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