Chapter 48.46 RCW

HEALTH MAINTENANCE ORGANIZATIONS

Sections
Legislative declarationPurpose.
Filings with secretary of stateCopy for commissioner.
Definitions.
Insurance producerDefinitionLicense requiredApplication, issuance, renewal, feesPenalties involving license.
Registration, requiredIssuance of securitiesPenalty.
Eligibility requirements for certificate of registrationApplication requirements, informationProvider compensation.
Unregistered activitiesActs committed in this stateSanctions.
Certificate of registrationIssuanceGrounds for refusalName restrictionsInspection and review of facilities.
Catastrophic health plans permitted.
Prepayment agreementsStandards for forms and documentsGrounds for disapprovalCancellation or failure to renewFiling of agreement forms.
Schedule of rates for individual agreementsLoss ratioDefinitions.
Calculation of premiumsMembers of a purchasing poolAdjusted community rating methodDefinitions.
Calculation of premiumsAdjusted community rateDefinitions.
Health plan benefits for small employersCoverageExemption from statutory requirementsPremium ratesRequirements for providing coverage for small employers.
Requirements for plans offered to small employersDefinitions.
Governing body.
Annual statementFilingsContentsFeePenalty for failure to fileAccuracy required.
Standard of services provided.
Grievance procedure.
Name restrictionsDiscriminationRecovery of costs of health care services participant not entitled to.
Examination of health maintenance organizationsDuties of organizations, powers of commissionerIndependent audit reports.
Investigation of violationsHearingFindingsPenaltiesOrder requiring compliance, etc.Suspension or revocation of certificate, effectApplication to courts.
Fine in addition to or in lieu of suspension, revocation, or refusal.
Fees.
Effect of chapter as to other lawsConstruction.
Duty of employer to inform and make available to employees option of enrolling in health maintenance organization.
Payroll deductions for capitation payments to health maintenance organizations.
Rules and regulations.
Compliance with federal funding requirementsConstruction.
Review of administrative action.
Financial failureSupervision of commissionerPriority of distribution of assets.
Minimum net worthRequirement to maintainDetermination of amount.
Minimum net worthDomestic or foreign health maintenance organization.
Funded reserve requirements.
ContractParticipant liability.
Plan for handling insolvencyCommissioner's review.
InsolvencyCommissioner's dutiesParticipants' optionsAllocation of coverage.
Coverage of dependent childrenNewborn infants, congenital anomaliesNotification period.
Individual health maintenance agreementReturn within ten days of deliveryRefundsVoid from beginning.
Financial interests of health maintenance organization authorities, restrictedExceptions, regulations.
Diabetes coverageDefinitions.
Prescribed, self-administered anticancer medication.
MammogramsInsurance coverage.
Prostate cancer screening.
Reconstructive breast surgery.
Mastectomy, lumpectomy.
Mental health servicesHealth plansDefinitionCoverage required, when.
Mental health treatmentWaiver of preauthorization for persons involuntarily committed.
Future dividends or refunds, restrictedIssuance or sale of securities regulated.
Registration not endorsement.
Dependent children, termination of coverage, conditions.
Option to cover child under age twenty-six.
Return of agreement within ten days.
Chemical dependency treatment.
"Chemical dependency" defined.
Payment of cost of agreement directly to holder during labor disputeChanges restrictedNotice to employee.
Coverage not denied for handicap.
Benefits for prenatal diagnosis of congenital disordersAgreements entered into or renewed on or after January 1, 1990.
Notice of reason for cancellation, denial, or refusal to renew agreement.
Providing information on cancellation or refusalNo liability for insurance commissioner or health maintenance organization.
False or misleading advertising prohibited.
Misrepresentations to induce termination or retention of agreement prohibited.
Penalty for violations.
Enforcement authority of commissioner.
Continuation option to be offered.
Conversion agreement to be offeredExceptions, conditions.
Conversion agreementRestrictions and requirementsRules.
Endorsement of modifications.
Continuation of coverage of former family members.
Coverage for adopted children.
Cancellation of rider.
Phenylketonuria.
Neurodevelopmental therapiesEmployer-sponsored group contracts.
Temporomandibular joint disordersInsurance coverage.
PrescriptionsPreapproval of individual claimsSubsequent rejection prohibitedWritten record required.
Nonresident pharmacies.
Foot care services.
Denturist services.
Doctor of osteopathic medicine and surgeryDiscrimination based on board certification is prohibited.
When injury caused by intoxication or use of narcotics.
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.
Liberal construction.
Short title.
ConstructionChapter applicable to state registered domestic partnerships2009 c 521.
NOTES:
Insurance producers appointed by health maintenance organizations, additional regulations applicable: RCW 48.17.065.
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