Title 48 — Title 48 INSURANCE
101 chapters · 2,134 sections in this title.
RCW 48.44.010 Definitions.
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For the purposes of this chapter:(1) "Carrier" means a health maintenance organization, an insurer, a health care service contractor, or other entity responsible for the payment of benefits or provision of services under a group or individual contract.(2) "Census date" means the …
RCW 48.44.011 Insurance producer—Definition—License required—Application, issuance, renewal, fees—Penalties involving license.
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(1) Insurance producer, as used in this chapter, means any person appointed or authorized by a health care service contractor to solicit applications for health care service contracts on its behalf.(2) No person shall act as or hold himself or herself out to be an appointed insur…
RCW 48.44.013 Filings with secretary of state—Copy for commissioner.
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Health care service contractors and limited health care service contractors shall send a copy specifically for the office of the insurance commissioner to the secretary of state of any corporate document required to be filed in the office of the secretary of state, including arti…
RCW 48.44.015 Registration by health care service contractors required—Penalty.
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(1) A person may not in this state, by mail or otherwise, act as or hold himself or herself out to be a health care service contractor, as defined in RCW 48.44.010 without first being registered with the commissioner.(2) The issuance, sale, or offer for sale in this state of secu…
RCW 48.44.016 Unregistered activities—Acts committed in this state—Sanctions.
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(1) As used in this section, "person" has the same meaning as in RCW 48.01.070.(2) For the purpose of this section, an act is committed in this state if it is committed, in whole or in part, in the state of Washington, or affects persons or property within the state and relates t…
RCW 48.44.017 Schedule of rates for individual contracts—Loss ratio—Definitions.
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(1) The definitions in this subsection apply throughout this section unless the context clearly requires otherwise.(a) "Claims" means the cost to the health care service contractor of health care services, as defined in RCW 48.43.005, provided to a contract holder or paid to or o…
RCW 48.44.020 Contracts for services—Examination of contract forms by commissioner—Grounds for disapproval—Liability of participant.
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(1) Any health care service contractor may enter into contracts with or for the benefit of persons or groups of persons which require prepayment for health care services by or for such persons in consideration of such health care service contractor providing one or more health ca…
RCW 48.44.021 Calculation of premiums—Members of a purchasing pool—Adjusted community rating method—Definitions.
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(1) Premiums for health benefit plans for individuals who purchase the plan as a member of a purchasing pool:(a) Consisting of five hundred or more individuals affiliated with a particular industry;(b) To whom care management services are provided as a benefit of pool membership;…
RCW 48.44.022 Calculation of premiums—Adjusted community rate—Definitions.
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(1) Except for health benefit plans covered under RCW 48.44.021, premium rates for health benefit plans for individuals shall be subject to the following provisions:(a) The health care service contractor shall develop its rates based on an adjusted community rate and may only var…
RCW 48.44.023 Health plan benefits for small employers—Coverage—Exemption from statutory requirements—Premium rates—Requirements for providing coverage for small employers.
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(1)(a) A health care services contractor 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 h…
RCW 48.44.024 Requirements for plans offered to small employers—Definitions.
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(1) A health care service contractor may not offer any health benefit plan to any small employer without complying with RCW 48.44.023(3).(2) Employers purchasing health plans provided through associations or through member-governed groups formed specifically for the purpose of pu…
RCW 48.44.026 Payment for certain health care services.
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Checks in payment for claims pursuant to any health care service contract for health care services provided by persons licensed or regulated under chapters 18.25, 18.29, 18.30, 18.32, 18.53, 18.57, 18.64, 18.71, 18.73, 18.74, 18.83, or 18.79 RCW, as it applies to registered nurse…
RCW 48.44.030 Underwriting of indemnity by insurance policy, bond, securities, or cash deposit.
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If any of the health care services which are promised in any such agreement are not to be performed by the health care service contractor, or by a participating provider, such activity shall not be subject to the laws relating to insurance, provided provision is made for reimburs…
RCW 48.44.033 Financial failure—Supervision of commissioner—Priority of distribution of assets.
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(1) Any rehabilitation, liquidation, or conservation of a health care service contractor shall be deemed to be the rehabilitation, liquidation, or conservation of an insurance company and shall be conducted under the supervision of the commissioner pursuant to the law governing t…
RCW 48.44.035 Limited health care service—Uncovered expenditures—Minimum net worth requirements.
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(1) For purposes of this section only, "limited health care service" means dental care services, vision care services, mental health services, chemical dependency services, pharmaceutical services, podiatric care services, and such other services as may be determined by the commi…
RCW 48.44.037 Minimum net worth—Requirement to maintain—Determination of amount.
