Title 48 — Title 48 INSURANCE
101 chapters · 2,134 sections in this title.
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…
RCW 48.44.290 Registered nurses or advanced registered nurses.
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Notwithstanding any provision of this chapter, for any health care service contract thereunder which is entered into or renewed after July 26, 1981, benefits shall not be denied under such contract for any health care service performed by a holder of a license for registered nurs…
RCW 48.44.299 Legislative finding.
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The legislature finds and declares that there is a paramount concern that the right of the people to obtain access to health care in all its facets is being impaired by prepaid agreements which provide benefits, reimbursement, or indemnity by health care service contractors, whet…
RCW 48.44.300 Podiatric medicine and surgery—Benefits not to be denied.
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Benefits shall not be denied under a contract for any health care service performed by a holder of a license issued under chapter 18.22 RCW if (1) the service performed was within the lawful scope of the person's license, and (2) the contract would have provided benefits if the s…
RCW 48.44.305 When injury caused by intoxication or use of narcotics.
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A health care service contractor 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 4.]Notes:Finding—Application—2004 c 1…
RCW 48.44.309 Legislative finding.
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The legislature finds and declares that there is a paramount concern that the right of the people to obtain access to health care in all its facets is being impaired. The legislature further finds that there is a heavy reliance by the public upon prepaid health care service agree…
RCW 48.44.310 Chiropractic care, coverage required, exceptions.
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(1) Each group contract for comprehensive health care service which is entered into, or renewed, on or after September 8, 1983, between a health care service contractor and the person or persons to receive such care shall offer coverage for chiropractic care on the same basis as …
RCW 48.44.315 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 48.44.320 Home health care, hospice care, optional coverage required—Standards, limitations, restrictions—Rules—Medicare supplemental contracts excluded.
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(1) Every health care service contractor entering into or renewing a group health care service contract 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 opt…
RCW 48.44.323 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 48.44.325 Mammograms—Insurance coverage.
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Each health care service contract issued or renewed after January 1, 1990, that provides benefits for hospital or medical care shall provide benefits for screening or diagnostic mammography services, provided that such services are delivered upon the recommendation of the patient…
RCW 48.44.327 Prostate cancer screening.
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(1) Each health care service contract 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 physici…
RCW 48.44.330 Reconstructive breast surgery.
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(1) Each contract for health care entered into or renewed after July 24, 1983, between a health care services contractor and the person or persons to receive the care shall provide coverage for reconstructive breast surgery resulting from a mastectomy which resulted from disease,…
RCW 48.44.335 Mastectomy, lumpectomy.
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No health care service contractor under this chapter may refuse to issue any contract 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. The amount of benefits pa…
RCW 48.44.341 Mental health services—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 issued or renewed before January 1, 2021, medically necessary outpatient and inpatient services provided to treat mental disorders covered by the diagnostic categories listed in the …
RCW 48.44.342 Mental health treatment—Waiver of preauthorization for persons involuntarily committed.
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A health care service contractor providing hospital or medical services or benefits in this state shall waive a preauthorization from the contractor before an insured or an insured's covered dependents receive mental health treatment rendered by a state hospital as defined in RCW…