "provider" has the same meaning as in RCW 7.70.020 (1) and (2).
(8) "Insuring entity" means:
(a) An insurer;
(b) A joint underwriting association;
(c) A risk retention group; or
(d) An unauthorized insurer that provides surplus lines coverage.
(9) "Medical malpractice" means an actual or alleged negligent act, error, or omission in providing or failing to provide health care services that is actionable under chapter 7.70 RCW.
(10) "Noneconomic damages" means subjective, nonmonetary losses including, but not limited to, pain, suffering, inconvenience, mental anguish, disability or disfigurement incurred by the injured party, emotional distress, loss of society and companionship, loss of consortium, injury to reputation and humiliation, and destruction of the parent-child relationship.
(11) "Self-insurer" means any health care provider, facility, or other individual or entity that assumes operational or financial risk for claims of medical malpractice.
[ 2023 c 102 § 6; 2006 c 8 § 201.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.140 - Medical Malpractice Closed Claim Reporting. › 48.140.020 - Closed claim reporting requirements.

RCW 48.140.020
Closed claim reporting requirements.
(1) For claims closed on or after January 1, 2008:
(a) Every insuring entity or self-insurer that provides medical malpractice insurance to any facility or provider in Washington state must report each medical malpractice closed claim to the commissioner.
(b) If a claim is not covered by an insuring entity or self-insurer, the facility or provider named in the claim must report it to the commissioner after a final claim disposition has occurred due to a court proceeding or a settlement by the parties.
Instances in which a claim may not be covered by an insuring entity or self-insurer include, but are not limited to, situations in which the:
(i) Facility or provider did not buy insurance or maintained a self-insured retention that was larger than the final judgment or settlement;
(ii) Claim was denied by an insuring entity or self-insurer because it did not fall within the scope of the insurance coverage agreement; or
(iii) Annual aggregate coverage limits had been exhausted by other claim payments.
(c) If a facility or provider is insured by a risk retention group and the risk retention group refuses to report closed claims and asserts that the federal liability risk retention act (95 Stat. 949; 15 U.S.C. Sec. 3901 et seq.) preempts state law, the facility or provider must report all data required by this chapter on behalf of the risk retention group.
(d) If a facility or provider is insured by an unauthorized insurer and the unauthorized insurer refuses to report closed claims and asserts a federal exemption or other jurisdictional preemption, the facility or provider must report all data required by this chapter on behalf of the unauthorized insurer.
(2) Beginning in 2009, reports required under subsection (1) of this section must be filed by March 1st, and include data for all claims closed in the preceding calendar year and any adjustments to data reported in prior years. The commissioner may adopt rules that require insuring entities, self-insurers, facilities, or providers to file closed claim data electronically.
(3) The commissioner may impose a fine of up to two hundred fifty dollars per day against any insuring entity, except a risk retention group, that violates the requirements of this section.
(4) The department of health, department of licensing, or department of social and health services may require a provider or facility to take corrective action to assure compliance with the requirements of this section.
[ 2007 c 32 § 1; 2006 c 8 § 202.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.140 - Medical Malpractice Closed Claim Reporting. › 48.140.040 - Statistical summaries.

RCW 48.140.040
Statistical summaries.
The commissioner must prepare aggregate statistical summaries of closed claims based on data submitted under RCW 48.140.020.
(1) At a minimum, the commissioner must summarize data by calendar year and calendar/incident year. The commissioner may also decide to display data in other ways if the commissioner:
(a) Protects information as required under RCW 48.140.060(2); and
(b) Exempts from disclosure data described in *RCW 42.56.400(11).
(2) The summaries must be available by April 30th of each year, unless the commissioner notifies legislative committees by March 15th that data are not available and informs the committees when the summaries will be completed.
(3) Information included in an individual closed claim report submitted by an insuring entity, self-insurer, provider, or facility under this chapter is confidential and exempt from public disclosure, and the commissioner must not make these data available to the public.
[ 2006 c 8 § 204.]
NOTES:
*Reviser's note: RCW 42.56.400 was amended by 2007 c 197 § 7, changing subsection (11) to subsection (10).
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.140 - Medical Malpractice Closed Claim Reporting. › 48.140.050 - Annual report.

