Title 48 — Title 48 INSURANCE
101 chapters · 2,134 sections in this title.
RCW 48.180.060 Investigation fee—Use—Failure to pay.
0.7K chars
(1) The state risk manager shall establish and charge an investigation fee in an amount necessary to cover the costs for the initial review and approval of a joint self-insurance program. The fee must accompany the initial submission of the plan of operation and management.(2) Th…
RCW 48.180.065 Immunity from liability—Person who files, reports, or furnishes information—State risk manager and agents or employees.
1.0K chars
(1) Any person who files, reports, or furnishes other information required under this title, required by the state risk manager under the authority granted under this title, or which is useful to the state risk manager in the administration of this title is immune from liability …
RCW 48.185.005 Delivery by electronic means authorized—Insurer requirements—Party consent—Definitions.
6.9K chars
The definitions in this subsection apply throughout this chapter unless the context clearly requires otherwise.(1)(a)(i) "Delivered by electronic means" includes:(A) Delivery to an electronic mail address at which a party has consented to receive notices or documents; or(B) Posti…
RCW 48.185.010 Certain property and casualty insurance information—May be mailed, delivered, or posted on website—Requirements to post on website.
2.2K chars
(1) Notwithstanding any other provisions of this chapter, standard property and casualty insurance policy forms and endorsements that do not contain personally identifiable information may be mailed, delivered, or posted on the insurer's website. If the insurer elects to post ins…
RCW 48.190.005 Intent.
1.4K chars
This chapter is intended to provide authority for two or more public benefit hospital entities to participate in a joint self-insurance program covering property or liability risks. This chapter provides public benefit hospital entities with the exclusive source of authority to j…
RCW 48.190.010 Definitions.
1.8K chars
The definitions in this section apply throughout this chapter unless the context clearly requires otherwise.(1) "Hospital services" means clinically related (i.e., preventive, diagnostic, curative, rehabilitative, or palliative) services provided in a hospital setting.(2) "Proper…
RCW 48.190.020 Formation—Powers—Service of process.
3.4K chars
(1) The governing body of a public benefit hospital entity may join or form a self-insurance program together with one or more other public benefit hospital entities, and may jointly purchase insurance or reinsurance with one or more other public benefit hospital entities for pro…
RCW 48.190.030 Applicability of chapter.
0.4K chars
This chapter does not apply to a public benefit hospital entity that:(1) Individually self-insures for property and liability risks; or(2) Participates in a risk pooling arrangement, including a risk retention group or a risk purchasing group, regulated under chapter 48.92 RCW, i…
RCW 48.190.040 State risk manager—Rules.
1.2K chars
The state risk manager shall adopt rules governing the management and operation of joint self-insurance programs for public benefit hospital entities that cover property or liability risks. All rules must be appropriate for the type of program and class of risk covered. The state…
RCW 48.190.050 State risk manager—Approval of program creation—Required submissions.
2.0K chars
Before the establishment of a joint self-insurance program covering property or liability risks by public benefit hospital entities, the entities must obtain the approval of the state risk manager. The entities proposing the creation of a joint self-insurance program requiring pr…
RCW 48.190.060 State risk manager—Approval and denial of program creation—Violations of chapter—Reports.
3.8K chars
(1) Within one hundred twenty days of receipt of a plan of management and operation, the state risk manager shall either approve or disapprove of the formation of the joint self-insurance program after reviewing the plan to determine whether the proposed program complies with thi…
RCW 48.190.070 Participation with entities from other states.
2.4K chars
A public benefit hospital entity may participate in a joint self-insurance program covering property or liability risks with similar public benefit hospital entities from other states if the program satisfies the following requirements:(1) An ownership interest in the program is …
RCW 48.190.080 Designation of treasurer—Interest and earnings.
0.7K chars
(1) A joint self-insurance program may by resolution of the program designate a person having experience with investments or financial matters as treasurer of the program. The program must require a bond obtained from a surety company in an amount and under the terms and conditio…
RCW 48.190.090 Receiving or soliciting anything of value—Inducement.
1.0K chars
(1) An employee or official of a participating public benefit hospital entity in a joint self-insurance program may not directly or indirectly receive anything of value for services rendered in connection with the operation and management of a self-insurance program other than th…
RCW 48.190.100 Tax exemptions.
0.6K chars
A joint self-insurance program approved in accordance with this chapter is exempt from insurance premium taxes, fees assessed under chapter 48.02 RCW, chapters 48.32 and 48.32A RCW, business and occupation taxes imposed under chapter 82.04 RCW, and any assigned risk plan or joint…
RCW 48.190.110 Fees.
0.7K chars
(1) The state risk manager shall establish and charge an investigation fee in an amount necessary to cover the costs for the initial review and approval of a joint self-insurance program. The fee must accompany the initial submission of the plan of operation and management.(2) Th…
RCW 48.190.120 Civil immunity—Filings and publications.
1.1K chars
(1) Any person who files reports or furnishes other information required under this title, required by the state risk manager under the authority granted under this title, or which is useful to the state risk manager in the administration of this title, is immune from liability i…
RCW 48.195.005 Purpose—Application.
