Revised Code of Washington
Chapter 48.46 - Health Maintenance Organizations.
48.46.110 - Name restrictions—Discrimination—Recovery of costs of health care services participant not entitled to.

RCW 48.46.110
Name restrictions—Discrimination—Recovery of costs of health care services participant not entitled to.

(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 description of any insurance or surety corporation or health care service contractor or other health maintenance organization doing business in this state.
(2) No health maintenance organization, nor any health care facility or provider with which such organization has contracted to provide health care services, shall discriminate against any person from whom or on whose behalf, payment to meet the required charge is available, with regard to enrollment, disenrollment, or the provision of health care services, on the basis of such person's race, color, sex, religion, place of residence if there is reasonable access to the facility of the health maintenance organization, socioeconomic status, or status as a recipient of medicare under Title XVIII of the Social Security Act, 42 U.S.C. section 1396, et seq.
(3) Where a health maintenance organization determines that an enrolled participant has received health care services to which such enrolled participant is not entitled under the terms of his or her health maintenance agreement, neither such organization, nor any health care facility or provider with which such organization has contracted to provide health care services, shall have recourse against such enrolled participant for any amount above the actual cost of providing such service, if any, specified in such agreement, unless the enrolled participant or a member of his or her family has given or withheld information to the health maintenance organization, the effect of which is to mislead or misinform the health maintenance organization as to the enrolled participant's right to receive such services.

[ 2009 c 549 § 7151; 1983 c 202 § 11; 1975 1st ex.s. c 290 § 12.]

Structure Revised Code of Washington

Revised Code of Washington

Title 48 - Insurance

Chapter 48.46 - Health Maintenance Organizations.

48.46.010 - Legislative declaration—Purpose.

48.46.012 - Filings with secretary of state—Copy for commissioner.

48.46.020 - Definitions.

48.46.023 - Insurance producer—Definition—License required—Application, issuance, renewal, fees—Penalties involving license.

48.46.027 - Registration, required—Issuance of securities—Penalty.

48.46.030 - Eligibility requirements for certificate of registration—Application requirements, information—Provider compensation.

48.46.033 - Unregistered activities—Acts committed in this state—Sanctions.

48.46.040 - Certificate of registration—Issuance—Grounds for refusal—Name restrictions—Inspection and review of facilities.

48.46.045 - Catastrophic health plans permitted.

48.46.060 - Prepayment agreements—Standards for forms and documents—Grounds for disapproval—Cancellation or failure to renew—Filing of agreement forms.

48.46.062 - Schedule of rates for individual agreements—Loss ratio—Definitions.

48.46.063 - Calculation of premiums—Members of a purchasing pool—Adjusted community rating method—Definitions.

48.46.064 - Calculation of premiums—Adjusted community rate—Definitions.

48.46.066 - Health plan benefits for small employers—Coverage—Exemption from statutory requirements—Premium rates—Requirements for providing coverage for small employers.

48.46.068 - Requirements for plans offered to small employers—Definitions.

48.46.070 - Governing body.

48.46.080 - Annual statement—Filings—Contents—Fee—Penalty for failure to file—Accuracy required.

48.46.090 - Standard of services provided.

48.46.100 - Grievance procedure.

48.46.110 - Name restrictions—Discrimination—Recovery of costs of health care services participant not entitled to.

48.46.120 - Examination of health maintenance organizations—Duties of organizations, powers of commissioner—Independent audit reports.

48.46.130 - Investigation of violations—Hearing—Findings—Penalties—Order requiring compliance, etc.—Suspension or revocation of certificate, effect—Application to courts.

48.46.135 - Fine in addition to or in lieu of suspension, revocation, or refusal.

48.46.140 - Fees.

48.46.170 - Effect of chapter as to other laws—Construction.

48.46.180 - Duty of employer to inform and make available to employees option of enrolling in health maintenance organization.

48.46.190 - Payroll deductions for capitation payments to health maintenance organizations.

48.46.200 - Rules and regulations.

48.46.210 - Compliance with federal funding requirements—Construction.

48.46.220 - Review of administrative action.