RCW 48.140.050
Annual report.
Beginning in 2010, the commissioner must prepare an annual report that summarizes and analyzes the closed claim reports for medical malpractice filed under RCW 48.140.020 and 7.70.140 and the annual financial reports filed by authorized insurers writing medical malpractice insurance in this state. The commissioner must complete the report by June 30th, unless the commissioner notifies legislative committees by June 1st that data are not available and informs the committees when the summaries will be completed.
(1) The report must include:
(a) An analysis of reported closed claims from prior years for which data are collected. The analysis must show:
(i) Trends in the frequency and severity of claim payments;
(ii) A comparison of economic and noneconomic damages;
(iii) A distribution of allocated loss adjustment expenses and other legal expenses;
(iv) The types of medical malpractice for which claims have been paid; and
(v) Any other information the commissioner finds relevant to trends in medical malpractice closed claims if the commissioner:
(A) Protects information as required under RCW 48.140.060(2); and
(B) Exempts from disclosure data described in *RCW 42.56.400(11);
(b) An analysis of the medical malpractice insurance market in Washington state, including:
(i) An analysis of the financial reports of the authorized insurers with a combined market share of at least ninety percent of direct written medical malpractice premium in Washington state for the prior calendar year;
(ii) A loss ratio analysis of medical malpractice insurance written in Washington state; and
(iii) A profitability analysis of the authorized insurers with a combined market share of at least ninety percent of direct written medical malpractice premium in Washington state for the prior calendar year;
(c) A comparison of loss ratios and the profitability of medical malpractice insurance in Washington state to other states based on financial reports filed with the national association of insurance commissioners and any other source of information the commissioner deems relevant; and
(d) A summary of the rate filings for medical malpractice that have been approved by the commissioner for the prior calendar year, including an analysis of the trend of direct incurred losses as compared to prior years.
(2) The commissioner must post reports required by this section on the internet no later than thirty days after they are due.
(3) The commissioner may adopt rules that require insuring entities and self-insurers required to report under RCW 48.140.020 and subsection (1)(a) of this section to report data related to:
(a) The frequency and severity of closed claims for the reporting period; and
(b) Any other closed claim information that helps the commissioner monitor losses and claim development patterns in the Washington state medical malpractice insurance market.
[ 2006 c 8 § 205.]
NOTES:
*Reviser's note: RCW 42.56.400 was amended by 2007 c 197 § 7, changing subsection (11) to subsection (10).
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.140 - Medical Malpractice Closed Claim Reporting. › 48.140.060 - Rules.

RCW 48.140.060
Rules.
The commissioner must adopt all rules needed to implement this chapter. The rules must:
(1) Identify which insuring entity or self-insurer has the primary obligation to report a closed claim when more than one insuring entity or self-insurer is providing medical malpractice liability coverage to a single health care provider or a single health care facility that has been named in a claim;
(2) Protect information that, alone or in combination with other data, could result in the ability to identify a claimant, health care provider, health care facility, or self-insurer involved in a particular claim or collection of claims; and
(3) Specify standards and methods for the reporting by claimants, insuring entities, self-insurers, facilities, and providers.
[ 2006 c 8 § 206.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.140 - Medical Malpractice Closed Claim Reporting. › 48.140.070 - Model statistical reporting standards—Report to legislature.

RCW 48.140.070
Model statistical reporting standards—Report to legislature.
(1) If the national association of insurance commissioners adopts revised model statistical reporting standards for medical malpractice insurance, the commissioner must analyze the new reporting standards and report this information to the legislature, as follows:
(a) An analysis of any differences between the model reporting standards and:
(i) RCW 48.140.010 through 48.140.060; and
(ii) Any statistical plans that the commissioner has adopted under RCW 48.19.370; and
(b) Recommendations, if any, about legislative changes necessary to implement the model reporting standards.
(2) The commissioner must submit the report required under subsection (1) of this section to the following legislative committees by the first day of December in the year after the national association of insurance commissioners adopts new model medical malpractice reporting standards:
(a) The house of representatives committees on health care; financial institutions and insurance; and judiciary; and
(b) The senate committees on health and long-term care; financial institutions, housing and consumer protection; and judiciary.
[ 2006 c 8 § 207.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.140 - Medical Malpractice Closed Claim Reporting. › 48.140.080 - Reporting requirements under RCW 48.19.370 not affected.

