Chapter 48.43 RCW

INSURANCE REFORM

Sections

48.43.001Intent.
48.43.005Definitions.
48.43.007Availability of price and quality informationTransparency tools for membersRequirements.
48.43.008Enrollment in employer-sponsored health planPerson eligible for medical assistance.
48.43.009Health care sharing ministries.
48.43.012Individual health benefit plansPreexisting conditions.
48.43.0122Individual health benefit plansPersons under age nineteen.
48.43.015Health benefit plansPreexisting conditions.
48.43.016Prior authorization standards and criteriaHealth carrier requirementsDefinitions.
48.43.017Organ transplant benefit waiting periodsPrior creditable coverage.
48.43.018Requirement to complete the standard health questionnaireExemptionsResults.
48.43.021Personally identifiable health informationRestrictions on release.
48.43.022Enrollee identification cardSocial security number restriction.
48.43.023Pharmacy identification cardsRules.
48.43.025Group health benefit plansPreexisting conditions.
48.43.028Eligibility to purchase certain health benefit plansSmall employers and small groups.
48.43.035Group health benefit plansGuaranteed issue and continuity of coverageExceptions.
48.43.038Individual health plansGuarantee of continuity of coverageExceptions.
48.43.039Grace periodNotification or informationInformation concerning delinquencies or nonpayment of premiumsDefined.
48.43.041Individual health benefit plansMandatory benefits.
48.43.043Colorectal cancer examinations and laboratory testsRequired benefits or coverage.
48.43.045Health plan requirementsAnnual reportsExemptions.
48.43.047Health plansMinimum coverage for preventative servicesNo cost-sharing requirements.
48.43.049Health carrier dataInformation from annual statementFormat prescribed by commissionerPublic availability.
48.43.055Procedures for review and adjudication of health care provider complaintsRequirements.
48.43.059Payments made by a second-party payment processDefinition.
48.43.065Right of individuals to receive servicesRight of providers, carriers, and facilities to refuse to participate in or pay for services for reason of conscience or religionRequirements.
48.43.071Health care informationRequirement to provide free copy to covered person appealing denial of social security benefitsExceptions.
48.43.072Required contraceptive coverageRestrictions on copayments, deductibles, and other form of cost sharing.
48.43.073Required abortion coverageLimitations.
48.43.078Digital breast tomosynthesisIntent to ensure women with accessCommissioner's and health care authority's duty to clarify mandates.
48.43.081Anatomic pathology servicesPayment for servicesDefinitions.
48.43.083Chiropractor servicesParticipating provider agreementHealth carrier reimbursement.
48.43.085Health carrier may not prohibit its enrollees from contracting for services outside the health care plan.
48.43.087Contracting for services at enrollee's expenseMental health care practitionerConditionsException.
48.43.091Health carrier coverage of outpatient mental health servicesRequirements.
48.43.093Health carrier coverage of emergency medical servicesRequirementsConditions.
48.43.094Pharmacist provided servicesHealth plan requirements.
48.43.096Medication synchronization policy required for health plans covering prescription drugsRequirementsDefinitions.
48.43.097Filing of financial statementsEvery health carrier.
48.43.105Preparation of documents that compare health carriersImmunityDue diligence.
48.43.115Maternity servicesIntentDefinitionsPatient preferenceClinical sovereignty of providerNotice to policyholdersApplication.
48.43.125Coverage at a long-term care facility following hospitalizationDefinition.
48.43.176Eosinophilic gastrointestinal associated disorderElemental formula.
48.43.180Denturist services.
48.43.185General anesthesia services for dental procedures.
48.43.190Payment of chiropractic servicesParity.
48.43.195Contraceptive drugsTwelve-month refill coverage.
48.43.200Disclosure of certain material transactionsReportInformation is confidential.
48.43.205Material acquisitions or dispositions.
48.43.210Asset acquisitionsAsset dispositions.
48.43.215Report of a material acquisition or disposition of assetsInformation required.
48.43.220Material nonrenewals, cancellations, or revisions of ceded reinsurance agreements.
