Title 48 — Title 48 INSURANCE
101 chapters · 2,134 sections in this title.
RCW 48.21.010 "Group disability insurance" defined—Issuance.
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(1) Group disability insurance is that form of disability insurance, including stop loss insurance as defined in RCW 48.11.030, provided by a master policy issued to an employer, to a trustee appointed by an employer or employers, or to an association of employers formed for purp…
RCW 48.21.015 "Group stop loss insurance" defined for the purpose of exemption—Scope of application.
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Group stop loss insurance is exempt from all sections of this chapter and chapter 48.32A RCW except for RCW 48.21.010 and this section. For the purpose of this exemption, group stop loss is further defined as follows:(1) The policy must be issued to and insure the employer, the t…
RCW 48.21.020 "Employees," "employer" defined.
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The term "employees" as used in this chapter shall be deemed to include as employees of a single employer, the compensated officers, managers, and employees of the employer and of subsidiary or affiliated corporations of a corporation employer, and the individual proprietors, par…
RCW 48.21.030 Health care groups.
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A policy of group disability insurance may be issued to a corporation, as policyholder, existing primarily for the purpose of assisting individuals who are its subscribers in securing medical, hospital, dental, and other health care services for themselves and their dependents, c…
RCW 48.21.040 "Blanket disability insurance" defined.
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(1) Any policy or contract of disability insurance which conforms with the description and complies with the requirements contained in one of the following six paragraphs shall be deemed a blanket disability insurance policy:(a) A policy issued to any common carrier of passengers…
RCW 48.21.045 Health plan benefits for small employers—Coverage—Exemption from statutory requirements—Premium rates—Requirements for providing coverage for small employers—Definitions.
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(1)(a) An insurer offering any health benefit plan to a small employer, either directly or through an association or member-governed group formed specifically for the purpose of purchasing health care, may offer and actively market to the small employer a health benefit plan feat…
RCW 48.21.047 Requirements for plans offered to small employers—Definitions.
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(1) An insurer may not offer any health benefit plan to any small employer without complying with RCW 48.21.045(3).(2) Employers purchasing health plans provided through associations or through member-governed groups formed specifically for the purpose of purchasing health care a…
RCW 48.21.050 Standard provisions required.
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Every policy of group or blanket disability insurance shall contain in substance the provisions as set forth in RCW 48.21.060 to 48.21.090, inclusive, or provisions which in the opinion of the commissioner are more favorable to the individuals insured, or at least as favorable to…
RCW 48.21.060 The contract—Representations.
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There shall be a provision that a copy of the application, if any, of the policyholder shall be attached to the policy when issued; that all statements made by the policyholder or by the individuals insured shall in the absence of fraud be deemed representations and not warrantie…
RCW 48.21.070 Payment of premiums.
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There shall be a provision that all premiums due under the policy shall be remitted by the employer or employers of the persons insured, by the policyholder, or by some other designated person acting on behalf of the association or group insured, to the insurer on or before the d…
RCW 48.21.075 Payment of premiums by employee in event of suspension of compensation due to labor dispute.
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Any employee whose compensation includes group disability or blanket disability insurance providing health care services, the premiums for which are paid in full or in part by an employer including the state of Washington, its political subdivisions, or municipal corporations, or…
RCW 48.21.080 Certificates of coverage.
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In group disability insurance policies there shall be a provision that the insurer shall issue to the employer, the policyholder, or other person or association in whose name such policy is issued, for delivery to each insured employee or member, a certificate setting forth in su…
RCW 48.21.090 Age limitations.
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There shall be a provision specifying the ages, if any there be, to which the insurance provided therein shall be limited; and the ages, if any there be, for which additional restrictions are placed on benefits, and the additional restrictions placed on the benefits at such ages.…
RCW 48.21.100 Examination and autopsy.
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There may be a provision that the insurer shall have the right and opportunity to examine the person of the insured employee, member or dependent when and so often as it may reasonably require during the pendency of claim under the policy and also the right and opportunity to mak…
RCW 48.21.110 Payment of benefits.
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The benefits payable under any policy or contract of group or blanket disability insurance shall be payable to the employee or other insured member of the group or to the beneficiary designated by him or her, other than the policyholder, employer or the association or any officer…
RCW 48.21.120 Readjustment of premiums—Dividends.
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Any contract of group disability insurance may provide for the readjustment of the rate of premium based on the experience thereunder at the end of the first year or of any subsequent year of insurance thereunder, and such readjustment may be made retroactive only for such policy…
RCW 48.21.125 When injury caused by intoxication or use of narcotics.
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An insurer may not deny coverage for the treatment of an injury solely because the injury was sustained as a consequence of the insured's being intoxicated or under the influence of a narcotic.[ 2004 c 112 s 3.]Notes:Finding—Application—2004 c 112: See notes following RCW 48.20.3…
RCW 48.21.130 Podiatric medicine and surgery.
