PERMANENT RULES
INSURANCE COMMISSIONER
Date of Adoption: September 5, 2001.
Purpose: The adopted rules revisit the subject of existing rules and provide greater focus and clarity regarding the subject of unfair discrimination based on sex in the provision of health coverage. The adopted rules include a new WAC section regarding unfair discrimination based on sex in the provision of health coverage. The area of prescription contraception is used as an example to clarify the application in that area.
Citation of Existing Rules Affected by this Order: Repealing WAC 284-43-821, 284-43-823, and 284-43-824.
Statutory Authority for Adoption: RCW 48.02.060, 48.18.480, 48.20.450, 48.20.460, 48.21.045, 48.30.010, 48.30.300, 48.41.110, 48.41.170, 48.42.010, 48.42.040, 48.42.100, 48.43.012, 48.43.025, 48.43.035, 48.43.041, 48.43.115, 48.43.520, 48.44.020, 48.44.023, 48.44.050, 48.44.220, 48.46.060, 48.46.066, 48.46.110, 48.46.200, 49.60.010, 49.60.030, 49.60.120, 49.60.178, 49.60.220.
Adopted under notice filed as WSR 01-15-084 on July 18, 2001.
Changes Other than Editing from Proposed to Adopted Version: Subsection (1), an example of "generally comprehensive coverage" is added.
Subsection (2)(a), "and" is changed to "and/or" in the first sentence "medically necessary services" is changed to "medical services" in the second sentence.
Subsection (2)(f), "oral, implant, and injectable" and "intrauterine" are deleted.
Subsection (2)(g), "otherwise exempted by law" is deleted.
Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 0, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.
Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.
Number of Sections Adopted on the Agency's Own Initiative: New 1, Amended 0, Repealed 3.
Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 0, Repealed 0.
Number of Sections Adopted Using Negotiated Rule Making:
New 0,
Amended 0,
Repealed 0;
Pilot Rule Making:
New 0,
Amended 0,
Repealed 0;
or Other Alternative Rule Making:
New 0,
Amended 0,
Repealed 0.
Effective Date of Rule:
Thirty-one days after filing.
September 5, 2001
Mike Kreidler
Insurance Commissioner
OTS-5040.5
NEW SECTION
WAC 284-43-822
Unfair practice relating to health coverage.
(1) It is an unfair practice for any health carrier to restrict,
exclude, or reduce coverage or benefits under any health plan on
the basis of sex. By way of example, a health plan providing
generally comprehensive coverage of prescription drugs and
prescription devices restricts, excludes, or reduces coverage or
benefits on the basis of sex if it fails to provide prescription
contraceptive coverage that complies with this regulation.
An example of a plan that provides generally comprehensive coverage of prescription drugs is a plan that covers prescription drugs but excludes some categories such as weight reduction or smoking cessation.
(2)(a) Health plans providing generally comprehensive coverage of prescription drugs and/or prescription devices shall not exclude prescription contraceptives or cover prescription contraceptives on a less favorable basis than other covered prescription drugs and prescription devices. Coverage of prescription contraceptives includes coverage for medical services associated with the prescribing, dispensing, delivery, distribution, administration and removal of a prescription contraceptive to the same extent, and on the same terms, as other outpatient services.
(b) Health plans may not impose benefit waiting periods, limitations, or restrictions on prescription contraceptives that are not required or imposed on other covered prescription drugs and prescription devices.
(c) Health plans may require cost sharing, such as copayments or deductibles, for prescription contraceptives and for services associated with the prescribing, dispensing, delivery, distribution, administration, and removal of the prescription contraceptives, to the same extent that such cost sharing is required for other covered prescription drugs, devices or services.
(d) Health carriers may use, and health plans may limit coverage to, a closed formulary for prescription contraceptives if they otherwise use a closed formulary, but the formulary shall cover each of the types of prescription contraception as defined in (f) of this subsection.
(e) If a health plan excludes coverage for nonprescription drugs and devices except for those required by law, it may also exclude coverage for nonprescription contraceptive drugs and devices.
(f) For purposes of subsections (1) and (2) of this section, "prescription contraceptives" include United States Food and Drug Administration (FDA) approved contraceptive drugs, devices, and prescription barrier methods, including contraceptive products declared safe and effective for use as emergency contraception by the FDA.
(g) This section applies prospectively to health plans offered, issued, or renewed by a health carrier on or after January 1, 2002.
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The following sections of the Washington Administrative Code are repealed:
| WAC 284-43-821 | Maternity and pregnancy-related exclusions, limitations and conditions in individual plans. |
| WAC 284-43-823 | Maternity and pregnancy-related exclusions, limitations and conditions in group plans. |
| WAC 284-43-824 | Effective date. |