Chapter

INSURANCE REFORM

RCW 48.43.001— Intent.
RCW 48.43.005— Definitions.
RCW 48.43.007— Availability of price and quality information—Transparency tools for members—Requirements.
RCW 48.43.008— Enrollment in employer-sponsored health plan—Person eligible for medical assistance.
RCW 48.43.009— Health care sharing ministries.
RCW 48.43.012— Health plans—Preexisting conditions—Rules.
RCW 48.43.016— Utilization management standards and criteria—Health carrier requirements—Definitions. (Effective until January 1, 2027.)
RCW 48.43.021— Personally identifiable health information—Restrictions on release.
RCW 48.43.022— Enrollee identification card—Social security number restriction.
RCW 48.43.023— Pharmacy identification cards—Rules.
RCW 48.43.028— Eligibility to purchase certain health benefit plans—Small employers and small groups.
RCW 48.43.035— Group health benefit plans—Guaranteed issue and continuity of coverage—Exceptions.
RCW 48.43.038— Individual health plans—Guarantee of continuity of coverage—Exceptions.
RCW 48.43.039— Grace period—Notification or information—Information concerning delinquencies or nonpayment of premiums—Defined.
RCW 48.43.041— Individual health benefit plans—Mandatory benefits.
RCW 48.43.043— Colorectal cancer examinations and laboratory tests—Required benefits or coverage.
RCW 48.43.045— Health plan requirements—Annual reports—Exemptions.
RCW 48.43.047— Health plans—Minimum coverage for preventive services—No cost-sharing requirements.
RCW 48.43.055— Procedures for review and adjudication of health care provider complaints—Requirements.
RCW 48.43.059— Payments made by a second-party payment process—Definition.
RCW 48.43.065— Right of individuals to receive services—Right of providers, carriers, and facilities to refuse to participate in or pay for services for reason of conscience or religion—Requirements.
RCW 48.43.071— Health care information—Requirement to provide free copy to covered person appealing denial of social security benefits—Exceptions.
RCW 48.43.072— Required reproductive health care coverage—Restrictions on copayments, deductibles, and other form of cost sharing.
RCW 48.43.073— Required abortion coverage—Limitations.
RCW 48.43.074— Qualified health plans—Single invoice billing—Certification of compliance required in the segregation plan for premium amounts attributable to coverage of abortion services.
RCW 48.43.076— Digital breast examinations—Cost sharing.
RCW 48.43.078— Digital breast tomosynthesis—Intent to ensure women with access—Commissioner's and health care authority's duty to clarify mandates.
RCW 48.43.081— Anatomic pathology services—Payment for services—Definitions.
RCW 48.43.083— Chiropractor services—Participating provider agreement—Health carrier reimbursement.
RCW 48.43.085— Health carrier may not prohibit its enrollees from contracting for services outside the health care plan.
RCW 48.43.087— Contracting for services at enrollee's expense—Mental health care practitioner—Conditions—Exception.
RCW 48.43.091— Health carrier coverage of outpatient mental health services—Requirements.
RCW 48.43.093— Health carrier coverage of emergency medical services—Requirements—Conditions.
RCW 48.43.094— Pharmacist provided services—Health plan requirements. (Effective until June 30, 2027.)
RCW 48.43.096— Medication synchronization policy required for health plans covering prescription drugs—Requirements—Definitions.
RCW 48.43.097— Filing of financial statements—Every health carrier.
RCW 48.43.105— Preparation of documents that compare health carriers—Immunity—Due diligence.
RCW 48.43.115— Maternity services—Intent—Definitions—Patient preference—Clinical sovereignty of provider—Notice to policyholders—Application. (Effective until June 30, 2027.)
RCW 48.43.121— Ground ambulance services organizations—Coverage.
RCW 48.43.0122— Individual health benefit plans—Open enrollment and special enrollment periods—Rules—Enforcement.
RCW 48.43.0123— Health plans—Rescission of coverage—Rules.
RCW 48.43.0124— Health plans—Cost sharing for essential health benefits—Rules.
RCW 48.43.0125— Essential health benefits—Annual or lifetime dollar limits.
RCW 48.43.125— Coverage at a long-term care facility following hospitalization—Definition.
RCW 48.43.0126— Summary of benefits and explanation of coverage—Standards and requirements—Notice of modification—Fines—Standards for definitions of health insurance terms—Rules.
RCW 48.43.0127— Group health plans—Waiting period—Rules.
RCW 48.43.0128— Nongrandfathered health plans and plans issued or renewed on or after January 1, 2022—Prohibited discrimination—Rules.
RCW 48.43.135— Hearing instruments—Coverage.
