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§ 48.43.001 |
Intent |
§ 48.43.005 |
Definitions |
§ 48.43.007 |
Availability of price and quality information — Transparency tools for members — Requirements |
§ 48.43.008 |
Enrollment in employer-sponsored health plan — Person eligible for medical assistance |
§ 48.43.009 |
Health care sharing ministries |
§ 48.43.012 |
Health plans — Preexisting conditions — Rules |
§ 48.43.01211 |
Health plans — Eligibility — Health status-related factors — Rules |
§ 48.43.0122 |
Individual health benefit plans — Open enrollment and special enrollment periods — Rules — Enforcement |
§ 48.43.0123 |
Health plans — Rescission of coverage — Rules |
§ 48.43.0124 |
Health plans — Cost sharing for essential health benefits — Rules |
§ 48.43.0125 |
Essential health benefits — Annual or lifetime dollar limits |
§ 48.43.0126 |
Summary of benefits and explanation of coverage — Standards and requirements — Notice of modification — Fines — Standards for definitions of health insurance terms — Rules |
§ 48.43.0127 |
Group health plans — Waiting period — Rules |
§ 48.43.0128 |
Nongrandfathered health plans and plans issued or renewed on or after January 1, 2022 — Prohibited discrimination — Rules |
§ 48.43.016 |
Utilization management standards and criteria — Health carrier requirements — Definitions |
§ 48.43.0161 |
Prior authorization practices — Carrier annual reporting requirements — Commissioner’s standardized report |
§ 48.43.021 |
Personally identifiable health information — Restrictions on release |
§ 48.43.022 |
Enrollee identification card — Social security number restriction |
§ 48.43.023 |
Pharmacy identification cards — Rules |
§ 48.43.028 |
Eligibility to purchase certain health benefit plans — Small employers and small groups |
§ 48.43.035 |
Group health benefit plans — Guaranteed issue and continuity of coverage — Exceptions |
§ 48.43.038 |
Individual health plans — Guarantee of continuity of coverage — Exceptions |
§ 48.43.039 |
Grace period — Notification or information — Information concerning delinquencies or nonpayment of premiums — Defined |
§ 48.43.041 |
Individual health benefit plans — Mandatory benefits |
§ 48.43.043 |
Colorectal cancer examinations and laboratory tests — Required benefits or coverage |
§ 48.43.045 |
Health plan requirements — Annual reports — Exemptions |
§ 48.43.047 |
Health plans — Minimum coverage for preventative services — No cost-sharing requirements |
§ 48.43.049 |
Health carrier data — Information from annual statement — Format prescribed by commissioner — Public availability |
§ 48.43.055 |
Procedures for review and adjudication of health care provider complaints — Requirements |
§ 48.43.059 |
Payments made by a second-party payment process — Definition |
§ 48.43.065 |
Right of individuals to receive services — Right of providers, carriers, and facilities to refuse to participate in or pay for services for reason of conscience or religion — Requirements |
§ 48.43.071 |
Health care information — Requirement to provide free copy to covered person appealing denial of social security benefits — Exceptions |
§ 48.43.072 |
Required reproductive health care coverage — Restrictions on copayments, deductibles, and other form of cost sharing |
§ 48.43.0725 |
Reproductive health plan coverage — Immediate postpartum contraception devices |
§ 48.43.073 |
Required abortion coverage — Limitations |
§ 48.43.074 |
Qualified health plans — Single invoice billing — Certification of compliance required in the segregation plan for premium amounts attributable to coverage of abortion services |
§ 48.43.076 |
Digital breast examinations — Cost sharing |
§ 48.43.078 |
Digital breast tomosynthesis — Intent to ensure women with access — Commissioner’s and health care authority’s duty to clarify mandates |
§ 48.43.081 |
Anatomic pathology services — Payment for services — Definitions |
§ 48.43.083 |
Chiropractor services — Participating provider agreement — Health carrier reimbursement |
§ 48.43.085 |
Health carrier may not prohibit its enrollees from contracting for services outside the health care plan |
§ 48.43.087 |
Contracting for services at enrollee’s expense — Mental health care practitioner — Conditions — Exception |
§ 48.43.091 |
Health carrier coverage of outpatient mental health services — Requirements |
§ 48.43.093 |
Health carrier coverage of emergency medical services — Requirements — Conditions |
§ 48.43.094 |
Pharmacist provided services — Health plan requirements |