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Notwithstanding any provision of any group disability insurance contract or blanket disability insurance contract, benefits shall not be denied thereunder for any medical or surgical service performed by a holder of a license issued pursuant to chapter 18.22 RCW provided that (1)…
RCW 48.21.140 Optometry.
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Notwithstanding any provision of any group disability insurance contract or blanket disability insurance contract, benefits shall not be denied thereunder for any eye care service rendered by a holder of a license issued pursuant to chapter 18.53 RCW, provided, that (1) the servi…
RCW 48.21.141 Registered nurses or advanced registered nurses.
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Notwithstanding any provision of any group disability insurance contract or blanket disability insurance contract as provided for in this chapter, benefits shall not be denied thereunder for any health service performed by a holder of a license for registered nursing practice or …
RCW 48.21.142 Chiropractic.
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Notwithstanding any provision of any group disability insurance contract or blanket disability insurance contract as provided for in this chapter, benefits shall not be denied thereunder for any health service performed by a holder of a license issued pursuant to chapter 18.25 RC…
RCW 48.21.143 Diabetes coverage—Definitions.
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The legislature finds that diabetes imposes a significant health risk and tremendous financial burden on the citizens and government of the state of Washington, and that access to the medically accepted standards of care for diabetes, its treatment and supplies, and self-manageme…
RCW 48.21.144 Psychological services.
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Notwithstanding any provision of any group disability insurance contract or blanket disability insurance contract, benefits shall not be denied thereunder for any psychological service rendered by a holder of a license issued pursuant to chapter 18.83 RCW: PROVIDED, That (1) the …
RCW 48.21.146 Dentistry.
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Notwithstanding any provision of any group disability insurance contract or blanket disability insurance contract as provided for in this chapter, benefits shall not be denied thereunder for any health service performed by a holder of a license issued pursuant to chapter 18.32 RC…
RCW 48.21.147 Dental services that are not subject to contract or provider agreement.
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(1) Notwithstanding any other provisions of law, no group disability insurance contract or blanket disability insurance contract of any disability insurer as provided for in this chapter subject to the jurisdiction of the state of Washington that covers any dental services, and n…
RCW 48.21.148 Denturist services.
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Notwithstanding any provision of any group disability insurance contract or blanket disability insurance contract covering dental care as provided for in this chapter, effective January 1, 1995, benefits shall not be denied thereunder for any service performed by a denturist lice…
RCW 48.21.150 Dependent child coverage—Continuation for incapacity.
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Any group disability insurance contract or blanket disability insurance contract, providing health care services, delivered or issued for delivery in this state more than one hundred twenty days after August 11, 1969, which provides that coverage of a dependent child of an employ…
RCW 48.21.155 Dependent child coverage—From moment of birth—Congenital anomalies—Notification of birth.
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(1) Any group disability insurance contract except blanket disability insurance contract, providing hospital and medical expenses and health care services, renewed, delivered or issued for delivery in this state more than one hundred twenty days after February 16, 1974, which pro…
RCW 48.21.157 Option to cover dependents under age twenty-six.
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Any group disability insurance contract or blanket disability insurance contract that provides coverage for a participating member's dependent must offer each participating member the option of covering any dependent under the age of twenty-six.[ 2011 c 314 s 17; 2007 c 259 s 20.…
RCW 48.21.160 Chemical dependency benefits—Legislative declaration.
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The legislature recognizes that chemical dependency is a disease and, as such, warrants the same attention from the health care industry as other similarly serious diseases warrant; the legislature further recognizes that health insurance contracts and contracts for health care s…
RCW 48.21.180 Chemical dependency benefits—Contracts issued or renewed after January 1, 1988.
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Each group disability insurance contract which is delivered or issued for delivery or renewed, on or after January 1, 1988, and which insures for hospital or medical care must contain provisions providing benefits for the treatment of chemical dependency rendered to the insured b…
RCW 48.21.190 Chemical dependency benefits—RCW 48.21.160 through 48.21.190, 48.44.240 inapplicable, when.
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RCW 48.21.160 through 48.21.190 and 48.44.240 as now or hereafter amended shall not apply to the renewal of a contract in force prior to the pertinent date provided for such contract under RCW 48.21.160 through 48.21.190 and 48.44.240 as now or hereafter amended where there exist…
RCW 48.21.195 "Chemical dependency" defined.
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For the purposes of RCW 48.21.160 and 48.21.180 "chemical dependency" means an illness characterized by a physiological or psychological dependency, or both, on a controlled substance regulated under chapter 69.50 RCW and/or alcoholic beverages. It is further characterized by a f…
RCW 48.21.197 Chemical dependency benefits—Rules.
