Title 48 — Title 48 INSURANCE
101 chapters · 2,134 sections in this title.
RCW 48.46.320 Dependent children, termination of coverage, conditions.
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Any health maintenance agreement which provides that coverage of a dependent child shall terminate upon attainment of the limiting age for dependent children specified in the agreement shall also provide in substance that attainment of such limiting age shall not operate to termi…
RCW 48.46.325 Option to cover child under age twenty-six.
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(1) Each individual health maintenance agreement 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 maintenance agreement that is not grandfathered and that pr…
RCW 48.46.340 Return of agreement within ten days.
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Every subscriber of an individual health maintenance agreement may return the agreement to the health maintenance organization or the insurance producer through whom it was purchased within ten days of its delivery to the subscriber if, after examination of the agreement, the sub…
RCW 48.46.350 Chemical dependency treatment.
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Each group agreement 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 which is an "approved subst…
RCW 48.46.355 "Chemical dependency" defined.
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For the purposes of RCW 48.46.350, "chemical dependency" means an illness characterized by a physiological of 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 48.46.360 Payment of cost of agreement directly to holder during labor dispute—Changes restricted—Notice to employee.
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Any employee whose compensation includes a health maintenance agreement, the cost of which is paid in full or in part by an employer including the state of Washington, its political subdivisions, or municipal corporations, or paid by payroll deduction, may pay the cost as it beco…
RCW 48.46.370 Coverage not denied for disability.
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No health maintenance organization may deny coverage to a person solely on account of the presence of any disability. Nothing in this section may be construed as limiting a health maintenance organization's authority to deny or otherwise limit coverage to a person when the person…
RCW 48.46.375 Benefits for prenatal diagnosis of congenital disorders—Agreements entered into or renewed on or after January 1, 1990.
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On or after January 1, 1990, every group health maintenance agreement entered into or renewed that covers hospital, medical, or surgical expenses and which provides benefits for pregnancy, childbirth, or related medical conditions to enrollees of such groups, shall offer benefits…
RCW 48.46.380 Notice of reason for cancellation, denial, or refusal to renew agreement.
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Every authorized health maintenance organization, upon canceling, denying, or refusing to renew any individual health maintenance agreement, shall, upon written request, directly notify in writing the applicant or enrolled participant as appropriate, of the reasons for the action…
RCW 48.46.390 Providing information on cancellation or refusal—No liability for insurance commissioner or health maintenance organization.
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With respect to the provisions of health maintenance agreements as set forth in RCW 48.46.380, 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 commission…
RCW 48.46.400 False or misleading advertising prohibited.
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No person may knowingly make, publish, or disseminate any false, deceptive, or misleading representation or advertising in the conduct of the business of a health maintenance organization, or relative to the business of a health maintenance organization or to any person engaged t…
RCW 48.46.410 Misrepresentations to induce termination or retention of agreement prohibited.
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No health maintenance organization nor any person representing a health maintenance organization may by misrepresentation or misleading comparisons induce or attempt to induce any member of a health maintenance organization to terminate or retain an agreement or membership in the…
RCW 48.46.420 Penalty for violations.
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(1) Except as otherwise provided in this chapter, any health maintenance organization which, or person who, violates any provision of this chapter is guilty of a gross misdemeanor.(2) A health maintenance organization that fails to comply with the net worth requirements of this c…
RCW 48.46.430 Enforcement authority of commissioner.
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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.[ 1983 c 106 s 21.]
RCW 48.46.440 Continuation option to be offered.
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Every health maintenance organization that issues agreements providing group coverage for hospital or medical care shall offer the agreement holder an option to include an agreement provision granting a person who becomes ineligible for coverage under the group agreement, the rig…
RCW 48.46.450 Conversion agreement to be offered—Exceptions, conditions.
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(1) Except as otherwise provided by this section, any group health maintenance agreement that provides benefits for hospital or medical care must contain a provision granting a person covered by the group agreement the right to obtain a conversion agreement from the health mainte…
RCW 48.46.460 Conversion agreement—Restrictions and requirements—Rules.
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(1) A health maintenance organization must offer a conversion agreement for comprehensive health care services and shall not require proof of insurability as a condition for issuance of the conversion agreement.(2) A conversion agreement may not contain an exclusion for preexisti…
RCW 48.46.470 Endorsement of modifications.
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If an individual health care service agreement is issued on any basis other than as applied for, an endorsement setting forth such modification must accompany and be attached to the agreement. No agreement shall be effective unless the endorsement is signed by the applicant, and …
RCW 48.46.480 Continuation of coverage of former family members.
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Every health care service agreement issued, amended, or renewed after January 1, 1986, for an individual and his or her dependents shall contain provisions to assure that the covered spouse and/or dependents, in the event that any cease to be a qualified family member by reason o…
RCW 48.46.490 Coverage for adopted children.
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(1) Any health maintenance agreement under this chapter which provides coverage for dependent children, as defined in the agreement of the enrolled participant, shall cover adoptive children placed with the enrolled participant on the same basis as other dependents, as provided i…
RCW 48.46.500 Cancellation of rider.