RCW 48.140.080
Reporting requirements under RCW 48.19.370 not affected.
This chapter does not amend or modify the statistical reporting requirements that apply to insurers under RCW 48.19.370.
[ 2006 c 8 § 208.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.140 - Medical Malpractice Closed Claim Reporting. › 48.140.900 - Findings—Intent—Part headings and subheadings not law—Severability—2006 c 8.

RCW 48.140.900
Findings—Intent—Part headings and subheadings not law—Severability—2006 c 8.
See notes following RCW 5.64.010.
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.150 - Direct Patient-Provider Primary Health Care. › 48.150.005 - Public policy.

RCW 48.150.005
Public policy.
It is the public policy of Washington to promote access to medical care for all citizens and to encourage innovative arrangements between patients and providers that will help provide all citizens with a medical home.
Washington needs a multipronged approach to provide adequate health care to many citizens who lack adequate access to it. Direct patient-provider practices, in which patients enter into a direct relationship with medical practitioners and pay a fixed amount directly to the health care provider for primary care services, represent an innovative, affordable option which could improve access to medical care, reduce the number of people who now lack such access, and cut down on emergency room use for primary care purposes, thereby freeing up emergency room facilities to treat true emergencies.
[ 2007 c 267 § 1.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.150 - Direct Patient-Provider Primary Health Care. › 48.150.020 - Prohibition on discrimination.

RCW 48.150.020
Prohibition on discrimination.
Except as provided in RCW 48.150.050, no direct practice shall decline to accept any person solely on account of race, religion, national origin, the presence of any sensory, mental, or physical disability, education, economic status, or sexual orientation.
[ 2007 c 267 § 4.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.150 - Direct Patient-Provider Primary Health Care. › 48.150.030 - Direct fee—Monthly basis—Designated contact person.

RCW 48.150.030
Direct fee—Monthly basis—Designated contact person.
(1) A direct practice must charge a direct fee on a monthly basis. The fee must represent the total amount due for all primary care services specified in the direct agreement and may be paid by the direct patient or on his or her behalf by others.
(2) A direct practice must:
(a) Maintain appropriate accounts and provide data regarding payments made and services received to direct patients upon request; and
(b) Either:
(i) Bill patients at the end of each monthly period; or
(ii) If the patient pays the monthly fee in advance, promptly refund to the direct patient all unearned direct fees following receipt of written notice of termination of the direct agreement from the direct patient. The amount of the direct fee considered earned shall be a proration of the monthly fee as of the date the notice of termination is received.
(3) If the patient chooses to pay more than one monthly direct fee in advance, the funds must be held in a trust account and paid to the direct practice as earned at the end of each month. Any unearned direct fees held in trust following receipt of termination of the direct agreement shall be promptly refunded to the direct patient. The amount of the direct fee earned shall be a proration of the monthly fee for the then current month as of the date the notice of termination is received.
(4) The direct fee schedule applying to an existing direct patient may not be increased over the annual negotiated amount more frequently than annually. A direct practice shall provide advance notice to existing patients of any change within the fee schedule applying to those existing direct patients. A direct practice shall provide at least sixty days' advance notice of any change in the fee.
(5) A direct practice must designate a contact person to receive and address any patient complaints.
(6) Direct fees for comparable services within a direct practice shall not vary from patient to patient based on health status or sex.
[ 2007 c 267 § 5.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.150 - Direct Patient-Provider Primary Health Care. › 48.150.050 - Acceptance or discontinuation of patients—Third-party payments.