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(1) Except as provided in subsection (2) of this section, every health care service contractor must have and maintain a minimum net worth equal to the greater of:(a) Three million dollars; or(b) Two percent of the annual premium earned, as reported on the most recent annual finan…
RCW 48.44.039 Minimum net worth—Domestic or foreign health care service contractor.
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(1) For purposes of this section:(a) "Domestic health care service contractor" means a health care service contractor formed under the laws of this state; and(b) "Foreign health care service contractor" means a health care service contractor formed under the laws of the United St…
RCW 48.44.040 Registration with commissioner—Fee.
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Every health care service contractor who or which enters into agreements which require prepayment for health care services shall register with the insurance commissioner on forms to be prescribed and provided by him or her. Such registrants shall state their name, address, type o…
RCW 48.44.050 Rules and regulations.
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The insurance commissioner shall make reasonable regulations in aid of the administration of this chapter which may include, but shall not be limited to regulations concerning the maintenance of adequate insurance, bonds, or cash deposits, information required of registrants, and…
RCW 48.44.055 Plan for handling insolvency—Commissioner's review.
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Each health care service contractor shall have a plan for handling insolvency that allows for continuation of benefits for the duration of the contract period for which premiums have been paid and continuation of benefits to members who are confined on the date of insolvency in a…
RCW 48.44.057 Insolvency—Commissioner's duties—Participants' options—Allocation of coverage.
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(1)(a) In the event of insolvency of a health services contractor or health maintenance organization and upon order of the commissioner, all other carriers then having active enrolled participants under a group plan with the affected agreement holder that participated in the enro…
RCW 48.44.060 Penalty.
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Except as otherwise provided in this chapter, any person who violates any of the provisions of this chapter is guilty of a gross misdemeanor.[ 2003 c 250 s 9; 1947 c 268 s 6; Rem. Supp. 1947 s 6131-15.]Notes:Severability—2003 c 250: See note following RCW 48.01.080.
RCW 48.44.080 Master lists of contractor's participating providers—Filing with commissioner—Notice of termination or participation.
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Every health care service contractor shall file with its annual statement with the insurance commissioner a master list of the participating providers with whom or with which such health care service contractor has executed contracts of participation, certifying that each such pa…
RCW 48.44.090 Refusal to register corporate, etc., contractor if name confusing with existing contractor or insurance company.
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The insurance commissioner shall refuse to accept the registration of any corporation, cooperative group, or association seeking to act as a health care service contractor if, in his or her discretion, the insurance commissioner deems that the name of the corporation, cooperative…
RCW 48.44.095 Annual financial statement—Filings—Contents—Fee—Penalty for failure to file.
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(1) Every domestic health care service contractor shall annually, on or before the first day of March, file with the commissioner a statement verified by at least two of the principal officers of the health care service contractor showing its financial condition as of the last da…
RCW 48.44.100 Filing inaccurate financial statement prohibited.
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No person shall knowingly file with any public official or knowingly make, publish, or disseminate any financial statement of a health care service contractor which does not accurately state the health care service contractor's financial condition.[ 1961 c 197 s 7.]
RCW 48.44.110 False representation, advertising.
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No person shall knowingly make, publish, or disseminate any false, deceptive, or misleading representation or advertising in the conduct of the business of a health care service contractor, or relative to the business of a health care service contractor or to any person engaged t…
RCW 48.44.120 Misrepresentations of contract terms, benefits, etc.
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No person shall knowingly make, issue, or circulate, or cause to be made, issued, or circulated, a misrepresentation of the terms of any contract, or the benefits or advantages promised thereby, or use the name or title of any contract or class of contract misrepresenting the nat…
RCW 48.44.130 Future dividends or refunds—When permissible.
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No health care service contractor nor any individual acting on behalf thereof shall guarantee or agree to the payment of future dividends or future refunds of unused charges or savings in any specific or approximate amounts or percentages in respect to any contract being offered …
RCW 48.44.140 Misleading comparisons to terminate or retain contract.
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No health care service contractor nor any person representing a health care service contractor shall by misrepresentation or misleading comparisons induce or attempt to induce any member of any health care service contractor to terminate or retain a contract or membership.[ 1961 …
RCW 48.44.145 Examination of contractors—Duties of contractor, powers of commissioner—Independent audit reports.
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(1) The commissioner may make an examination of the operations of any health care service contractor as often as he or she deems necessary in order to carry out the purposes of this chapter.(2) Every health care service contractor shall submit its books and records relating to it…
RCW 48.44.150 Certificate of registration not an endorsement—Display in solicitation prohibited.
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The granting of a certificate of registration to a health care service contractor is permissive only, and shall not constitute an endorsement by the insurance commissioner of any person or thing related to the health care service contractor, and no person shall advertise or displ…
RCW 48.44.160 Revocation, suspension, refusal of registration—Hearing—Cease and desist orders, injunctive action—Grounds.
