HEALTH BENEFIT PLAN MANAGEMENT
WAC Sections
SUBCHAPTER A GENERAL PROVISIONS | ||
| HTMLPDF | 284-170-110 | Purpose. |
| HTMLPDF | 284-170-120 | Applicability and scope. |
| HTMLPDF | 284-170-125 | Compliance with state and federal laws. |
| HTMLPDF | 284-170-130 | Definitions. |
SUBCHAPTER B HEALTH CARE NETWORKS | ||
| HTMLPDF | 284-170-200 | Network access—General standards. |
| HTMLPDF | 284-170-210 | Alternate access delivery request. |
| HTMLPDF | 284-170-220 | Amended alternate access delivery request for services subject to the Balance Billing Protection Act. |
| HTMLPDF | 284-170-230 | Maintenance of sufficient provider networks. |
| HTMLPDF | 284-170-240 | Use of subcontracted networks. |
| HTMLPDF | 284-170-260 | Provider directories. |
| HTMLPDF | 284-170-270 | Every category of health care providers. |
| HTMLPDF | 284-170-280 | Network reports—Format. |
| HTMLPDF | 284-170-285 | Mental health and substance use disorder web page model format and required content. |
| HTMLPDF | 284-170-300 | Essential community providers for exchange plans—Definition. |
| HTMLPDF | 284-170-310 | Essential community providers for exchange plans—Network access. |
| HTMLPDF | 284-170-320 | Issuer recordkeeping—Provider networks. |
| HTMLPDF | 284-170-330 | Tiered provider networks. |
| HTMLPDF | 284-170-340 | Assessment of access. |
| HTMLPDF | 284-170-350 | Issuer standards for women's right to directly access certain health care practitioners for women's health care services. |
| HTMLPDF | 284-170-360 | Enrollee's access to providers. |
| HTMLPDF | 284-170-370 | Hospital emergency service departments and practice groups. |
| HTMLPDF | 284-170-380 | Standards for temporary substitution of contracted network providers—"Locum tenens" providers. |
| HTMLPDF | 284-170-390 | Rule concerning contracted network providers called to active duty military service. |
SUBCHAPTER C PROVIDER CONTRACTS AND PAYMENT | ||
| HTMLPDF | 284-170-401 | Provider and facility contracts with issuers—Generally. |
| HTMLPDF | 284-170-411 | Selection of participating providers—Credentialing and unfair discrimination. |
| HTMLPDF | 284-170-421 | Provider contracts—Standards—Hold harmless provisions. |
| HTMLPDF | 284-170-431 | Provider contracts—Terms and conditions of payment. |
| HTMLPDF | 284-170-433 | Provider contracts—Telemedicine. |
| HTMLPDF | 284-170-440 | Provider contracts—Dispute resolution process. |
| HTMLPDF | 284-170-450 | Pharmacy identification cards. |
| HTMLPDF | 284-170-460 | Provider contracts—Audit guidelines. |
| HTMLPDF | 284-170-470 | Pharmacy claims—Rejections, notifications and disclosures. |
| HTMLPDF | 284-170-480 | Participating provider—Filing and approval. |
| HTMLPDF | 284-170-490 | Effective date. |
DISPOSITION OF SECTIONS FORMERLY CODIFIED IN THIS TITLE
| 284-170-001 | Transitional reinsurance program. [Statutory Authority: RCW 48.02.060, 48.43.720. WSR 13-05-024 (Matter No. R 2012-09), § 284-170-001, filed 2/11/13, effective 3/14/13.] Decodified by WSR 16-01-081, filed 12/14/15, effective 12/14/15. Recodified as § 284-43-0210. |
| 284-170-002 | Risk adjustment program. [Statutory Authority: RCW 48.02.060, 48.43.720. WSR 13-05-025 (Matter No. R 2012-12), § 284-170-002, filed 2/11/13, effective 3/14/13.] Decodified by WSR 16-01-081, filed 12/14/15, effective 12/14/15. Recodified as § 284-43-0230. |
| 284-170-250 | Geographic rating area factor development. [Statutory Authority: RCW 48.02.060, 48.44.050, 48.46.200, and 45 C.F.R. 147.102. WSR 13-11-003 (Matter No. R 2013-01), § 284-170-250, filed 5/1/13, effective 6/1/13.] Decodified by WSR 16-01-081, filed 12/14/15, effective 12/14/15. Recodified as § 284-43-6200. |