RCW 48.150.050
Acceptance or discontinuation of patients—Third-party payments.
(1) Direct practices may not decline to accept new direct patients or discontinue care to existing patients solely because of the patient's health status. A direct practice may decline to accept a patient if the practice has reached its maximum capacity, or if the patient's medical condition is such that the provider is unable to provide the appropriate level and type of health care services in the direct practice. So long as the direct practice provides the patient notice and opportunity to obtain care from another physician, the direct practice may discontinue care for direct patients if: (a) The patient fails to pay the direct fee under the terms required by the direct agreement; (b) the patient has performed an act that constitutes fraud; (c) the patient repeatedly fails to comply with the recommended treatment plan; (d) the patient is abusive and presents an emotional or physical danger to the staff or other patients of the direct practice; or (e) the direct practice discontinues operation as a direct practice.
(2) Subject to the restrictions established in this chapter, direct practices may accept payment of direct fees directly or indirectly from third parties. A direct practice may accept a direct fee paid by an employer on behalf of an employee who is a direct patient. However, a direct practice shall not enter into a contract with an employer relating to direct practice agreements between the direct practice and employees of that employer, other than to establish the timing and method of the payment of the direct fee by the employer.
[ 2009 c 552 § 3; 2007 c 267 § 7.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.150 - Direct Patient-Provider Primary Health Care. › 48.150.060 - Direct practices are not insurers.

RCW 48.150.060
Direct practices are not insurers.
Direct practices, as defined in RCW 48.150.010, who comply with this chapter are not insurers under RCW 48.01.050, health carriers under chapter 48.43 RCW, health care service contractors under chapter 48.44 RCW, or health maintenance organizations under chapter 48.46 RCW.
[ 2007 c 267 § 8.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.150 - Direct Patient-Provider Primary Health Care. › 48.150.070 - Conduct of business—Prohibitions.

RCW 48.150.070
Conduct of business—Prohibitions.
A person shall not make, publish, or disseminate any false, deceptive, or misleading representation or advertising in the conduct of the business of a direct practice, or relative to the business of a direct practice.
[ 2007 c 267 § 9.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.150 - Direct Patient-Provider Primary Health Care. › 48.150.080 - Misrepresenting the terms of a direct agreement.

RCW 48.150.080
Misrepresenting the terms of a direct agreement.
A person shall not make, issue, or circulate, or cause to be made, issued, or circulated, a misrepresentation of the terms of any direct agreement, or the benefits or advantages promised thereby, or use the name or title of any direct agreement misrepresenting the nature thereof.
[ 2007 c 267 § 10.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.150 - Direct Patient-Provider Primary Health Care. › 48.150.100 - Annual statements—Commissioner's report.

RCW 48.150.100
Annual statements—Commissioner's report.
(1) Direct practices must submit annual statements, beginning on October 1, 2007, to the office of [the] insurance commissioner specifying the number of providers in each practice, total number of patients being served, the average direct fee being charged, providers' names, and the business address for each direct practice. The form and content for the annual statement must be developed in a manner prescribed by the commissioner.
(2) A health care provider may not act as, or hold himself or herself out to be, a direct practice in this state, nor may a direct agreement be entered into with a direct patient in this state, unless the provider submits the annual statement in subsection (1) of this section to the commissioner.
(3) The commissioner shall report annually to the legislature on direct practices including, but not limited to, participation trends, complaints received, voluntary data reported by the direct practices, and any necessary modifications to this chapter. The initial report shall be due December 1, 2009.
[ 2007 c 267 § 12.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.150 - Direct Patient-Provider Primary Health Care. › 48.150.110 - Direct agreement requirements—Disclaimer.

RCW 48.150.110
Direct agreement requirements—Disclaimer.
(1) A direct agreement must include the following disclaimer: "This agreement does not provide comprehensive health insurance coverage. It provides only the health care services specifically described." The direct agreement may not be sold to a group and may not be entered with a group of subscribers. It must be an agreement between a direct practice and an individual direct patient. Nothing prohibits the presentation of marketing materials to groups of potential subscribers or their representatives.
(2) A comprehensive disclosure statement shall be distributed to all direct patients with their participation forms. Such disclosure must inform the direct patients of their financial rights and responsibilities to the direct practice as provided for in this chapter, encourage that direct patients obtain and maintain insurance for services not provided by the direct practice, and state that the direct practice will not bill a carrier for services covered under the direct agreement. The disclosure statement shall include contact information for the office of the insurance commissioner.
[ 2007 c 267 § 13.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.155 - Health Care Discount Plan Organization Act. › 48.155.003 - Purpose.