1.3K chars
(1) The purpose of this chapter is to:(a) Provide the insurance commissioner a summary of an insurer or insurance group's corporate governance structure, policies, and practices to permit the commissioner to gain and maintain an understanding of the insurer's corporate governance…
RCW 48.195.010 Definitions.
0.7K chars
The definitions in this section apply throughout this chapter unless the context clearly requires otherwise.(1) "Commissioner" means the insurance commissioner of this state.(2) "Corporate governance annual disclosure" means a confidential report filed by the insurer or insurance…
RCW 48.195.020 Annual disclosure—Lead state when insurer part of insurance group—Additional information may be required.
3.2K chars
(1) An insurer, or the insurance group of which the insurer is a member, must, no later than June 1st of each calendar year, submit to the commissioner a corporate governance annual disclosure that contains the information described in RCW 48.195.030(2). If the insurer is a membe…
RCW 48.195.030 Responses to annual disclosure inquiries—Documentation and supporting information.
1.1K chars
(1) The insurer or insurance group has discretion over the responses to the corporate governance annual disclosure inquiries, provided the corporate governance annual disclosure contains the material information necessary to permit the commissioner to gain an understanding of the…
RCW 48.195.040 Documents, materials, and other information are confidential—Restricted use by commission—Restricted use in civil actions.
4.2K chars
(1) Documents, materials, or other information including the corporate governance annual disclosure, in the possession or control of the commissioner that are obtained by, created by, or disclosed to the commissioner or any other person under this chapter, are recognized by this …
RCW 48.195.050 Retaining third-party consultants—Under direction and control of the commissioner—Written agreements and consent.
3.9K chars
(1) The commissioner may retain at the insurer's expense, third-party consultants, including attorneys, actuaries, accountants, and other experts not otherwise part of the commissioner's staff as may be reasonably necessary to assist the commissioner in reviewing the corporate go…
RCW 48.195.060 Failure to timely file—Penalties.
0.7K chars
Any insurer failing, without just cause, to timely file the corporate governance annual disclosure as required by this chapter is required, after notice and hearing under chapters 48.04 and 34.05 RCW, to pay a penalty of five hundred dollars for each day's delay, to be recovered …
RCW 48.195.100 Rules.
0.3K chars
The commissioner may, under chapter 34.05 RCW, adopt rules to implement and administer this chapter, including the national association of insurance commissioners' corporate governance annual disclosure model rule.[ 2018 c 30 s 8.]Notes:Effective date—2018 c 30: See note followin…
RCW 48.200.010 Findings—Intent.
1.0K chars
(1) The legislature finds that growth in managed health care systems has shifted substantial authority over health care decisions from providers and patients to health carriers and health care benefit managers. Health care benefit managers acting as intermediaries between carrier…
RCW 48.200.020 Definitions.
7.6K chars
The definitions in this section apply throughout this chapter unless the context clearly requires otherwise.(1) "Affiliate" or "affiliated employer" means a person who directly or indirectly through one or more intermediaries, controls or is controlled by, or is under common cont…
RCW 48.200.030 Registration requirements—Application—Fees—Retention of transaction records.
2.8K chars
(1) To conduct business in this state, a health care benefit manager must register with the commissioner and annually renew the registration.(2) To apply for registration with the commissioner under this section, a health care benefit manager must:(a) Submit an application on for…
RCW 48.200.040 Contract requirements—Written agreement describing rights and responsibilities—Filing of contracts—Confidentiality.
2.0K chars
(1) A health care benefit manager may not provide health care benefit management services to a health carrier or employee benefits programs without a written agreement describing the rights and responsibilities of the parties conforming to the provisions of this chapter and any r…
RCW 48.200.050 Inquiries or complaints—Violations of chapter—Enforcement actions—Responsibility of carriers and programs for compliance.
4.6K chars
(1) Upon notifying a carrier or health care benefit manager of an inquiry or complaint filed with the commissioner pertaining to the conduct of a health care benefit manager identified in the inquiry or complaint, the commissioner must provide notice of the inquiry or complaint t…
RCW 48.200.210 Definitions applicable to RCW 48.200.220 through 48.200.290.
1.6K chars
The definitions in this section apply throughout this section and RCW 48.200.220 through 48.200.290 unless the context clearly requires otherwise.(1) "Audit" means an on-site or remote review of the records of a pharmacy by or on behalf of an entity.(2) "Claim" means a request fr…
RCW 48.200.220 Definitions applicable to RCW 48.200.220 through 48.200.290.
2.0K chars
An entity that audits claims or an independent third party that contracts with an entity to audit claims:(1) Must establish, in writing, a procedure for a pharmacy to appeal the entity's findings with respect to a claim and must provide a pharmacy with a notice regarding the proc…
RCW 48.200.230 Basis of finding of claim.
