Title 48 — Title 48 INSURANCE
101 chapters · 2,134 sections in this title.
RCW 48.44.344 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 health care services 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, s…
RCW 48.44.350 Financial interests of health care service contractors, restricted—Exceptions, regulations.
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(1) No person having any authority in the investment or disposition of the funds of a health care service contractor and no officer or director of a health care service contractor shall accept, except for the health care service contractor, or be the beneficiary of any fee, broke…
RCW 48.44.360 Continuation option to be offered.
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Every health care service contractor that issues group contracts providing group coverage for hospital or medical expense shall offer the contract holder an option to include a contract provision granting a person who becomes ineligible for coverage under the group contract, the …
RCW 48.44.370 Conversion contract to be offered—Exceptions, conditions.
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(1) Except as otherwise provided by this section, any group health care service contract that provides benefits for hospital or medical expenses must contain a provision granting a person covered by the group contract the right to obtain a conversion contract from the contractor …
RCW 48.44.380 Conversion contract—Restrictions and requirements—Rules.
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(1) A health care service contractor shall not require proof of insurability as a condition for issuance of the conversion contract.(2) A conversion contract may not contain an exclusion for preexisting conditions for any applicant.(3) A health care service contractor must offer …
RCW 48.44.390 Modification of basis of agreement, endorsement required.
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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 48.44.400 Continuance provisions for former family members.
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After July 1, 1986, or on the next renewal date of the agreement, whichever is later, every health care service agreement issued, amended, or renewed for an individual and his or her dependents shall contain provisions to assure that the covered spouse and/or dependents, in the e…
RCW 48.44.420 Coverage for adopted children.
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(1) Any health care service contract under this chapter delivered or issued for delivery in this state, which provides coverage for dependent children, as defined in the contract of the subscriber, shall cover adoptive children placed with the subscriber on the same basis as othe…
RCW 48.44.430 Cancellation of rider.
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Upon application by a subscriber, a rider shall be canceled if at least five years after its issuance, no health care services have been received by the subscriber during that time for the condition specified in the rider, and a physician, selected by the carrier for that purpose…
RCW 48.44.440 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 48.44.450 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 48.44.460 Temporomandibular joint disorders—Insurance coverage.
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(1) Except as provided in this section, a group health care service contract entered into or renewed after December 31, 1989, shall offer optional coverage for the treatment of temporomandibular joint disorders.(a) Health care service contractors offering medical coverage only ma…
RCW 48.44.465 Prescriptions—Preapproval of individual claims—Subsequent rejection prohibited—Written record required.
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Health care service contractors 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 kee…
RCW 48.44.470 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 48.44.495 Dental services that are not subject to contract or provider agreement.
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(1) Notwithstanding any other provisions of law, no contract of any health care service contractor subject to the jurisdiction of the state of Washington that covers any dental services, and no contract or participating provider agreement with a dentist may:(a) Require, directly …
RCW 48.44.500 Denturist services.
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Notwithstanding any provision of any health care service 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 licensed under chapter 18.30 RCW if (1) the service …
RCW 48.44.530 Disclosure of certain material transactions—Report—Information is confidential.
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(1) Every health care service contractor 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 an…
RCW 48.44.535 Material acquisitions or dispositions.
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No acquisitions or dispositions of assets need be reported pursuant to RCW 48.44.530 if the acquisitions or dispositions are not material. For purposes of RCW 48.44.530 through 48.44.555, a material acquisition, or the aggregate of any series of related acquisitions during any th…
RCW 48.44.540 Asset acquisitions—Asset dispositions.
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(1) Asset acquisitions subject to RCW 48.44.530 through 48.44.555 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 care service contractor or…
RCW 48.44.545 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 48.44.550 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 48.44.530 if the nonrenewals, cancellations, or revisions are not material. For purposes of RCW 48.44.530 through 48.44.555, a material nonrenewal, cancellation, or revision…
RCW 48.44.555 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 ini…
RCW 48.44.900 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 …
RCW 48.45.005 Findings.
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The legislature finds that the residents of rural communities are having difficulties in locating and purchasing affordable health insurance. The legislature further finds that many rural communities have sufficient funds to pay for needed services, but those funds are being expe…
RCW 48.45.010 Definitions.
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Unless the context clearly requires otherwise, the definitions in this section apply throughout this chapter.(1) "Rural community" means any grouping of consumers, seventy-five percent of whom reside in areas outside of a standard metropolitan statistical area as defined by the U…
RCW 48.45.020 Rural health care service arrangements.
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Rural health care service arrangements existing on March 29, 1990, may continue in full operation only so long as they comply with all of the following:(1) Within ten days following March 29, 1990, all rural health care service arrangements shall inform the insurance commissioner…
RCW 48.45.030 Rule making.
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The insurance commissioner, pursuant to chapter 34.05 RCW, may promulgate rules to implement RCW 48.45.010 and 48.45.020.[ 1990 c 271 s 24.]
RCW 48.46.010 Legislative declaration—Purpose.