RCW 48.155.003
Purpose.
The purposes of this chapter are to promote the public interest by establishing standards for discount plan organizations, to protect consumers from unfair or deceptive marketing, sales, or enrollment practices, and to facilitate consumer understanding of the role and function of discount plan organizations in providing discounts on charges for health care services.
[ 2009 c 175 § 2.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.155 - Health Care Discount Plan Organization Act. › 48.155.015 - Application of chapter.

RCW 48.155.015
Application of chapter.
(1) This chapter applies to all discount plans and all discount plan organizations doing business in or from this state or that affect subjects located wholly or in part or to be performed within this state, and all persons having to do with this business.
(2) A discount plan organization that is a health carrier, as defined under RCW 48.43.005, with a license, certificate of authority, or registration:
(a) Is not required to obtain a license under RCW 48.155.020, except that any of its affiliates that operate as a discount plan organization in this state must obtain a license under RCW 48.155.020 and comply with all other provisions of this chapter;
(b) Is required to comply with RCW 48.155.060 through 48.155.090 and report, in the form and manner as the commissioner may require, any of the information described in RCW 48.155.110(2) (b), (c), or (d) that is not otherwise already reported; and
(c) Is subject to RCW 48.155.130 and 48.155.140.
[ 2015 c 122 § 20; 2009 c 175 § 4.]
NOTES:
Effective dates—2015 c 122: See note following RCW 48.31B.005.
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.155 - Health Care Discount Plan Organization Act. › 48.155.030 - Minimum net worth.

RCW 48.155.030
Minimum net worth.
(1) Except under subsection (3) of this section, before the commissioner issues a license to any person required to obtain a license under RCW 48.155.020, the person seeking to operate a discount plan organization must have a net worth of at least one hundred fifty thousand dollars.
(2) At all times, except under subsection (3) of this section, each discount plan organization must maintain a net worth of at least one hundred fifty thousand dollars.
(3) By rule of the commissioner, the amounts in subsections (1) and (2) of this section may be adjusted annually for inflation.
[ 2009 c 175 § 6.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.155 - Health Care Discount Plan Organization Act. › 48.155.040 - Surety bond—Deposit in lieu of bond.

RCW 48.155.040
Surety bond—Deposit in lieu of bond.
(1) Each licensed discount plan organization shall continuously maintain in force a surety bond in its own name in an amount not less than thirty-five thousand dollars to be used in the discretion of the commissioner to protect the financial interest of Washington members. The bond must be issued by an insurance company licensed to do business in this state.
(2) In lieu of the bond specified in subsection (1) of this section, a licensed discount plan organization may deposit and maintain deposited with the commissioner, or at the discretion of the commissioner, with any organization or trustee acceptable to the commissioner through which a custodial or controlled account is utilized, cash, securities, or any combination of these or other measures that are acceptable to the commissioner which always have a market value of not less than thirty-five thousand dollars.
(3) All income from a deposit made under subsection (2) of this section is an asset of the discount plan organization.
(4) Except for the commissioner, the assets or securities held in this state as a deposit under subsection (1) or (2) of this section are not subject to levy by a judgment creditor or other claimant of the discount plan organization.
[ 2009 c 175 § 7.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.155 - Health Care Discount Plan Organization Act. › 48.155.050 - Investigations by commissioner—Organization must maintain detailed books and records.

