48.43.043  <<  48.43.045 >>   48.43.047

Health plan requirementsAnnual reportsExemptions.

(1) Every health plan delivered, issued for delivery, or renewed by a health carrier on and after January 1, 1996, shall:
(a) Permit every category of health care provider to provide health services or care included in the basic essential health benefits benchmark plan established by the commissioner consistent with RCW 48.43.715, to the extent that:
(i) The provision of such health services or care is within the health care providers' permitted scope of practice;
(ii) The providers agree to abide by standards related to:
(A) Provision, utilization review, and cost containment of health services;
(B) Management and administrative procedures; and
(C) Provision of cost-effective and clinically efficacious health services; and
(iii) The plan covers such services or care in the essential health benefits benchmark plan. The reference to the essential health benefits does not create a mandate to cover a service that is otherwise not a covered benefit.
(b) Annually report the names and addresses of all officers, directors, or trustees of the health carrier during the preceding year, and the amount of wages, expense reimbursements, or other payments to such individuals, unless substantially similar information is filed with the commissioner or the national association of insurance commissioners. This requirement does not apply to a foreign or alien insurer regulated under chapter 48.20 or 48.21 RCW that files a supplemental compensation exhibit in its annual statement as required by law.
(2) The requirements of subsection (1)(a) of this section do not apply to a licensed health care profession regulated under Title 18 RCW when the licensing statute for the profession states that such requirements do not apply.


Effective dateImplementation2007 c 253: See RCW 18.250.901 and 18.250.902.
Effective dates2007 c 98: See RCW 18.74.912.
Short titlePart headings and captions not lawSeverabilityEffective dates1997 c 231: See notes following RCW 48.43.005.
Captions not lawEffective datesSavingsSeverability1995 c 265: See notes following RCW 70.47.015.
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