Chapter 48.43 RCW

INSURANCE REFORM

Sections
Intent.
Definitions.
Availability of price and quality informationTransparency tools for membersRequirements.
Enrollment in employer-sponsored health planPerson eligible for medical assistance.
Health care sharing ministries.
Individual health benefit plansPreexisting conditions.
Individual health benefit plansPersons under age nineteen.
Health benefit plansPreexisting conditions.
Prior authorization standards and criteriaHealth carrier requirementsDefinitions.
Organ transplant benefit waiting periodsPrior creditable coverage.
Requirement to complete the standard health questionnaireExemptionsResults.
Personally identifiable health informationRestrictions on release.
Enrollee identification cardSocial security number restriction.
Pharmacy identification cardsRules.
Group health benefit plansPreexisting conditions.
Eligibility to purchase certain health benefit plansSmall employers and small groups.
Group health benefit plansGuaranteed issue and continuity of coverageExceptions.
Individual health plansGuarantee of continuity of coverageExceptions.
Grace periodNotification or informationInformation concerning delinquencies or nonpayment of premiumsReportsDefined.
Individual health benefit plansMandatory benefits.
Colorectal cancer examinations and laboratory testsRequired benefits or coverage.
Health plan requirementsAnnual reportsExemptions.
Health carrier dataInformation from annual statementFormat prescribed by commissionerPublic availability.
Procedures for review and adjudication of health care provider complaintsRequirements.
Payments made by a second-party payment processDefinition.
Right 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.
Anatomic pathology servicesPayment for servicesDefinitions.
Chiropractor servicesParticipating provider agreementHealth carrier reimbursement.
Health carrier may not prohibit its enrollees from contracting for services outside the health care plan.
Contracting for services at enrollee's expenseMental health care practitionerConditionsException.
Health carrier coverage of outpatient mental health servicesRequirements.
Health carrier coverage of emergency medical servicesRequirementsConditions.
Pharmacist provided servicesHealth plan requirements.
Medication synchronization policy required for health plans covering prescription drugsRequirementsDefinitions.
Filing of financial statementsEvery health carrier.
Preparation of documents that compare health carriersImmunityDue diligence.
Maternity servicesIntentDefinitionsPatient preferenceClinical sovereignty of providerNotice to policyholdersApplication.
Coverage at a long-term care facility following hospitalizationDefinition.
Eosinophilic gastrointestinal associated disorderElemental formula.
Denturist services.
General anesthesia services for dental procedures.
Payment of chiropractic servicesParity.
Contraceptive drugsTwelve-month refill coverage.
Disclosure of certain material transactionsReportInformation is confidential.
Material acquisitions or dispositions.
Asset acquisitionsAsset dispositions.
Report of a material acquisition or disposition of assetsInformation required.
Material nonrenewals, cancellations, or revisions of ceded reinsurance agreements.
Report of a material nonrenewal, cancellation, or revision of ceded reinsurance agreementsInformation required.
Coverage for prescribed durable medical equipment and mobility enhancing equipmentSales and use taxesDefinitions.
Definitions.
Report of RBC levelsDistribution of reportFormula for determinationCommissioner may make adjustments.
Company action level eventRequired RBC planCommissioner's reviewNotificationChallenge by carrier.
Regulatory action level eventRequired RBC planCommissioner's reviewNotificationChallenge by carrier.
Authorized control level eventCommissioner's options.
Mandatory control level eventCommissioner's dutyRegulatory control.
Carrier's right to hearingRequest by carrierDate set by commissioner.
Confidentiality of RBC reports and plansUse of certain comparisons prohibitedCertain information intended solely for use by commissioner.
Powers or duties of commissioner not limitedRules.
Foreign or alien carriersRequired RBC reportCommissioner may require RBC planMandatory control level event.
No liability or cause of action against commissioner or department.
Notice by commissioner to carrierWhen effective.
Initial RBC reportsCalculation of initial RBC levelsSubsequent reports.
Self-funded multiple employer welfare arrangements.
RBC standards not applicable to certain carriers.
IntentPurpose2000 c 5.
Requirement to protect enrollee's right to privacy or confidential servicesRules.
Carrier required to disclose health plan informationMarketing and advertising restrictionsRules.
Access to appropriate health servicesEnrollee optionsRules.
Enrollment of child participating in medical assistance programEmployer-sponsored health plan.
Requirement to maintain a documented utilization review program description and written utilization review criteriaRules.
Prohibition against retrospective denial of health plan coverageRules.
Requirement for carriers to have comprehensive grievance and appeal processesCarrier's dutiesProceduresAppealsRules.
Independent review of health care disputesSystem for using certified independent review organizationsRules.
Health care disputesCertifying independent review organizationsApplicationRestrictionsMaximum fee schedule for conducting reviewsRules.
Requirement to designate a licensed medical directorExemption.
Standard of careLiabilityCauses of actionDefenseException.
Delegation of dutiesCarrier accountability.
Overpayment recoveryCarrier.
Overpayment recoveryHealth care provider.
Fixed payment insurance productsCommissioner's annual report.
Plan or contract renewalModification of wellness program.
Lifetime limit on transplantsDefinition.
Assessments under RCW 70.290.040 considered medical expenses.
ExchangePlans that a carrier must offerReviewRules.
Plans offered outside of exchange.
Certification as qualified health plan not an exemption.
Individual and small group marketSelection of benchmark planMinimum requirementsCriteriaList of state-mandated health benefits.
Reinsurance and risk adjustment programsAffordable care actRules.
Carrier must file provider contracts and compensation agreements with commissionerApproval or disapprovalConfidentialityHearingsRulesDefinitions.
Rates and forms of group health benefit plansTiming of filingsExceptionsRules.
Reimbursement of health care services provided through telemedicine or store and forward technology.
Dental only planEmergency dental conditionsDefinitions.
Dental only planAnnual data statementContentsPublic useDefinition.
Health care provider credentialing applicationsUse of electronic database by health carriers.
Health care provider credentialing applicationsUse of electronic database by providers.
Effective date1996 c 312.
ConstructionChapter applicable to state registered domestic partnerships2009 c 521.
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