§ 48.43.096 |
Medication synchronization policy required for health plans covering prescription drugs — Requirements — Definitions |
§ 48.43.0961 |
Continuity of coverage for health plans covering prescription drugs for behavioral health |
§ 48.43.097 |
Filing of financial statements — Every health carrier |
§ 48.43.105 |
Preparation of documents that compare health carriers — Immunity — Due diligence |
§ 48.43.115 |
Maternity services — Intent — Definitions — Patient preference — Clinical sovereignty of provider — Notice to policyholders — Application |
§ 48.43.125 |
Coverage at a long-term care facility following hospitalization — Definition |
§ 48.43.135 |
Hearing instruments — Coverage |
§ 48.43.176 |
Eosinophilic gastrointestinal associated disorder — Elemental formula |
§ 48.43.180 |
Denturist services |
§ 48.43.185 |
General anesthesia services for dental procedures |
§ 48.43.190 |
Payment of chiropractic services — Parity |
§ 48.43.195 |
Contraceptive drugs — Twelve-month refill coverage |
§ 48.43.200 |
Disclosure of certain material transactions — Report — Information is confidential |
§ 48.43.205 |
Material acquisitions or dispositions |
§ 48.43.210 |
Asset acquisitions — Asset dispositions |
§ 48.43.215 |
Report of a material acquisition or disposition of assets — Information required |
§ 48.43.220 |
Material nonrenewals, cancellations, or revisions of ceded reinsurance agreements |
§ 48.43.225 |
Report of a material nonrenewal, cancellation, or revision of ceded reinsurance agreements — Information required |
§ 48.43.290 |
Coverage for prescribed durable medical equipment and mobility enhancing equipment — Sales and use taxes — Definitions |
§ 48.43.300 |
Definitions |
§ 48.43.305 |
Report of RBC levels — Distribution of report — Formula for determination — Commissioner may make adjustments |
§ 48.43.310 |
Company action level event — Required RBC plan — Commissioner’s review — Notification — Challenge by carrier |
§ 48.43.315 |
Regulatory action level event — Required RBC plan — Commissioner’s review — Notification — Challenge by carrier |
§ 48.43.320 |
Authorized control level event — Commissioner’s options |
§ 48.43.325 |
Mandatory control level event — Commissioner’s duty — Regulatory control |
§ 48.43.330 |
Carrier’s right to hearing — Request by carrier — Date set by commissioner |
§ 48.43.335 |
Confidentiality of RBC reports and plans — Use of certain comparisons prohibited — Certain information intended solely for use by commissioner |
§ 48.43.340 |
Powers or duties of commissioner not limited — Rules |
§ 48.43.345 |
Foreign or alien carriers — Required RBC report — Commissioner may require RBC plan — Mandatory control level event |
§ 48.43.350 |
No liability or cause of action against commissioner or department |
§ 48.43.355 |
Notice by commissioner to carrier — When effective |
§ 48.43.360 |
Initial RBC reports — Calculation of initial RBC levels — Subsequent reports |
§ 48.43.366 |
Self-funded multiple employer welfare arrangements |
§ 48.43.370 |
RBC standards not applicable to certain carriers |
§ 48.43.400 |
Prescription drug utilization management — Definitions |
§ 48.43.410 |
Prescription drug utilization management — Clinical review criteria — Requirement to be evidence-based and updated regularly |
§ 48.43.420 |
Prescription drug utilization management — Exception request process — Conditions, requirements, and time frames for approval or denial of requests — Emergency fill coverage — Notice of new policies and pro |
§ 48.43.430 |
Prescription medication — Maximum charge at point of sale — Requirements |
§ 48.43.435 |
Prescription medication — Cost-sharing calculation — Application — Rules |
§ 48.43.500 |
Intent — Purpose — 2000 c 5 |
§ 48.43.505 |
Enrollee’s and protected individual’s right to privacy and confidential services — Health carrier or insurer duties — Requests for confidential communications — Rules |
§ 48.43.5051 |
Requests for confidential communications — Monitoring and ensuring compliance — Standardized form for submission of requests — Rules |
§ 48.43.510 |
Carrier required to disclose health plan information — Marketing and advertising restrictions — Rules |
§ 48.43.515 |
Access to appropriate health services — Enrollee options — Rules |
§ 48.43.517 |
Enrollment of child participating in medical assistance program — Employer-sponsored health plan |
§ 48.43.520 |
Requirement to maintain a documented utilization review program description and written utilization review criteria — Rules |
