Chapter 48.43. Insurance Reform
Index
- 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 48.43.01211 Health Plans-Eligibility-Health Status-Related Factors-Rules
- 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 48.43.0126 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 48.43.016 Utilization Management Standards and Criteria-Health Carrier Requirements-Definitions
- RCW 48.43.0161 Prior Authorization Practices-Carrier Annual Reporting Requirements-Commissioner's Standardized Report
- RCW 48.43.021 Personally Identifiable Health Information-Restrictions On Release
- RCW 48.43.0161 [Effective 1/1/2024] Prior Authorization Practices-Carrier Annual Reporting Requirements-Commissioner's Standardized Report
- 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 Preventative Services-No Cost-Sharing Requirements
- RCW 48.43.049 Health Carrier Data-Information From Annual Statement-Format Prescribed By Commissioner-Public Availability
- 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 48.43.0725 Reproductive Health Plan Coverage-Immediate Postpartum Contraception Devices
- 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
- RCW 48.43.096 Medication Synchronization Policy Required For Health Plans Covering Prescription Drugs-Requirements-Definitions
- RCW 48.43.0961 Continuity of Coverage For Health Plans Covering Prescription Drugs For Behavioral Health
- 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
- RCW 48.43.125 Coverage At a Long-Term Care Facility Following Hospitalization-Definition
- RCW 48.43.135 Hearing Instruments-Coverage
- 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
- 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
- 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 48.43.500 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 48.43.5051 Requests For Confidential Communications-Monitoring and Ensuring Compliance-Standardized Form For Submission of Requests-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
- 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
- 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
- RCW 48.43.605 Overpayment Recovery-Health Care Provider
- RCW 48.43.650 Fixed Payment Insurance Products-Commissioner's Annual Report
- 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 48.43.725 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 48.43.733 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 48.43.750 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 48.43.765 Health Carrier Network Adequacy-Mental Health and Substance Abuse Treatment
- 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 Insulin Drugs-Cap On Enrollee's Required Payment Amount-Cost-Sharing Requirements
- RCW 48.43.785 [Contingent Expiration Date] Covid-19 Personal Protective Equipment Expenses-Health Care Provider Reimbursement
- 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 Assessment-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 Specialist Services-Network Access Standards
- RCW 48.43.830 Prior Authorization
- RCW 48.43.902 Effective Date-1996 C 312
- RCW 48.43.904 Construction-Chapter Applicable to State Registered Domestic Partnerships-2009 C 521