RCW 48.43.0161— Prior authorization practices—Carrier annual reporting requirements—Commissioner's standardized report.
RCW 48.43.176— Eosinophilic gastrointestinal associated disorder—Elemental formula.
RCW 48.43.180— Denturist services.
RCW 48.43.185— General anesthesia services for dental procedures.
RCW 48.43.190— Payment of chiropractic services—Parity.
RCW 48.43.195— Contraceptive drugs—Twelve-month refill coverage. (Effective until January 1, 2026.)
RCW 48.43.200— Disclosure of certain material transactions—Report—Information is confidential.
RCW 48.43.205— Material acquisitions or dispositions.
RCW 48.43.210— Asset acquisitions—Asset dispositions.
RCW 48.43.215— Report of a material acquisition or disposition of assets—Information required.
RCW 48.43.220— Material nonrenewals, cancellations, or revisions of ceded reinsurance agreements.
RCW 48.43.225— Report of a material nonrenewal, cancellation, or revision of ceded reinsurance agreements—Information required.
RCW 48.43.290— Coverage for prescribed durable medical equipment and mobility enhancing equipment—Sales and use taxes—Definitions.
RCW 48.43.300— Definitions.
RCW 48.43.305— Report of RBC levels—Distribution of report—Formula for determination—Commissioner may make adjustments.
RCW 48.43.310— Company action level event—Required RBC plan—Commissioner's review—Notification—Challenge by carrier.
RCW 48.43.315— Regulatory action level event—Required RBC plan—Commissioner's review—Notification—Challenge by carrier.
RCW 48.43.320— Authorized control level event—Commissioner's options.
RCW 48.43.325— Mandatory control level event—Commissioner's duty—Regulatory control.
RCW 48.43.330— Carrier's right to hearing—Request by carrier—Date set by commissioner.
RCW 48.43.335— Confidentiality of RBC reports and plans—Use of certain comparisons prohibited—Certain information intended solely for use by commissioner.
RCW 48.43.340— Powers or duties of commissioner not limited—Rules.
RCW 48.43.345— Foreign or alien carriers—Required RBC report—Commissioner may require RBC plan—Mandatory control level event.
RCW 48.43.350— No liability or cause of action against commissioner or department.
RCW 48.43.355— Notice by commissioner to carrier—When effective.
RCW 48.43.360— Initial RBC reports—Calculation of initial RBC levels—Subsequent reports.
RCW 48.43.366— Self-funded multiple employer welfare arrangements.
RCW 48.43.370— RBC standards not applicable to certain carriers.
RCW 48.43.400— Prescription drug utilization management—Definitions.
RCW 48.43.410— Prescription drug utilization management—Clinical review criteria—Requirement to be evidence-based and updated regularly. (Effective until January 1, 2027.)
RCW 48.43.420— Prescription drug utilization management—Exception request process—Conditions, requirements, and time frames for approval or denial of requests—Emergency fill coverage—Notice of new policies and procedures.
RCW 48.43.430— Prescription medication—Maximum charge at point of sale—Requirements.
RCW 48.43.435— Prescription medication—Cost-sharing calculation—Application—Rules.
RCW 48.43.440— Human immunodeficiency virus postexposure prophylaxis drugs—Cost sharing and prior authorization.
RCW 48.43.500— Intent—Purpose—2000 c 5.
RCW 48.43.505— Enrollee's and protected individual's right to privacy and confidential services—Health carrier or insurer duties—Requests for confidential communications—Rules.
RCW 48.43.510— Carrier required to disclose health plan information—Marketing and advertising restrictions—Rules.
RCW 48.43.515— Access to appropriate health services—Enrollee options—Rules.
RCW 48.43.517— Enrollment of child participating in medical assistance program—Employer-sponsored health plan.
RCW 48.43.520— Requirement to maintain a documented utilization review program description and written utilization review criteria—Rules. (Effective until January 1, 2027.)
RCW 48.43.525— Prohibition against retrospective denial of health plan coverage—Rules.
RCW 48.43.530— Requirement for carriers to have comprehensive grievance and appeal processes—Carrier's duties—Procedures—Appeals—Rules.
RCW 48.43.535— Independent review of health care disputes—System for using certified independent review organizations—Rules. (Effective until January 1, 2027.)
RCW 48.43.537— Health care disputes—Certifying independent review organizations—Application—Restrictions—Maximum fee schedule for conducting reviews—Rules.
RCW 48.43.540— Requirement to designate a licensed medical director—Exemption.
RCW 48.43.545— Standard of care—Liability—Causes of action—Defense—Exception.
RCW 48.43.550— Delegation of duties—Carrier accountability.
RCW 48.43.600— Overpayment recovery—Carrier. (Effective until January 1, 2027.)