§ 48.43.525 |
Prohibition against retrospective denial of health plan coverage — Rules |
§ 48.43.530 |
Requirement for carriers to have comprehensive grievance and appeal processes — Carrier’s duties — Procedures — Appeals — Rules |
§ 48.43.535 |
Independent review of health care disputes — System for using certified independent review organizations — Rules |
§ 48.43.537 |
Health care disputes — Certifying independent review organizations — Application — Restrictions — Maximum fee schedule for conducting reviews — Rules |
§ 48.43.540 |
Requirement to designate a licensed medical director — Exemption |
§ 48.43.545 |
Standard of care — Liability — Causes of action — Defense — Exception |
§ 48.43.550 |
Delegation of duties — Carrier accountability |
§ 48.43.600 |
Overpayment recovery — Carrier |
§ 48.43.605 |
Overpayment recovery — Health care provider |
§ 48.43.650 |
Fixed payment insurance products — Commissioner’s annual report |
§ 48.43.670 |
Plan or contract renewal — Modification of wellness program |
§ 48.43.680 |
Lifetime limit on transplants — Definition |
§ 48.43.690 |
Assessments under RCW 70.290.040 considered medical expenses |
§ 48.43.700 |
Exchange — Plans that a carrier must offer — Review — Rules |
§ 48.43.705 |
Plans offered outside of exchange |
§ 48.43.710 |
Certification as qualified health plan not an exemption |
§ 48.43.715 |
Individual and small group market — Selection of benchmark plan — Minimum requirements — Criteria — List of state-mandated health benefits |
§ 48.43.720 |
Reinsurance and risk adjustment programs — Affordable care act — Rules |
§ 48.43.725 |
Exclusion of mandated benefits from health plan — Carrier requirements — Notice — Fees — Commissioner’s duties |
§ 48.43.730 |
Carrier must file provider contracts and compensation agreements with commissioner — Approval or disapproval — Confidentiality — Hearings — Rules — Definitions |
§ 48.43.731 |
Health care benefit management contracts — Carrier filing requirements — Notice to enrollees — Confidentiality of filings |
§ 48.43.733 |
Rates and forms of group health benefit plans — Timing of filings — Exceptions — Rules |
§ 48.43.734 |
Health carrier rate filings — Review of surplus, capital, and profit levels |
§ 48.43.735 |
Reimbursement of health care services provided through telemedicine or store and forward technology — Audio-only telemedicine |
§ 48.43.740 |
Dental only plan — Emergency dental conditions — Definitions |
§ 48.43.743 |
Dental only plan — Annual data statement — Contents — Public use — Definition |
§ 48.43.745 |
Dental only plan — Denturist services |
§ 48.43.750 |
Health care provider credentialing applications — Use of electronic database by health carriers |
§ 48.43.755 |
Health care provider credentialing applications — Use of electronic database by providers |
§ 48.43.757 |
Health care provider credentialing applications — Reimbursement requirements |
§ 48.43.760 |
Opioid use disorder — Coverage without prior authorization |
§ 48.43.761 |
Withdrawal management services — Substance use disorder treatment services — Prior authorization — Utilization review — Medical necessity review |
§ 48.43.762 |
Opioid overdose reversal medication bulk purchasing and distribution program |
§ 48.43.765 |
Health carrier network adequacy — Mental health and substance abuse treatment |
§ 48.43.767 |
Behavioral health services — Network access |
§ 48.43.770 |
Individual market health plan availability — Annual report |
§ 48.43.775 |
Qualified health plan participation — Reimbursement rate for other health plans |
§ 48.43.780 |
Insulin drugs — Cap on enrollee’s required payment amount — Cost-sharing requirements |
§ 48.43.785 |
COVID-19 personal protective equipment expenses — Health care provider reimbursement |
§ 48.43.790 |
Behavioral services — Next-day appointments |
§ 48.43.795 |
Qualified health plans — Acceptance of premium and cost-sharing assistance |
§ 48.43.800 |
Primary care expenditures assessment — Review |
§ 48.43.805 |
Prescription drug upper payment limit — Rules |
§ 48.43.810 |
Biomarker testing — Standards — Construction |
§ 48.43.815 |
Donor human milk — Standards |
§ 48.43.820 |
Consolidated appropriations act enforcement — Implementation of federal regulations |
§ 48.43.825 |
Certified peer specialist services — Network access standards |
§ 48.43.830 |
Prior authorization |
§ 48.43.902 |
Effective date — 1996 c 312 |
§ 48.43.904 |
Construction — Chapter applicable to state registered domestic partnerships — 2009 c 521 |