Title 48 — Title 48 INSURANCE
101 chapters · 2,134 sections in this title.
RCW 48.41.010 Short title.
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This chapter shall be known and may be cited as the "Washington state health insurance coverage access act".[ 1987 c 431 s 1.]
RCW 48.41.020 Intent.
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It is the purpose and intent of the legislature to provide access to health insurance coverage to all residents of Washington who are denied health insurance. It is the intent of the Washington state health insurance coverage access act to provide a mechanism to ensure the availa…
RCW 48.41.030 Definitions.
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The definitions in this section apply throughout this chapter unless the context clearly requires otherwise.(1) "Accounting year" means a twelve-month period determined by the board for purposes of recordkeeping and accounting. The first accounting year may be more or less than t…
RCW 48.41.037 Washington state health insurance pool account.
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The Washington state health insurance pool account is created in the custody of the state treasurer. All receipts from moneys specifically appropriated to the account must be deposited in the account. Expenditures from this account shall be used to cover deficits incurred by the …
RCW 48.41.040 Health insurance pool—Creation, membership, organization, operation, rules.
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(1) There is created a nonprofit entity to be known as the Washington state health insurance pool. All members in this state on or after May 18, 1987, shall be members of the pool. When authorized by federal law, all self-insured employers shall also be members of the pool.(2) Pu…
RCW 48.41.050 Operation plan—Contents.
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The plan of operation submitted by the board to the commissioner shall:(1) Establish procedures for the handling and accounting of assets and moneys of the pool;(2) Establish regular times and places for meetings of the board of directors;(3) Establish procedures for records to b…
RCW 48.41.060 Board powers and duties.
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(1) The board shall have the general powers and authority granted under the laws of this state to insurance companies, health care service contractors, and health maintenance organizations, licensed or registered to offer or provide the kinds of health coverage defined under this…
RCW 48.41.070 Examination and report.
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The pool shall be subject to examination by the commissioner as provided under chapter 48.03 RCW. The board of directors shall submit to the commissioner, not later than one hundred twenty days after the end of each accounting year, a financial report for the year in a form appro…
RCW 48.41.080 Pool administrator—Selection, term, duties, pay.
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The board shall select an administrator through a competitive bidding process to administer the pool.(1) The board shall evaluate bids based upon criteria established by the board, which shall include:(a) The administrator's proven ability to handle health coverage;(b) The effici…
RCW 48.41.090 Financial participation in pool—Computation, deficit assessments.
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(1) Following the close of each accounting year, the pool administrator shall determine the total net cost of pool operation which shall include:(a) Net premium (premiums less administrative expense allowances), the pool expenses of administration, and incurred losses for the yea…
RCW 48.41.100 Eligibility for coverage.
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(1)(a) The following persons who are residents of this state are eligible for pool coverage:(i) Any resident of the state not eligible for medicare coverage or medicaid coverage, and residing in a county where an individual health plan other than a catastrophic health plan as def…
RCW 48.41.110 Policy coverage—Eligible expenses, cost containment, limits—Explanatory brochure.
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(1) The pool shall offer one or more care management plans of coverage. Such plans may, but are not required to, include point of service features that permit participants to receive in-network benefits or out-of-network benefits subject to differential cost shares. The pool may …
RCW 48.41.120 Comprehensive pool policy—Deductibles—Coinsurance—Carryover.
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(1) Subject to the limitation provided in subsection (3) of this section, the comprehensive pool policy offered under RCW 48.41.110(4) shall impose a deductible as provided in this subsection. Deductibles of five hundred dollars and one thousand dollars on a per person per calend…
RCW 48.41.130 Policy forms—Approval required.
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All policy forms issued by the pool shall conform in substance to prototype forms developed by the pool, and shall in all other respects conform to the requirements of this chapter, and shall be filed with and approved by the commissioner before they are issued.[ 2000 c 79 s 15; …
RCW 48.41.140 Coverage for children, dependents.
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(1) Coverage shall provide that health insurance benefits are applicable to children of the person in whose name the policy is issued including adopted and newly born natural children. Coverage shall also include necessary care and treatment of medically diagnosed congenital defe…
RCW 48.41.150 Medical supplement policy.
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(1) The board shall offer a medical supplement policy for persons receiving medicare parts A and B. The supplement policy shall provide benefits of one hundred percent of the deductible and copayment required under medicare and eighty percent of the charges for covered services u…
RCW 48.41.160 Pool policy requirements—Continued coverage—Rate changes—Continuation—Statement of intent to discontinue pool coverage.
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(1) On or before December 31, 2007, the pool shall cancel all existing pool policies and replace them with policies that are identical to the existing policies except for the inclusion of a provision providing for a guarantee of the continuity of coverage consistent with this sec…
RCW 48.41.170 Required rule making.
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The commissioner shall adopt rules pursuant to chapter 34.05 RCW that:(1) Provide for disclosure by the member of the availability of insurance coverage from the pool; and(2) Implement this chapter.[ 1987 c 431 s 17.]
RCW 48.41.190 Civil and criminal immunity.
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The pool, members of the pool, board directors of the pool, officers of the pool, employees of the pool, the commissioner, the commissioner's representatives, and the commissioner's employees shall not be civilly or criminally liable and shall not have any penalty or cause of act…
RCW 48.41.200 Rates—Standard risk and maximum.
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(1) The pool shall determine the standard risk rate by calculating the average individual standard rate charged for coverage comparable to pool coverage by the five largest members, measured in terms of individual market enrollment, offering such coverages in the state. In the ev…
RCW 48.41.210 Last payor of benefits.
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It is the express intent of this chapter that the pool be the last payor of benefits whenever any other benefit is available.(1) Benefits otherwise payable under pool coverage shall be reduced by all amounts paid or payable through any other health insurance, or health benefit pl…
RCW 48.41.220 Mental health services—Definition—Coverage required, when.
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(1) For the purposes of this section, "mental health services" means:(a) For each health insurance policy issued or renewed by the pool before January 1, 2021, medically necessary outpatient and inpatient services provided to treat mental disorders covered by the diagnostic categ…
RCW 48.41.240 Review of populations needing coverage through pool—Analysis and recommendations—Report.
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(1) The board shall review populations that may need ongoing access to coverage through the pool, with specific attention to those persons who may be excluded from or may receive inadequate coverage beginning January 1, 2014, such as persons with end-stage renal disease or HIV/AI…
RCW 48.41.250 Administration of risk management functions—Contract with commissioner authorized—Recommendations—Report to legislature.
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(1) The pool is authorized to contract with the commissioner to administer risk management functions if necessary, consistent with RCW 48.43.720, and consistent with P.L. 111-148 of 2010, as amended. Prior to entering into a contract, the pool may conduct preoperational and plann…
RCW 48.41.900 Federal supremacy.
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If any part of this chapter is found to be in conflict with federal requirements which are a prescribed condition to the allocation of federal funds to the state, the conflicting part of this chapter is hereby declared to be inoperative solely to the extent of the conflict and wi…
RCW 48.41.920 Construction—Chapter applicable to state registered domestic partnerships—2009 c 521.
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For the purposes of this chapter, the terms spouse, marriage, marital, husband, wife, widow, widower, next of kin, and family shall be interpreted as applying equally to state registered domestic partnerships or individuals in state registered domestic partnerships as well as to …