RCW 48.155.050
Investigations by commissioner—Organization must maintain detailed books and records.
(1) The commissioner may conduct investigations to determine whether any person has violated any provision of this chapter and may, if the commissioner has a reason to believe that the discount plan organization is not complying with the requirements of this chapter, examine the business and affairs of any discount plan organization.
(2) An examination conducted under subsection (1) of this section must be performed in accordance with chapter 48.03 RCW, except that RCW 48.03.060 (1) and (2) shall not be applicable to the examination of persons registered under this chapter.
(3) The commissioner may:
(a) Order any discount plan organization or applicant that operates a discount plan organization to produce any records, books, files, advertising, and solicitation materials or other information; and
(b) Gather evidence and take statements under oath to determine whether the discount plan organization or applicant is in violation of the law or is acting contrary to the public interest.
(4) The discount plan organization or applicant that is the subject of the examination or investigation shall pay the expenses incurred in conducting the examination or investigation. Failure by the discount plan organization or applicant to pay the expenses is grounds for denial or revocation of a license to operate as a discount plan organization.
(5) All discount plan organizations or applicants that are subject to examinations, investigations, or annual reporting requirements under this chapter shall maintain detailed books and records of the following:
(a) Records documenting all Washington transactions, showing all funds received and all funds disbursed to Washington members, prospective members, providers, and provider networks;
(b) All contracts or agreements with providers of the services under a discount plan offered in Washington or sold to Washington residents; and
(c) Telephone scripts for marketing activities to which this chapter applies.
The discount plan organization shall maintain the books and records described in this section, in addition to the books and records required to be maintained under RCW 48.155.070, for a period of at least two years.
[ 2009 c 175 § 8.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.155 - Health Care Discount Plan Organization Act. › 48.155.060 - Charges and fees—When writing is required—Cancellation.

RCW 48.155.060
Charges and fees—When writing is required—Cancellation.
(1) A discount plan organization may charge a periodic charge as well as a reasonable one-time processing fee of no more than thirty dollars for a discount plan, or such other amount as established by rule, but may not require payment of these or any other charges or fees by direct debit from a banking, credit, or debit card account unless that method of payment is clearly and conspicuously disclosed to the prospective member. All charges and fees must be provided in writing to the member when the member first joins the plan.
(2) When a marketer or discount plan organization solicits a discount plan in conjunction with any other product, all charges that a member or prospective member must pay for each discount plan must be provided in writing as a separate item to the member or prospective member, unless the entire amount of the periodic charge which includes the periodic discount plan charge will be refunded if the member cancels his or her membership in the discount plan organization within the first thirty days after the date of receipt of the written documents for the discount plan as provided in subsection (3) of this section.
(3)(a)(i) If a member cancels his or her membership in the discount plan organization within the first thirty days after the date of receipt of the written documents for the discount plan described in RCW 48.155.090(4), the member must receive a reimbursement of all periodic charges upon return of the discount plan card to the discount plan organization.
(ii)(A) Cancellation occurs when notice of cancellation is given to the discount plan organization.
(B) Notice of cancellation is given when delivered by hand or deposited in a mailbox, properly addressed and postage prepaid to the mailing address of the discount plan organization, or emailed to the email address of the discount plan organization.
(iii) A discount plan organization shall return in full any periodic charge charged or collected after the member has given the discount plan organization notice of cancellation.
(b) If the discount plan organization cancels a membership for any reason other than nonpayment of charges by the member, the discount plan organization shall make a pro rata reimbursement of all periodic charges to the member.
[ 2009 c 175 § 9.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.155 - Health Care Discount Plan Organization Act. › 48.155.070 - Written health care provider agreements required—Terms—Internet website.