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The insurance commissioner may, subject to a hearing if one is demanded pursuant to chapters 48.04 and 34.05 RCW, revoke, suspend, or refuse to accept or renew registration from any health care service contractor, or he or she may issue a cease and desist order, or bring an actio…
RCW 48.44.164 Notice of suspension, revocation, or refusal to be given contractor—Authority of insurance producers.
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Upon the suspension, revocation or refusal of a health care service contractor's registration, the commissioner shall give notice thereof to such contractor and shall likewise suspend, revoke, or refuse the authority of its appointed insurance producers to represent it in this st…
RCW 48.44.166 Fine in addition to or in lieu of suspension, revocation, or refusal.
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After hearing or upon stipulation by the registrant and in addition to or in lieu of the suspension, revocation or refusal to renew any registration of a health care service contractor the commissioner may levy a fine against the party involved for each offense in an amount not l…
RCW 48.44.170 Hearings and appeals.
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For the purposes of this chapter, the insurance commissioner shall be subject to and may avail himself or herself of the provisions of chapter 48.04 RCW, which relate to hearings and appeals.[ 2009 c 549 s 7149; 1961 c 197 s 14.]
RCW 48.44.180 Enforcement.
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For the purposes of this chapter, the insurance commissioner shall have the same powers and duties of enforcement as are provided in RCW 48.02.080.[ 1961 c 197 s 15.]
RCW 48.44.200 Individual health care service plan contracts—Coverage of dependent child with developmental or physical disability.
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An individual health care service plan contract, 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 shall terminate upon attainment of the limiting age for dependent children sp…
RCW 48.44.210 Group health care service plan contracts—Coverage of dependent child with developmental or physical disability.
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A group health care service plan contract, 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 employee or other member of the covered group shall terminate upon attainment…
RCW 48.44.212 Coverage of dependent children to include newborn infants and congenital anomalies from moment of birth—Notification period.
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(1) Any health care service plan contract under this chapter delivered or issued for delivery in this state more than one hundred twenty days after February 16, 1974, which provides coverage for dependent children of the insured or covered group member, shall provide coverage for…
RCW 48.44.215 Option to cover child under age twenty-six.
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(1) Each individual health care service plan contract that is not grandfathered and that provides coverage for a subscriber's child must offer the option of covering any child under the age of twenty-six.(2) Each group health care service plan contract that is not grandfathered a…
RCW 48.44.220 Discrimination prohibited.
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No health care service contractor shall deny coverage to any person solely on account of race, religion, national origin, or the presence of any disability. Nothing in this section shall be construed as limiting a health care service contractor's authority to deny or otherwise li…
RCW 48.44.225 Podiatric physicians and surgeons not excluded.
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A health care service contractor which provides foot care services shall not exclude any individual doctor who is licensed to perform podiatric health care services from being a participant for reason that the doctor is licensed under chapter 18.22 RCW. Rejections of requests by …
RCW 48.44.230 Individual health service plan contract—Return within ten days of delivery—Refunds—Void from beginning—Notice required.
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Every subscriber of an individual health care service plan contract issued after September 1, 1973, may return the contract to the health care service contractor or the insurance producer through whom it was purchased within ten days of its delivery to the subscriber if, after ex…
RCW 48.44.240 Chemical dependency benefits—Provisions of group contracts delivered or renewed after January 1, 1988.
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Each group contract for health care services that is delivered or issued for delivery or renewed, on or after January 1, 1988, must contain provisions providing benefits for the treatment of chemical dependency rendered to covered persons by a provider that is an "approved substa…
RCW 48.44.241 Chemical dependency benefits—RCW 48.21.160 through 48.21.190, 48.44.240 inapplicable, when.
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See RCW 48.21.190.
RCW 48.44.245 "Chemical dependency" defined.
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For the purposes of RCW 48.44.240, "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 frequent or in…
RCW 48.44.250 Payment of premium by employee in event of suspension of compensation due to labor dispute.
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Any employee whose compensation includes a health care services contract providing health care services expenses, 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 paid by…
RCW 48.44.260 Notice of reason for cancellation, denial, or refusal to renew contract.
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Every authorized health care service contractor, upon canceling, denying, or refusing to renew any individual health care service contract, shall, upon written request, directly notify in writing the applicant or subscriber, as the case may be, of the reasons for the action by th…
RCW 48.44.270 Immunity from libel or slander.
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With respect to health care service contracts as defined in RCW 48.44.260, there shall be no liability on the part of, and no cause of action of any nature shall arise against, the insurance commissioner, the commissioner's agents, or members of the commissioner's staff, or again…