| 284-170-252 | Geographic rating area designation. [Statutory Authority: RCW 48.02.060, 48.44.050, 48.46.200, and 45 C.F.R. 147.102. WSR 13-11-003 (Matter No. R 2013-01), § 284-170-252, filed 5/1/13, effective 6/1/13.] Decodified by WSR 16-01-081, filed 12/14/15, effective 12/14/15. Recodified as § 284-43-6220. |
| 284-170-400 | Preexisting condition limitations. [Statutory Authority: RCW 48.02.060, 48.18.120(2), 48.20.450, 48.43.0211, 48.43.720(3), 48.44.050, 48.46.200, 45 C.F.R. §§ 147.104, 147.106, 155.420, and 155.725. WSR 14-01-042 (Matter No. R 2013-02), § 284-170-400, filed 12/11/13, effective 1/1/14.] Decodified by WSR 16-01-081, filed 12/14/15, effective 12/14/15. Recodified as § 284-43-5000. |
| 284-170-410 | Special enrollment requirements for small group plans. [Statutory Authority: RCW 48.02.060, 48.18.120(2), 48.20.450, 48.43.0211, 48.43.720(3), 48.44.050, 48.46.200, 45 C.F.R. §§ 147.104, 147.106, 155.420, and 155.725. WSR 14-01-042 (Matter No. R 2013-02), § 284-170-410, filed 12/11/13, effective 1/1/14.] Decodified by WSR 16-01-081, filed 12/14/15, effective 12/14/15. Recodified as § 284-43-1020. |
| 284-170-412 | Special enrollment periods for small group qualified health plans. [Statutory Authority: RCW 48.02.060, 48.18.120(2), 48.20.450, 48.43.0211, 48.43.720(3), 48.44.050, 48.46.200, 45 C.F.R. §§ 147.104, 147.106, 155.420, and 155.725. WSR 14-01-042 (Matter No. R 2013-02), § 284-170-412, filed 12/11/13, effective 1/1/14.] Decodified by WSR 16-01-081, filed 12/14/15, effective 12/14/15. Recodified as § 284-43-1040. |
| 284-170-415 | Duration and effective dates of small group special enrollment periods. [Statutory Authority: RCW 48.02.060, 48.18.120(2), 48.20.450, 48.43.0211, 48.43.720(3), 48.44.050, 48.46.200, 45 C.F.R. §§ 147.104, 147.106, 155.420, and 155.725. WSR 14-01-042 (Matter No. R 2013-02), § 284-170-415, filed 12/11/13, effective 1/1/14.] Decodified by WSR 16-01-081, filed 12/14/15, effective 12/14/15. Recodified as § 284-43-1060. |
| 284-170-420 | Individual market open enrollment requirements. [Statutory Authority: RCW 48.02.060, 48.18.120(2), 48.44.050, 48.46.200 and 45 C.F.R. Parts 144, 146 and 147. WSR 14-08-036 (Matter No. R 2014-01), § 284-170-420, filed 3/26/14, effective 4/26/14. Statutory Authority: RCW 48.02.060, 48.18.120(2), 48.20.450, 48.43.0211, 48.43.720(3), 48.44.050, 48.46.200, 45 C.F.R. §§ 147.104, 147.106, 155.420, and 155.725. WSR 14-01-042 (Matter No. R 2013-02), § 284-170-420, filed 12/11/13, effective 1/1/14.] Decodified by WSR 16-01-081, filed 12/14/15, effective 12/14/15. Recodified as § 284-43-1080. |
| 284-170-425 | Individual market special enrollment requirements. [Statutory Authority: RCW 48.02.060, 48.18.120(2), 48.20.450, 48.43.0211, 48.43.720(3), 48.44.050, 48.46.200, 45 C.F.R. §§ 147.104, 147.106, 155.420, and 155.725. WSR 14-01-042 (Matter No. R 2013-02), § 284-170-425, filed 12/11/13, effective 1/1/14.] Decodified by WSR 16-01-081, filed 12/14/15, effective 12/14/15. Recodified as § 284-43-1100. |
| 284-170-430 | Individual market special enrollment period requirements for qualified health plans. [Statutory Authority: RCW 48.02.060, 48.18.120(2), 48.20.450, 48.43.0211, 48.43.720(3), 48.44.050, 48.46.200, 45 C.F.R. §§ 147.104, 147.106, 155.420, and 155.725. WSR 14-01-042 (Matter No. R 2013-02), § 284-170-430, filed 12/11/13, effective 1/1/14.] Decodified by WSR 16-01-081, filed 12/14/15, effective 12/14/15. Recodified as § 284-43-1120. |
| 284-170-435 | Duration, notice requirements and effective dates of coverage for individual market special enrollment periods. [Statutory Authority: RCW 48.02.060, 48.18.120(2), 48.20.450, 48.43.0211, 48.43.720(3), 48.44.050, 48.46.200, 45 C.F.R. §§ 147.104, 147.106, 155.420, and 155.725. WSR 14-01-042 (Matter No. R 2013-02), § 284-170-435, filed 12/11/13, effective 1/1/14.] Decodified by WSR 16-01-081, filed 12/14/15, effective 12/14/15. Recodified as § 284-43-1140. |