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Upon application by an enrollee, a rider shall be canceled if at least five years after its issuance, no health care services have been received by the enrollee during that time for the condition specified in the rider, and a physician, selected by the carrier for that purpose, a…
RCW 48.46.510 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…
RCW 48.46.520 Neurodevelopmental therapies—Employer-sponsored group contracts.
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(1) Each employer-sponsored group contract for comprehensive health care service which is entered into, or renewed, on or after twelve months after July 23, 1989, shall include coverage for neurodevelopmental therapies for covered individuals age six and under.(2) Benefits provid…
RCW 48.46.530 Temporomandibular joint disorders—Insurance coverage.
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(1) Except as provided in this section, a health maintenance agreement entered into or renewed after December 31, 1989, shall offer optional coverage for the treatment of temporomandibular joint disorders.(a) Health maintenance organizations offering medical coverage only may lim…
RCW 48.46.535 Prescriptions—Preapproval of individual claims—Subsequent rejection prohibited—Written record required.
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Health maintenance organizations who through an authorized representative have first approved, by any means, an individual prescription claim as eligible may not reject that claim at some later date. Pharmacists or drug dispensing outlets who obtain preapproval of claims shall ke…
RCW 48.46.540 Nonresident pharmacies.
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For the purposes of this chapter, a nonresident pharmacy is defined as any pharmacy located outside this state that ships, mails, or delivers, in any manner, except when delivered in person to an enrolled participant or his/her representative, controlled substances, legend drugs,…
RCW 48.46.565 Foot care services.
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Except to the extent that a health maintenance organization contracts with a group medical practice which only treats that organization's patients, a health maintenance organization may not discriminate in the terms and conditions, including reimbursement, for the provision of fo…
RCW 48.46.570 Denturist services.
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Notwithstanding any provision of any health maintenance organization agreement 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 licensed under chapter 18.30 RCW if (1)…
RCW 48.46.575 Doctor of osteopathic medicine and surgery—Discrimination based on board certification is prohibited.
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A health maintenance organization that provides health care services to the general public may not discriminate against a qualified doctor of osteopathic medicine and surgery licensed under chapter 18.57 RCW, who has applied to practice with the health maintenance organization, s…
RCW 48.46.580 When injury caused by intoxication or use of narcotics.
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A health maintenance organization may not deny coverage for the treatment of an injury solely because the injury was sustained as a consequence of the enrolled participant's being intoxicated or under the influence of a narcotic.[ 2004 c 112 s 5.]Notes:Finding—Application—2004 c …
RCW 48.46.600 Disclosure of certain material transactions—Report—Information is confidential.
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(1) Every health maintenance organization domiciled in this state shall file a report with the commissioner disclosing material acquisitions and dispositions of assets or material nonrenewals, cancellations, or revisions of ceded reinsurance agreements unless these acquisitions a…
RCW 48.46.605 Material acquisitions or dispositions.
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No acquisitions or dispositions of assets need be reported pursuant to RCW 48.46.600 if the acquisitions or dispositions are not material. For purposes of RCW 48.46.600 through 48.46.625, a material acquisition, or the aggregate of any series of related acquisitions during any th…
RCW 48.46.610 Asset acquisitions—Asset dispositions.
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(1) Asset acquisitions subject to RCW 48.46.600 through 48.46.625 include every purchase, lease, exchange, merger, consolidation, succession, or other acquisition other than the construction or development of real property by or for the reporting health maintenance organization o…
RCW 48.46.615 Report of a material acquisition or disposition of assets—Information required.
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The following information is required to be disclosed in any report of a material acquisition or disposition of assets:(1) Date of the transaction;(2) Manner of acquisition or disposition;(3) Description of the assets involved;(4) Nature and amount of the consideration given or r…
RCW 48.46.620 Material nonrenewals, cancellations, or revisions of ceded reinsurance agreements.
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(1) No nonrenewals, cancellations, or revisions of ceded reinsurance agreements need be reported under RCW 48.46.600 if the nonrenewals, cancellations, or revisions are not material. For purposes of RCW 48.46.600 through 48.46.625, a material nonrenewal, cancellation, or revision…
RCW 48.46.625 Report of a material nonrenewal, cancellation, or revision of ceded reinsurance agreements—Information required.
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The following is required to be disclosed in any report of a material nonrenewal, cancellation, or revision of ceded reinsurance agreements:(1) The effective date of the nonrenewal, cancellation or revision;(2) The description of the transaction with an identification of the init…
RCW 48.46.900 Liberal construction.
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It is intended that the provisions of this chapter shall be liberally construed to accomplish the purposes provided for and authorized herein.[ 1975 1st ex.s. c 290 s 24.]
RCW 48.46.920 Short title.
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This 1975 amendatory act may be known and cited as "The Washington Health Maintenance Organization Act of 1975".[ 1975 1st ex.s. c 290 s 27.]
RCW 48.46.930 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 …