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In affirmation of the declared principle that health care is a right of every citizen of the state, the legislature expresses its concern that the present high costs of health care in Washington may be preventing or inhibiting a large segment of the people from obtaining access t…
RCW 48.46.012 Filings with secretary of state—Copy for commissioner.
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Health maintenance organizations 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 articles of incorporation and bylaws, and any a…
RCW 48.46.020 Definitions.
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As used in this chapter, the terms defined in this section shall have the meanings indicated unless the context indicates otherwise.(1) "Carrier" means a health maintenance organization, an insurer, a health care services contractor, or other entity responsible for the payment of…
RCW 48.46.023 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 maintenance organization to solicit applications for health care service agreements on its behalf.(2) No person shall act as or hold himself or herself out to be an appointed ins…
RCW 48.46.027 Registration, required—Issuance of securities—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 maintenance organization as defined in RCW 48.46.020 without first being registered with the commissioner.(2) The issuance, sale, or offer for sale in this state of secu…
RCW 48.46.030 Eligibility requirements for certificate of registration—Application requirements, information—Provider compensation.
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Any corporation, cooperative group, partnership, individual, association, or groups of health professionals licensed by the state of Washington, public hospital district, or public institutions of higher education shall be entitled to a certificate of registration from the insura…
RCW 48.46.033 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 48.46.040 Certificate of registration—Issuance—Grounds for refusal—Name restrictions—Inspection and review of facilities.
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The commissioner shall issue a certificate of registration to the applicant within sixty days of such filing unless he or she notifies the applicant within such time that such application is not complete and the reasons therefor; or that he or she is not satisfied that:(1) The ba…
RCW 48.46.045 Catastrophic health plans permitted.
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Notwithstanding the provisions of this chapter, a health maintenance organization may offer catastrophic health plans as defined in RCW 48.43.005.[ 2000 c 79 s 27.]Notes:Effective date—Severability—2000 c 79: See notes following RCW 48.04.010.
RCW 48.46.060 Prepayment agreements—Standards for forms and documents—Grounds for disapproval—Cancellation or failure to renew—Filing of agreement forms.
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(1) Any health maintenance organization may enter into agreements 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 the health maintenance organization providing health care servic…
RCW 48.46.062 Schedule of rates for individual agreements—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 maintenance organization of health care services, as defined in RCW 48.43.005, provided to an enrollee or paid to or on beh…
RCW 48.46.063 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 48.46.064 Calculation of premiums—Adjusted community rate—Definitions.
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(1) Except for health benefit plans covered under RCW 48.46.063, premium rates for health benefit plans for individuals shall be subject to the following provisions:(a) The health maintenance organization shall develop its rates based on an adjusted community rate and may only va…
RCW 48.46.066 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 maintenance organization 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 48.46.068 Requirements for plans offered to small employers—Definitions.
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(1) A health maintenance organization may not offer any health benefit plan to any small employer without complying with RCW 48.46.066(3).(2) Employers purchasing health plans provided through associations or through member-governed groups formed specifically for the purpose of p…
RCW 48.46.070 Governing body.
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(1) The members of the governing body of a health maintenance organization shall be nominated by the voting members or by the enrolled participants and providers, and shall be elected by the enrolled participants or voting members pursuant to the provisions of their bylaws, which…
RCW 48.46.080 Annual statement—Filings—Contents—Fee—Penalty for failure to file—Accuracy required.
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(1) Every domestic health maintenance organization 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 maintenance organization showing its financial condition as of the last …
RCW 48.46.090 Standard of services provided.
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A health maintenance organization, and the health care facilities and providers with which such organization has entered into contracts to provide health care services to its enrolled participants, shall provide such services in a manner consistent with the dignity of each enroll…
RCW 48.46.100 Grievance procedure.
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A health maintenance organization shall establish and maintain a grievance procedure, approved by the commissioner, to provide reasonable and effective resolution of complaints initiated by enrolled participants concerning any matter relating to the interpretation of any provisio…
RCW 48.46.110 Name restrictions—Discrimination—Recovery of costs of health care services participant not entitled to.
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(1) No health maintenance organization may refer to itself in its name or advertising with any of the words: "insurance", "casualty", "surety", "mutual", or any other words descriptive of the insurance, casualty, or surety business, or deceptively similar to the name or descripti…
RCW 48.46.120 Examination of health maintenance organizations—Duties of organizations, powers of commissioner—Independent audit reports.
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(1) The commissioner may make an examination of the operations of any health maintenance organization as often as he or she deems necessary in order to carry out the purposes of this chapter.(2) Every health maintenance organization shall submit its books and records relating its…
RCW 48.46.130 Investigation of violations—Hearing—Findings—Penalties—Order requiring compliance, etc.—Suspension or revocation of certificate, effect—Application to courts.
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(1) The commissioner may, consistent with the provisions of the administrative procedure act, chapter 34.05 RCW, initiate proceedings to determine whether a health maintenance organization has:(a) Operated in a manner that materially violates its organizational documents;(b) Mate…
RCW 48.46.135 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 maintenance organization, the commissioner may levy a fine against the party involved for each offense in an amount no…