RCW 48.155.070
Written health care provider agreements required—Terms—Internet website.
(1)(a) A discount plan organization shall have a written health care provider agreement with all health care providers for whose health care services it provides access to a discount to its members. The written health care provider agreement may be entered into directly with the health care provider or indirectly with a health care provider network to which the health care provider belongs.
(b) A health care provider agreement between a discount plan organization and a health care provider must provide the following:
(i) A list of the health care services and products to be provided at a discount;
(ii) The amount or amounts of the discounts or, alternatively, a fee schedule that reflects the health care provider's discounted rates; and
(iii) That the health care provider may not charge members more than the discounted rates.
(c) A health care provider agreement between a discount plan organization and a health care provider network must require that the health care provider network have written agreements with its health care providers that:
(i) Contain the provisions described in (b) of this subsection;
(ii) Authorize the health care provider network to contract with the discount plan organization on behalf of the health care provider; and
(iii) Require the health care provider network to maintain an up-to-date list of its contracted health care providers and to provide the list on a monthly basis to the discount plan organization.
(d) A health care provider agreement between a discount plan organization and an entity that contracts with a health care provider network must require that the entity, in its contract with the health care provider network, require the health care provider network to have written agreements with its health care providers that comply with (c) of this subsection.
(e) The discount plan organization shall maintain a copy of each health care provider agreement into which it has entered and shall promptly furnish a copy of each agreement to the commissioner when requested.
(2)(a) Each discount plan organization shall maintain on an internet website a list of the names and addresses of the health care providers with which it has a current provider agreement directly or through a health care provider network. This list must be updated every thirty days. The internet website address must be prominently displayed on all of its advertisements, marketing materials, brochures, and discount plan cards.
(b) This subsection applies to those health care providers with which the discount plan organization has a current provider agreement directly as well as those health care providers that are members of a health care provider network with which the discount plan organization has a current provider agreement.
[ 2009 c 175 § 10.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.155 - Health Care Discount Plan Organization Act. › 48.155.080 - Marketing products—Directly to consumers—By contract with marketers.

RCW 48.155.080
Marketing products—Directly to consumers—By contract with marketers.
(1) A discount plan organization may market its products directly to consumers or contract with marketers for the distribution of its discount plans.
(2)(a) The discount plan organization shall have an executed written agreement with a marketer prior to the marketer's marketing, promoting, selling, or distributing the discount plan organization's discount plans.
(b) The agreement between the discount plan organization and the marketer must prohibit the marketer from using advertising, marketing materials, brochures, and discount plan cards without first having the discount plan organization's approval in writing.
(c) The discount plan organization is bound by and responsible for the activities of a marketer that are within the scope of the marketer's agency relationship with the organization.
(3) A discount plan organization shall approve in writing all advertisements, marketing materials, brochures, and discount cards used by marketers to market, promote, sell, or distribute the discount plan prior to their use.
(4) Upon request, a discount plan organization shall submit to the commissioner all advertising, marketing materials, and brochures used or to be used in connection with the organization's discount plans.
[ 2009 c 175 § 11.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.155 - Health Care Discount Plan Organization Act. › 48.155.100 - Organization changes require notice to commissioner.

RCW 48.155.100
Organization changes require notice to commissioner.
Each discount plan organization shall provide the commissioner at least thirty days' advance notice of any change in the discount plan organization's name, address, principal business address, mailing address, toll-free telephone number, or internet website address.
[ 2009 c 175 § 13.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.155 - Health Care Discount Plan Organization Act. › 48.155.110 - Annual report required—Fee—Contents—Failure to file.

RCW 48.155.110
Annual report required—Fee—Contents—Failure to file.
(1) If the information required in subsection (2) of this section is not provided at the time of renewal of a license under RCW 48.155.020, a discount plan organization shall file an annual report with the commissioner in the form prescribed by the commissioner no later than March 31st of the following year.
(2) The annual report must be filed with the commissioner, accompanied by the twenty dollar annual reporting fee to be deposited into the general fund. The annual report must include:
(a) Audited financial statements prepared in accordance with generally accepted accounting principles certified by an independent certified public accountant, including the organization's balance sheet, income statement, and statement of changes in cash flow for the preceding year. However, subject to the approval of the commissioner, an organization that is an affiliate of a parent entity that is publicly traded and that prepares audited financial statements reflecting the consolidated operations of the parent entity may submit the audited financial statement of the parent entity and a written guaranty that the minimum capital requirements required under RCW 48.155.030 will be met by the parent entity instead of the audited financial statement of the organization;
(b) If different from the initial application for a license, or at the time of renewal of a license, or the last annual report, as appropriate, a list of the names and residence addresses of all persons responsible for the conduct of the organization's affairs, together with a disclosure of the extent and nature of any contracts or arrangements with these persons and the discount plan organization, including any possible conflicts of interest;
(c) The number of current members the discount plan organization has in the state; and
(d) Any other information relating to the performance of the discount plan organization that may be required by the commissioner.
(3) Any discount plan organization that fails to file an annual report in the form and within the time required by this section is subject to the following:
(a) Monetary penalties of:
(i) Up to five hundred dollars each day for the first ten days during which the violation continues; and
(ii) Up to one thousand dollars each day after the first ten days during which the violation continues; and
(b) Upon notice by the commissioner, loss, suspension, or revocation of its license and authority to enroll new members or to do business in this state while the violation continues.
[ 2009 c 175 § 14.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.155 - Health Care Discount Plan Organization Act. › 48.155.120 - Designation of compliance officer.