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By September 1, 1987, the insurance commissioner shall adopt rules governing benefits for treatment of chemical dependency under medical plans issued under chapters 48.21, 48.44, and 48.46 RCW. These rules shall recognize that many persons are dependent on both alcohol and drugs;…
RCW 48.21.200 Individual or group disability, health care service contract, health maintenance agreement—Reduction of benefits on basis of other existing coverages.
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(1) No individual or group disability insurance policy, health care service contract, or health maintenance agreement providing hospital, medical or surgical expense benefits and which contains a provision for the reduction of benefits otherwise payable or available thereunder on…
RCW 48.21.220 Home health care, hospice care, optional coverage required—Standards, limitations, restrictions—Rules—Medicare supplemental contracts excluded.
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(1) Every insurer entering into or renewing group or blanket disability insurance policies governed by this chapter shall offer optional coverage for home health care and hospice care for persons who are homebound and would otherwise require hospitalization. Such optional coverag…
RCW 48.21.223 Prescribed, self-administered anticancer medication.
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(1) Each health plan issued or renewed on or after January 1, 2012, that provides coverage for cancer chemotherapy treatment must provide coverage for prescribed, self-administered anticancer medication that is used to kill or slow the growth of cancerous cells on a basis at leas…
RCW 48.21.225 Mammograms—Insurance coverage.
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Each group disability insurance policy issued or renewed after January 1, 1990, that provides coverage for hospital or medical expenses shall provide coverage for screening or diagnostic mammography services, provided that such services are delivered upon the recommendation of th…
RCW 48.21.227 Prostate cancer screening.
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(1) Each group disability insurance policy issued or renewed after December 31, 2006, that provides coverage for hospital or medical expenses shall provide coverage for prostate cancer screening, provided that the screening is delivered upon the recommendation of the patient's ph…
RCW 48.21.230 Reconstructive breast surgery.
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(1) Each group disability insurance contract issued or renewed after July 24, 1983, which insures for hospital or medical care shall provide coverage for reconstructive breast surgery resulting from a mastectomy which resulted from disease, illness, or injury.(2) Each group disab…
RCW 48.21.235 Mastectomy, lumpectomy.
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No person engaged in the business of insurance under this chapter may refuse to issue any contract of insurance or cancel or decline to renew the contract solely because of a mastectomy or lumpectomy performed on the insured or prospective insured more than five years previously.…
RCW 48.21.241 Mental health services—Group health plans—Definition—Coverage required, when.
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(1) For the purposes of this section, "mental health services" means:(a) For health benefit plans that provide coverage for medical and surgical services issued or renewed before January 1, 2021, medically necessary outpatient and inpatient services provided to treat mental disor…
RCW 48.21.242 Mental health treatment—Waiver of preauthorization for persons involuntarily committed.
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An insurer providing group disability insurance coverage for health care in this state shall waive a preauthorization requirement from the insurer before an insured or the insured's covered dependents receive mental health care and treatment rendered by a state hospital if the in…
RCW 48.21.244 Benefits for prenatal diagnosis of congenital disorders—Contracts entered into or renewed on or after January 1, 1990.
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On or after January 1, 1990, every group disability contract entered into or renewed that covers hospital, medical, or surgical expenses on a group basis, and which provides benefits for pregnancy, childbirth, or related medical conditions to enrollees of such groups, shall offer…
RCW 48.21.250 Continuation option to be offered.
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Every insurer that issues policies providing group coverage for hospital or medical expense shall offer the policyholder an option to include a policy provision granting a person who becomes ineligible for coverage under the group policy, the right to continue the group benefits …
RCW 48.21.260 Conversion policy to be offered—Exceptions, conditions.
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(1) Except as otherwise provided by this section, any group disability insurance policy that provides benefits for hospital or medical expenses must contain a provision granting a person covered by the group policy the right to obtain a conversion policy from the insurer upon ter…
RCW 48.21.270 Conversion policy—Restrictions and requirements—Rules.
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(1) An insurer shall not require proof of insurability as a condition for issuance of the conversion policy.(2) A conversion policy may not contain an exclusion for preexisting conditions for any applicant.(3) An insurer must offer at least three policy benefit plans that comply …
RCW 48.21.280 Coverage for adopted children.
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(1) Any group disability insurance contract, except a blanket disability insurance contract, providing hospital and medical expenses and health care services, delivered or issued for delivery in this state, which provides coverage for dependent children, as defined in the contrac…
RCW 48.21.290 Cancellation of rider.
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Upon application by an insured, a rider shall be canceled if at least five years after its issuance, no health care services have been received by the insured during that time for the condition specified in the rider, and a physician, selected by the carrier for that purpose, agr…
RCW 48.21.300 Phenylketonuria.
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(1) The legislature finds that:(a) Phenylketonuria is a rare inherited genetic disorder.(b) Children with phenylketonuria are unable to metabolize an essential amino acid, phenylalanine, which is found in the proteins of most food.(c) To remain healthy, children with phenylketonu…