RCW 48.43.605— Overpayment recovery—Health care provider.
RCW 48.43.670— Plan or contract renewal—Modification of wellness program.
RCW 48.43.680— Lifetime limit on transplants—Definition.
RCW 48.43.690— Assessments under RCW 70.290.040 considered medical expenses.
RCW 48.43.700— Exchange—Plans that a carrier must offer—Review—Rules.
RCW 48.43.705— Plans offered outside of exchange.
RCW 48.43.710— Certification as qualified health plan not an exemption.
RCW 48.43.715— Individual and small group market—Selection of benchmark plan—Minimum requirements—Criteria—List of state-mandated health benefits.
RCW 48.43.720— Reinsurance and risk adjustment programs—Affordable care act—Rules.
RCW 48.43.0725— Reproductive health plan coverage—Immediate postpartum contraception devices.
RCW 48.43.725— Exclusion of mandated benefits from health plan—Carrier requirements—Notice—Fees—Commissioner's duties.
RCW 48.43.730— Carrier must file provider contracts and compensation agreements with commissioner—Approval or disapproval—Confidentiality—Hearings—Rules—Definitions.
RCW 48.43.731— Health care benefit management contracts—Carrier filing requirements—Notice to enrollees—Confidentiality of filings.
RCW 48.43.732— Provider contracts—Public statements—Language.
RCW 48.43.733— Rates and forms of group health benefit plans—Timing of filings—Exceptions—Rules.
RCW 48.43.734— Health carrier rate filings—Review of surplus, capital, and profit levels.
RCW 48.43.735— Reimbursement of health care services provided through telemedicine or store and forward technology—Audio-only telemedicine.
RCW 48.43.740— Dental only plan—Emergency dental conditions—Definitions.
RCW 48.43.743— Dental only plan—Annual data statement—Contents—Public use—Definition.
RCW 48.43.745— Dental only plan—Denturist services.
RCW 48.43.747— Dental only plan—Coverage for same day procedures.
RCW 48.43.748— Dental only plan—Payments by credit card.
RCW 48.43.750— Health care provider credentialing applications—Use of electronic database by health carriers.
RCW 48.43.755— Health care provider credentialing applications—Use of electronic database by providers.
RCW 48.43.757— Health care provider credentialing applications—Reimbursement requirements.
RCW 48.43.760— Opioid use disorder—Coverage without prior authorization.
RCW 48.43.761— Withdrawal management services—Substance use disorder treatment services—Prior authorization—Utilization review—Medical necessity review.
RCW 48.43.762— Opioid overdose reversal medication bulk purchasing and distribution program.
RCW 48.43.764— Standard set of criteria—Authority review.
RCW 48.43.765— Health carrier network adequacy—Mental health and substance abuse treatment.
RCW 48.43.766— Mental health and substance use disorder services—Coverage—Utilization reviews. (Effective January 1, 2027.)
RCW 48.43.767— Behavioral health services—Network access.
RCW 48.43.770— Individual market health plan availability—Annual report.
RCW 48.43.775— Qualified health plan participation—Reimbursement rate for other health plans.
RCW 48.43.780— Cap on enrollee's required payment amount for specific drugs and equipment—Cost-sharing requirements.
RCW 48.43.785— COVID-19 personal protective equipment expenses—Health care provider reimbursement. (Contingent expiration date.)
RCW 48.43.790— Behavioral services—Next-day appointments.
RCW 48.43.795— Qualified health plans—Acceptance of premium and cost-sharing assistance.
RCW 48.43.800— Primary care expenditures reporting—Review.
RCW 48.43.805— Prescription drug upper payment limit—Rules.
RCW 48.43.810— Biomarker testing—Standards—Construction.
RCW 48.43.815— Donor human milk—Standards.
RCW 48.43.820— Consolidated appropriations act enforcement—Implementation of federal regulations.
RCW 48.43.825— Certified peer support specialist services—Network access standards.
RCW 48.43.830— Prior authorization. (Effective until January 1, 2027.)
RCW 48.43.835— Physician assistants—Coverage.
RCW 48.43.840— Prosthetic limbs and custom orthotic braces—Coverage—Reporting.
RCW 48.43.845— Prescription hormone therapy—Coverage.
RCW 48.43.902— Effective date—1996 c 312.
RCW 48.43.904— Construction—Chapter applicable to state registered domestic partnerships—2009 c 521.
RCW 48.43.0961— Continuity of coverage for health plans covering prescription drugs for behavioral health.
RCW 48.43.01211— Health plans—Eligibility—Health status-related factors—Rules.
RCW 48.43.5051— Requests for confidential communications—Monitoring and ensuring compliance—Standardized form for submission of requests—Rules.