Chapter 284-43 WAC: HEALTH CARRIERS AND HEALTH PLANS

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WACs > Title 284 > Chapter 284-43

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Chapter 284-43 WAC	Last Update: 1/9/13
HEALTH CARRIERS AND HEALTH PLANS

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WAC Sections

SUBCHAPTER A GENERAL PROVISIONS
284-43-110	Purpose.
284-43-120	Applicability and scope.
284-43-125	Compliance with state and federal laws.
284-43-130	Definitions.
SUBCHAPTER B HEALTH CARE NETWORKS
284-43-200	Network adequacy.
284-43-205	Every category of health care providers.
284-43-220	Network reports -- Format.
284-43-250	Health carrier standards for women's right to directly access certain health care practitioners for women's health care services.
284-43-251	Covered person's access to providers.
284-43-260	Standards for temporary substitution of contracted network providers -- "Locum tenens" providers.
284-43-262	Rule concerning contracted network providers called to active duty military service.
SUBCHAPTER C PROVIDER CONTRACTS AND PAYMENT
284-43-300	Provider and facility contracts with health carriers -- Generally.
284-43-310	Selection of participating providers -- Credentialing and unfair discrimination.
284-43-320	Provider contracts -- Standards -- Hold harmless provisions.
284-43-321	Provider contracts -- Terms and conditions of payment.
284-43-322	Provider contracts -- Dispute resolution process.
284-43-323	Pharmacy identification cards.
284-43-324	Provider contracts -- Audit guidelines.
284-43-330	Participating provider -- Filing and approval.
284-43-331	Effective date.
284-43-340	Effective date.
SUBCHAPTER D UTILIZATION REVIEW
284-43-410	Utilization review -- Generally.
SUBCHAPTER E ADVERSE BENEFIT DETERMINATION PROCESS REQUIREMENTS FOR NONGRANDFATHERED PLANS
284-43-500	Scope and intent.
284-43-505	Definitions.
284-43-510	Review of adverse benefit determinations -- Generally.
284-43-511	Explanation of right to review.
284-43-515	Notice and explanation of adverse benefit determination -- General requirements.
284-43-520	Electronic disclosure and communication by carriers.
284-43-525	Internal review of adverse benefit determinations.
284-43-530	Exhaustion of internal review remedies.
284-43-535	Notice of internal review determination.
284-43-540	Expedited review.
284-43-545	Concurrent expedited review of adverse benefit determinations.
284-43-550	External review of adverse benefit determinations.
SUBCHAPTER F GRANDFATHERED HEALTH PLAN APPEAL PROCEDURES
284-43-611	Application of subchapter F.
284-43-615	Grievance and complaint procedures -- Generally.
284-43-620	Procedures for review and appeal of adverse determinations.
284-43-630	Independent review of adverse determinations.
SUBCHAPTER G GRIEVANCES
284-43-711	Definition.
284-43-721	Grievance process -- Generally.
SUBCHAPTER H HEALTH PLAN BENEFITS
284-43-800	Recognizing the exercise of conscience by purchasers of basic health plan services and ensuring access for all enrollees to such services.
284-43-815	Coverage for pharmacy services.
284-43-816	General prescription drug benefit requirements.
284-43-817	Prescription drug benefit design.
284-43-818	Formulary changes.
284-43-819	Cost-sharing for prescription drugs.
284-43-820	Health plan disclosure requirements.
284-43-822	Unfair practice relating to health coverage.
284-43-825	Prescription drug benefit disclosures.
284-43-840	Anticancer medication.
284-43-850	Clinical trials.
284-43-865	Essential health benefits package benchmark reference plan.
284-43-899	Effective date.
SUBCHAPTER I -- HEALTH PLAN RATES
284-43-901	Authority and purpose.
284-43-905	Applicability and scope.
284-43-910	Definitions.
284-43-915	Demonstration that benefits provided are not reasonable in relation to the amount charged for a contract per RCW 48.44.020 and 48.46.060.
284-43-920	When a carrier is required to file.
284-43-925	General contents of all filings.
284-43-930	Contents of individual and small group filings.
284-43-935	Experience records.
284-43-940	Evaluating experience data.
284-43-945	Summary for individual and small group contract filings.
284-43-950	Summary for group contract filings other than small group contract filings.
SUBCHAPTER J HEALTH PLAN ENROLLMENT AND COVERAGE REQUIREMENTS
284-43-970	Purpose and scope.
284-43-975	Definitions.
284-43-980	Preexisting conditions.
284-43-985	Enrollment of persons under age nineteen.