RCW 48.155.120
Designation of compliance officer.
Each discount plan organization shall designate and provide the commissioner with the name, address, and telephone number of the organization's compliance officer responsible for ensuring compliance with this chapter.
[ 2009 c 175 § 15.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.155 - Health Care Discount Plan Organization Act. › 48.155.130 - Violation of chapter—Commissioner's authority—Penalties—Criminal sanctions—Civil action for recovery of damages.

RCW 48.155.130
Violation of chapter—Commissioner's authority—Penalties—Criminal sanctions—Civil action for recovery of damages.
(1) In lieu of or in addition to suspending or revoking a discount plan organization's license under *RCW 48.155.020(8), whenever the commissioner has cause to believe that any person is violating or is about to violate any provision of this chapter or any rules adopted under this chapter or any order of the commissioner, the commissioner may:
(a) Issue a cease and desist order; and
(b) After hearing or with the consent of the discount plan organization and in addition to or in lieu of the suspension, revocation, or refusal to renew any license, impose a monetary penalty of not less than one hundred dollars for each violation and not more than ten thousand dollars for each violation.
(2) A person that willfully operates as or aids and abets another operating as a discount plan organization in violation of RCW 48.155.020(1) commits insurance fraud and is subject to RCW 48.15.020 and 48.15.023, as if the unlicensed discount plan organization were an unauthorized insurer, and the fees, dues, charges, or other consideration collected from the members by the unlicensed discount plan organization or marketer were insurance premiums.
(3) A person that collects fees for purported membership in a discount plan but willfully fails to provide the promised benefits commits a theft and upon conviction is subject to the provisions of Title 9A RCW. In addition, upon conviction, the person shall pay restitution to persons aggrieved by the violation of this chapter.
(4) Any person damaged by acts that violate this chapter may maintain an action for the recovery of damages caused by that act or acts.
(a) An action for violation of this section may be brought:
(i) In the county where the plaintiff resides;
(ii) In the county where the plaintiff conducts business; or
(iii) In the county where the discount plan was sold, marketed, promoted, advertised, or otherwise distributed.
(b) The acceptance or use of any discount plan or discount plan card does not operate as a waiver of any civil, criminal, or administrative claim that may be asserted under this chapter.
[ 2009 c 175 § 16.]
NOTES:
*Reviser's note: RCW 48.155.020 was amended by 2011 c 47 § 18, changing subsection (8) to subsection (9).
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.155 - Health Care Discount Plan Organization Act. › 48.155.140 - Temporary and permanent injunctive relief—When authorized.

RCW 48.155.140
Temporary and permanent injunctive relief—When authorized.
(1)(a) In addition to the penalties and other enforcement provisions of this chapter, the commissioner may seek both temporary and permanent injunctive relief when:
(i) A discount plan is being operated by a person or entity that is not licensed under this chapter; or
(ii) Any person, entity, or discount plan organization has engaged in any activity prohibited by this chapter or any rule adopted under this chapter.
(b) The venue for any court proceeding brought under this section is Thurston county.
(2) The commissioner's authority to seek injunctive relief is not conditioned on having conducted any proceeding under chapter 34.05 RCW.
[ 2009 c 175 § 17.]