Chapter 48.43 RCW
INSURANCE REFORM

(Formerly Certified health plans)

RCW SECTIONS

48.43.001Intent.
48.43.005Definitions.
48.43.008Enrollment in employer-sponsored health plan -- Person eligible for medical assistance.
48.43.012Individual health benefit plans -- Preexisting conditions.
48.43.015Health benefit plans -- Preexisting conditions.
48.43.017Organ transplant benefit waiting periods -- Prior creditable coverage.
48.43.018Requirement to complete the standard health questionnaire -- Exemptions -- Results.
48.43.021Personally identifiable health information -- Restrictions on release.
48.43.022Enrollee identification card -- Social security number restriction.
48.43.023Pharmacy identification cards--Rules.
48.43.025Group health benefit plans -- Preexisting conditions.
48.43.028Eligibility to purchase certain health benefit plans -- Small employers and small groups.
48.43.035Group health benefit plans -- Guaranteed issue and continuity of coverage -- Exceptions -- Group of one.
48.43.038Individual health plans -- Guarantee of continuity of coverage--Exceptions.
48.43.041Individual health benefit plans -- Mandatory benefits.
48.43.043Colorectal cancer examinations and laboratory tests -- Required benefits or coverage.
48.43.045Health plan requirements -- Annual reports -- Exemptions.
48.43.049Health carrier data -- Information from annual statement -- Format prescribed by commissioner -- Public availability.
48.43.055Procedures for review and adjudication of health care provider complaints -- Requirements.
48.43.065Right 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.
48.43.083Chiropractor services -- Participating provider agreement -- Health carrier reimbursement.
48.43.085Health carrier may not prohibit its enrollees from contracting for services outside the health care plan.
48.43.087Contracting for services at enrollee's expense -- Mental health care practitioner -- Conditions -- Exception.
48.43.091Health carrier coverage of outpatient mental health services -- Requirements.
48.43.093Health carrier coverage of emergency medical services -- Requirements -- Conditions.
48.43.097Filing of financial statements -- Every health carrier.
48.43.105Preparation of documents that compare health carriers -- Immunity -- Due diligence.
48.43.115Maternity services -- Intent -- Definitions -- Patient preference -- Clinical sovereignty of provider -- Notice to policyholders -- Application.
48.43.125Coverage at a long-term care facility following hospitalization -- Definition.
48.43.180Denturist services.
48.43.185General anesthesia services for dental procedures.
48.43.190Payment of chiropractic services -- Parity.
48.43.200Disclosure of certain material transactions -- Report -- Information is confidential.
48.43.205Material acquisitions or dispositions.
48.43.210Asset acquisitions -- Asset dispositions.
48.43.215Report of a material acquisition or disposition of assets -- Information required.
48.43.220Material nonrenewals, cancellations, or revisions of ceded reinsurance agreements.
48.43.225Report of a material nonrenewal, cancellation, or revision of ceded reinsurance agreements -- Information required.
48.43.300Definitions.
48.43.305Report of RBC levels -- Distribution of report -- Formula for determination -- Commissioner may make adjustments.
48.43.310Company action level event -- Required RBC plan -- Commissioner's review -- Notification -- Challenge by carrier.
48.43.315Regulatory action level event -- Required RBC plan -- Commissioner's review -- Notification -- Challenge by carrier.
48.43.320Authorized control level event -- Commissioner's options.
48.43.325Mandatory control level event -- Commissioner's duty -- Regulatory control.
48.43.330Carrier's right to hearing -- Request by carrier -- Date set by commissioner.
48.43.335Confidentiality of RBC reports and plans -- Use of certain comparisons prohibited -- Certain information intended solely for use by commissioner.
48.43.340Powers or duties of commissioner not limited -- Rules.
48.43.345Foreign or alien carriers -- Required RBC report -- Commissioner may require RBC plan -- Mandatory control level event.
48.43.350No liability or cause of action against commissioner or department.
48.43.355Notice by commissioner to carrier -- When effective.
48.43.360Initial RBC reports -- Calculation of initial RBC levels -- Subsequent reports.
48.43.366Self-funded multiple employer welfare arrangements.
48.43.370RBC standards not applicable to certain carriers.
48.43.500Intent -- Purpose -- 2000 c 5.
48.43.505Requirement to protect enrollee's right to privacy or confidential services -- Rules.
48.43.510Carrier required to disclose health plan information -- Marketing and advertising restrictions -- Rules.
48.43.515Access to appropriate health services -- Enrollee options -- Rules.
48.43.517Enrollment of child participating in medical assistance program -- Employer-sponsored health plan.
48.43.520Requirement to maintain a documented utilization review program description and written utilization review criteria -- Rules.
48.43.525Prohibition against retrospective denial of health plan coverage -- Rules.
48.43.530Requirement for carriers to have a comprehensive grievance process -- Carrier's duties -- Procedures -- Appeals -- Rules.
48.43.535Independent review of health care disputes -- System for using certified independent review organizations -- Rules.
48.43.540Requirement to designate a licensed medical director -- Exemption.
48.43.545Standard of care -- Liability -- Causes of action -- Defense -- Exception.
48.43.550Delegation of duties -- Carrier accountability.
48.43.600Overpayment recovery -- Carrier.
48.43.605Overpayment recovery -- Health care provider.
48.43.650Fixed payment insurance products -- Commissioner's annual report.
48.43.670Plan or contract renewal -- Modification of wellness program.
48.43.680Lifetime limit on transplants -- Definition.
48.43.901Captions not law -- 1996 c 312.
48.43.902Effective date -- 1996 c 312.
48.43.903Severability -- 1998 c 241.
48.43.904Construction -- Chapter applicable to state registered domestic partnerships -- 2009 c 521.