0.4K chars
An entity's finding that a claim was incorrectly presented or paid must be based on identified transactions and not based on probability sampling, extrapolation, or other means that project an error using the number of patients served who have a similar diagnosis or the number of…
RCW 48.200.240 Contract with third party—Prohibited practices.
0.4K chars
An entity that contracts with an independent third party to conduct audits may not:(1) Agree to compensate the independent third party based on a percentage of the amount of overpayments recovered; or(2) Disclose information obtained during an audit except to the contracting enti…
RCW 48.200.250 Evidence of validation of claim.
1.0K chars
For purposes of RCW 48.200.210 through 48.200.270, an entity, or an independent third party that contracts with an entity to conduct audits, must allow as evidence of validation of a claim:(1) An electronic or physical copy of a valid prescription if the prescribed drug was, with…
RCW 48.200.260 Preliminary audit report—Dispute or denial of claim—Final audit report—Recoupment of disputed funds.
2.1K chars
(1)(a) After conducting an audit, an entity must provide the pharmacy that is the subject of the audit with a preliminary report of the audit. The preliminary report must be received by the pharmacy no later than forty-five days after the date on which the audit was completed and…
RCW 48.200.270 Application.
0.6K chars
RCW 48.200.210 through 48.200.270 do not:(1) Preclude an entity from instituting an action for fraud against a pharmacy;(2) Apply to an audit of pharmacy records when fraud or other intentional and willful misrepresentation is indicated by physical review, review of claims data o…
RCW 48.200.280 Predetermination of reimbursement costs—Appeals—Review by commissioner.
16.2K chars
(1) The definitions in this subsection apply throughout this section unless the context clearly requires otherwise.(a) "List" means the list of drugs for which predetermined reimbursement costs have been established, such as a maximum allowable cost or maximum allowable cost list…
RCW 48.200.290 Definitions applicable to RCW 48.200.220 through 48.200.290.
1.0K chars
(1) The commissioner shall have enforcement authority over this chapter and shall have authority to render a binding decision in any dispute between a pharmacy benefit manager, or third-party administrator of prescription drug benefits, and a pharmacy arising out of an appeal und…
RCW 48.200.300 Service of process.
1.4K chars
(1) Each health care benefit manager must appoint the commissioner as its attorney to receive service of, and upon whom must be served, all legal process issued against it in this state for causes of action arising within this state. Service upon the commissioner as attorney cons…
RCW 48.200.310 Prohibitions and duties.
1.8K chars
(1) A pharmacy benefit manager may not:(a) Reimburse a network pharmacy an amount less than the contract price between the pharmacy benefit manager and the insurer, third-party payor, or the prescription drug purchasing consortium the pharmacy benefit manager has contracted with;…
RCW 48.200.320 Prohibitions on retaliation.
1.4K chars
(1) A pharmacy benefit manager may not retaliate against a pharmacist or pharmacy for disclosing information in a court, in an administrative hearing, or legislative hearing, if the pharmacist or pharmacy has a good faith belief that the disclosed information is evidence of a vio…
RCW 48.200.330 Application—Plans governed by the federal employee retirement income security act.
1.8K chars
(1) Nothing in chapter 242, Laws of 2024 expands or restricts the entities subject to this chapter. Therefore, except as provided in subsection (2) of this section, this chapter continues to be inapplicable to a person or entity providing services to, or acting on behalf of, a un…
RCW 48.200.900 Rule making—2020 c 240.
0.1K chars
The insurance commissioner may adopt any rules necessary to implement this act.[ 2020 c 240 s 20.]
RCW 48.200.901 Effective date—2020 c 240.
0.1K chars
Sections 1 through 19 of this act take effect January 1, 2022.[ 2020 c 240 s 23.]
RCW 48.201.010 Findings—Intent—2021 c 281.
1.2K chars
The legislature finds that creating a framework for Washington private entities and public institutions of higher education to manage their risks through captive insurers will facilitate the growth and safety of those entities and protect the public interest. The legislature furt…
RCW 48.201.020 Definitions.
2.0K chars
The definitions in this section apply throughout this chapter unless the context clearly requires otherwise.(1) "Affiliate" means an entity directly or indirectly controlling, controlled by, or under common control with another entity, such as a parent or a subsidiary corporation…
RCW 48.201.030 Eligible captive insurer—Registration.
1.9K chars
(1) Within 120 days after May 12, 2021, or, if later, within 120 days after first issuing a policy that covers Washington risks, an entity acting as an eligible captive insurer must register with the commissioner.(2) The commissioner will approve an eligible captive insurer's reg…
RCW 48.201.040 Tax on premiums—Remittance.
2.8K chars
(1) On or before the first day of March of each year, a registered eligible captive insurer must remit to the state treasurer through the commissioner a tax in the amount of two percent of the premiums, exclusive of returned premiums and sums collected to cover federal and state …
RCW 48.201.050 Commissioner's enforcement authority.
1.1K chars
(1) The commissioner is authorized to make use of any of the powers established under Title 48 RCW to enforce the laws of this state. This includes, but is not limited to, the commissioner's administrative authority to investigate, issue subpoenas, conduct depositions and hearing…