48.46.225 - Financial failure—Supervision of commissioner—Priority of distribution of assets.

48.46.235 - Minimum net worth—Requirement to maintain—Determination of amount.

48.46.237 - Minimum net worth—Domestic or foreign health maintenance organization.

48.46.240 - Funded reserve requirements.

48.46.243 - Contract—Participant liability.

48.46.245 - Plan for handling insolvency—Commissioner's review.

48.46.247 - Insolvency—Commissioner's duties—Participants' options—Allocation of coverage.

48.46.250 - Coverage of dependent children—Newborn infants, congenital anomalies—Notification period.

48.46.260 - Individual health maintenance agreement—Return within ten days of delivery—Refunds—Void from beginning.

48.46.270 - Financial interests of health maintenance organization authorities, restricted—Exceptions, regulations.

48.46.272 - Diabetes coverage—Definitions.

48.46.274 - Prescribed, self-administered anticancer medication.

48.46.275 - Mammograms—Insurance coverage.

48.46.277 - Prostate cancer screening.

48.46.280 - Reconstructive breast surgery.

48.46.285 - Mastectomy, lumpectomy.

48.46.291 - Mental health services—Health plans—Definition—Coverage required, when.

48.46.292 - Mental health treatment—Waiver of preauthorization for persons involuntarily committed.

48.46.300 - Future dividends or refunds, restricted—Issuance or sale of securities regulated.

48.46.310 - Registration not endorsement.

48.46.320 - Dependent children, termination of coverage, conditions.

48.46.325 - Option to cover child under age twenty-six.

48.46.340 - Return of agreement within ten days.

48.46.350 - Chemical dependency treatment.

48.46.355 - "Chemical dependency" defined.

48.46.360 - Payment of cost of agreement directly to holder during labor dispute—Changes restricted—Notice to employee.

48.46.370 - Coverage not denied for disability.

48.46.375 - Benefits for prenatal diagnosis of congenital disorders—Agreements entered into or renewed on or after January 1, 1990.

48.46.380 - Notice of reason for cancellation, denial, or refusal to renew agreement.

48.46.390 - Providing information on cancellation or refusal—No liability for insurance commissioner or health maintenance organization.

48.46.400 - False or misleading advertising prohibited.

48.46.410 - Misrepresentations to induce termination or retention of agreement prohibited.

48.46.420 - Penalty for violations.

48.46.430 - Enforcement authority of commissioner.

48.46.440 - Continuation option to be offered.

48.46.450 - Conversion agreement to be offered—Exceptions, conditions.

48.46.460 - Conversion agreement—Restrictions and requirements—Rules.

48.46.470 - Endorsement of modifications.

48.46.480 - Continuation of coverage of former family members.

48.46.490 - Coverage for adopted children.

48.46.500 - Cancellation of rider.

48.46.510 - Phenylketonuria.

48.46.520 - Neurodevelopmental therapies—Employer-sponsored group contracts.

48.46.530 - Temporomandibular joint disorders—Insurance coverage.

48.46.535 - Prescriptions—Preapproval of individual claims—Subsequent rejection prohibited—Written record required.

48.46.540 - Nonresident pharmacies.

48.46.565 - Foot care services.

48.46.570 - Denturist services.

48.46.575 - Doctor of osteopathic medicine and surgery—Discrimination based on board certification is prohibited.

48.46.580 - When injury caused by intoxication or use of narcotics.

48.46.600 - Disclosure of certain material transactions—Report—Information is confidential.

48.46.605 - Material acquisitions or dispositions.

48.46.610 - Asset acquisitions—Asset dispositions.

48.46.615 - Report of a material acquisition or disposition of assets—Information required.

48.46.620 - Material nonrenewals, cancellations, or revisions of ceded reinsurance agreements.

48.46.625 - Report of a material nonrenewal, cancellation, or revision of ceded reinsurance agreements—Information required.

48.46.900 - Liberal construction.

48.46.920 - Short title.

48.46.930 - Construction—Chapter applicable to state registered domestic partnerships—2009 c 521.