| 284-170-800 | Purpose and scope—Pediatric dental benefits for health benefit plans sold outside of the health benefit exchange. [Statutory Authority: RCW 48.02.060 and 48.43.715. WSR 14-09-080 (Matter No. R 2013-19), § 284-170-800, filed 4/18/14, effective 5/19/14.] Decodified by WSR 16-01-081, filed 12/14/15, effective 12/14/15. Recodified as § 284-43-5720. |
| 284-170-805 | Definitions. [Statutory Authority: RCW 48.02.060 and 48.43.715. WSR 14-09-080 (Matter No. R 2013-19), § 284-170-805, filed 4/18/14, effective 5/19/14.] Decodified by WSR 16-01-081, filed 12/14/15, effective 12/14/15. Recodified as § 284-43-5740. |
| 284-170-810 | Pediatric dental benefits design—Methods of satisfying requirements. [Statutory Authority: RCW 48.02.060 and 48.43.715. WSR 14-09-080 (Matter No. R 2013-19), § 284-170-810, filed 4/18/14, effective 5/19/14.] Decodified by WSR 16-01-081, filed 12/14/15, effective 12/14/15. Recodified as § 284-43-5760. |
| 284-170-870 | Deadline for filing individual health plans, small group health plans, and stand-alone dental plans. [Statutory Authority: RCW 48.02.060, 48.18.100, 48.43.340, 48.43.715, 48.44.050, and 48.46.200. WSR 14-07-047 (Matter No. R 2013-27), § 284-170-870, filed 3/13/14, effective 4/13/14.] Decodified by WSR 16-01-081, filed 12/14/15, effective 12/14/15. Recodified as § 284-43-0200. |
| 284-170-950 | Grandfathered health plan status. [Statutory Authority: RCW 48.02.060, 48.43.700, 48.43.715, 48.44.050, 48.46.200, and 45 C.F.R. 150.101(2). WSR 14-01-039 (Matter No. R 2013-13), § 284-170-950, filed 12/11/13, effective 1/11/14.] Decodified by WSR 16-01-081, filed 12/14/15, effective 12/14/15. Recodified as § 284-43-0250. |
| 284-170-952 | Market conduct requirements related to grandfathered status. [Statutory Authority: RCW 48.02.060, 48.43.700, 48.43.715, 48.44.050, 48.46.200, and 45 C.F.R. 150.101(2). WSR 14-01-039 (Matter No. R 2013-13), § 284-170-952, filed 12/11/13, effective 1/11/14.] Decodified by WSR 16-01-081, filed 12/14/15, effective 12/14/15. Recodified as § 284-43-0270. |
| 284-170-954 | Small group coverage market transition requirements. [Statutory Authority: RCW 48.02.060, 48.43.700, 48.43.715, 48.44.050, 48.46.200, and 45 C.F.R. 150.101(2). WSR 14-01-039 (Matter No. R 2013-13), § 284-170-954, filed 12/11/13, effective 1/11/14.] Decodified by WSR 16-01-081, filed 12/14/15, effective 12/14/15. Recodified as § 284-43-0290. |
| 284-170-955 | Association health plan compliance with statutory or regulatory changes. [Statutory Authority: RCW 48.02.060, 48.43.700, 48.43.715, 48.44.050, 48.46.200, and 45 C.F.R. 150.101(2). WSR 14-01-039 (Matter No. R 2013-13), § 284-170-955, filed 12/11/13, effective 1/11/14.] Decodified by WSR 16-01-081, filed 12/14/15, effective 12/14/15. Recodified as § 284-43-0310. |
| 284-170-958 | Transition of plans purchased by association members. [Statutory Authority: RCW 48.02.060, 48.43.700, 48.43.715, 48.44.050, 48.46.200, and 45 C.F.R. 150.101(2). WSR 14-01-039 (Matter No. R 2013-13), § 284-170-958, filed 12/11/13, effective 1/11/14.] Decodified by WSR 16-01-081, filed 12/14/15, effective 12/14/15. Recodified as § 284-43-0330. |
| 284-170-959 | Individual coverage market transition requirements. [Statutory Authority: RCW 48.02.060, 48.43.700, 48.43.715, 48.44.050, 48.46.200, and 45 C.F.R. 150.101(2). WSR 14-01-039 (Matter No. R 2013-13), § 284-170-959, filed 12/11/13, effective 1/11/14.] Decodified by WSR 16-01-081, filed 12/14/15, effective 12/14/15. Recodified as § 284-43-0350. |