48.43.225Report of a material nonrenewal, cancellation, or revision of ceded reinsurance agreementsInformation required.
48.43.290Coverage for prescribed durable medical equipment and mobility enhancing equipmentSales and use taxesDefinitions.
48.43.300Definitions.
48.43.305Report of RBC levelsDistribution of reportFormula for determinationCommissioner may make adjustments.
48.43.310Company action level eventRequired RBC planCommissioner's reviewNotificationChallenge by carrier.
48.43.315Regulatory action level eventRequired RBC planCommissioner's reviewNotificationChallenge by carrier.
48.43.320Authorized control level eventCommissioner's options.
48.43.325Mandatory control level eventCommissioner's dutyRegulatory control.
48.43.330Carrier's right to hearingRequest by carrierDate set by commissioner.
48.43.335Confidentiality of RBC reports and plansUse of certain comparisons prohibitedCertain information intended solely for use by commissioner.
48.43.340Powers or duties of commissioner not limitedRules.
48.43.345Foreign or alien carriersRequired RBC reportCommissioner may require RBC planMandatory control level event.
48.43.350No liability or cause of action against commissioner or department.
48.43.355Notice by commissioner to carrierWhen effective.
48.43.360Initial RBC reportsCalculation of initial RBC levelsSubsequent reports.
48.43.366Self-funded multiple employer welfare arrangements.
48.43.370RBC standards not applicable to certain carriers.
48.43.500IntentPurpose2000 c 5.
48.43.505Requirement to protect enrollee's right to privacy or confidential servicesRules.
48.43.510Carrier required to disclose health plan informationMarketing and advertising restrictionsRules.
48.43.515Access to appropriate health servicesEnrollee optionsRules.
48.43.517Enrollment of child participating in medical assistance programEmployer-sponsored health plan.
48.43.520Requirement to maintain a documented utilization review program description and written utilization review criteriaRules.
48.43.525Prohibition against retrospective denial of health plan coverageRules.
48.43.530Requirement for carriers to have comprehensive grievance and appeal processesCarrier's dutiesProceduresAppealsRules.
48.43.535Independent review of health care disputesSystem for using certified independent review organizationsRules.
48.43.537Health care disputesCertifying independent review organizationsApplicationRestrictionsMaximum fee schedule for conducting reviewsRules.
48.43.540Requirement to designate a licensed medical directorExemption.
48.43.545Standard of careLiabilityCauses of actionDefenseException.
48.43.550Delegation of dutiesCarrier accountability.
48.43.600Overpayment recoveryCarrier.
48.43.605Overpayment recoveryHealth care provider.
48.43.650Fixed payment insurance productsCommissioner's annual report.
48.43.670Plan or contract renewalModification of wellness program.
48.43.680Lifetime limit on transplantsDefinition.
48.43.690Assessments under RCW 70.290.040 considered medical expenses.
48.43.700ExchangePlans that a carrier must offerReviewRules.
48.43.705Plans offered outside of exchange.
48.43.710Certification as qualified health plan not an exemption.
48.43.715Individual and small group marketSelection of benchmark planMinimum requirementsCriteriaList of state-mandated health benefits.
48.43.720Reinsurance and risk adjustment programsAffordable care actRules.
48.43.730Carrier must file provider contracts and compensation agreements with commissionerApproval or disapprovalConfidentialityHearingsRulesDefinitions.
48.43.733Rates and forms of group health benefit plansTiming of filingsExceptionsRules.
48.43.735Reimbursement of health care services provided through telemedicine or store and forward technology.
48.43.740Dental only planEmergency dental conditionsDefinitions.
48.43.743Dental only planAnnual data statementContentsPublic useDefinition.
48.43.750Health care provider credentialing applicationsUse of electronic database by health carriers.
48.43.755Health care provider credentialing applicationsUse of electronic database by providers.
48.43.902Effective date1996 c 312.
48.43.904ConstructionChapter applicable to state registered domestic partnerships2009 c 521.
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