RCW 48.44.020
Contracts for services -- Examination of
contract forms by commissioner -- Grounds for
disapproval -- Liability of participant. (Effective until July 1,
2009.)
(1) Any health care service contractor may enter into
contracts with or for the benefit of persons or groups of persons
which require prepayment for health care services by or for such
persons in consideration of such health care service contractor
providing one or more health care services to such persons and
such activity shall not be subject to the laws relating to
insurance if the health care services are rendered by the health
care service contractor or by a participating provider.
(2) The commissioner may on examination, subject to the
right of the health care service contractor to demand and receive
a hearing under chapters 48.04 and 34.05 RCW, disapprove any
individual or group contract form for any of the following
grounds:
(a) If it contains or incorporates by reference any
inconsistent, ambiguous or misleading clauses, or exceptions and
conditions which unreasonably or deceptively affect the risk
purported to be assumed in the general coverage of the contract;
or
(b) If it has any title, heading, or other indication of its
provisions which is misleading; or
(c) If purchase of health care services thereunder is being
solicited by deceptive advertising; or
(d) If it contains unreasonable restrictions on the
treatment of patients; or
(e) If it violates any provision of this chapter; or
(f) If it fails to conform to minimum provisions or
standards required by regulation made by the commissioner
pursuant to chapter 34.05 RCW; or
(g) If any contract for health care services with any state
agency, division, subdivision, board, or commission or with any
political subdivision, municipal corporation, or quasi-municipal
corporation fails to comply with state law.
(3) In addition to the grounds listed in subsection (2) of
this section, the commissioner may disapprove any contract if the
benefits provided therein are unreasonable in relation to the
amount charged for the contract. Rates, or any modification of
rates effective on or after July 1, 2008, for individual health
benefit plans may not be used until sixty days after they are
filed with the commissioner. If the commissioner does not
disapprove a rate filing within sixty days after the health care
service contractor has filed the documents required in RCW 48.44.017(2) and any rules adopted pursuant thereto, the filing
shall be deemed approved.
(4)(a) Every contract between a health care service
contractor and a participating provider of health care services
shall be in writing and shall state that in the event the health
care service contractor fails to pay for health care services as
provided in the contract, the enrolled participant shall not be
liable to the provider for sums owed by the health care service
contractor. Every such contract shall provide that this
requirement shall survive termination of the contract.
(b) No participating provider, agent, trustee, or assignee
may maintain any action against an enrolled participant to
collect sums owed by the health care service contractor.
[2008 c 303 § 2; 2000 c 79 § 28; 1990 c 120 § 5; 1986 c 223 § 2; 1985 c 283 § 1; 1983 c 286 § 4; 1973 1st ex.s. c 65 § 1; 1969 c 115 § 1; 1961 c 197 § 2; 1947 c 268 § 2; Rem. Supp. 1947 § 6131-11.]
NOTES:
Effective date -- Severability -- 2000 c 79: See notes following RCW 48.04.010.
Severability -- 1983 c 286: See note following RCW 48.44.309.
RCW 48.44.020
Contracts for services -- Examination of
contract forms by commissioner -- Grounds for
disapproval -- Liability of participant. (Effective July 1, 2009.)
(1) Any health care service contractor may enter into contracts
with or for the benefit of persons or groups of persons which
require prepayment for health care services by or for such
persons in consideration of such health care service contractor
providing one or more health care services to such persons and
such activity shall not be subject to the laws relating to
insurance if the health care services are rendered by the health
care service contractor or by a participating provider.
(2) The commissioner may on examination, subject to the
right of the health care service contractor to demand and receive
a hearing under chapters 48.04 and 34.05 RCW, disapprove any
individual or group contract form for any of the following
grounds:
(a) If it contains or incorporates by reference any
inconsistent, ambiguous or misleading clauses, or exceptions and
conditions which unreasonably or deceptively affect the risk
purported to be assumed in the general coverage of the contract;
or
(b) If it has any title, heading, or other indication of its
provisions which is misleading; or
(c) If purchase of health care services thereunder is being
solicited by deceptive advertising; or
(d) If it contains unreasonable restrictions on the
treatment of patients; or
(e) If it violates any provision of this chapter; or
(f) If it fails to conform to minimum provisions or
standards required by regulation made by the commissioner
pursuant to chapter 34.05 RCW; or
(g) If any contract for health care services with any state
agency, division, subdivision, board, or commission or with any
political subdivision, municipal corporation, or quasi-municipal
corporation fails to comply with state law.
(3) In addition to the grounds listed in subsection (2) of
this section, the commissioner may disapprove any contract if the
benefits provided therein are unreasonable in relation to the
amount charged for the contract. Rates, or any modification of
rates effective on or after July 1, 2008, for individual health
benefit plans may not be used until sixty days after they are
filed with the commissioner. If the commissioner does not
disapprove a rate filing within sixty days after the health care
service contractor has filed the documents required in RCW 48.44.017(2) and any rules adopted pursuant thereto, the filing
shall be deemed approved.
(4)(a) Every contract between a health care service
contractor and a participating provider of health care services
shall be in writing and shall state that in the event the health
care service contractor fails to pay for health care services as
provided in the contract, the enrolled participant shall not be
liable to the provider for sums owed by the health care service
contractor. Every such contract shall provide that this
requirement shall survive termination of the contract.
(b) No participating provider, insurance producer, trustee,
or assignee may maintain any action against an enrolled
participant to collect sums owed by the health care service
contractor.
[2008 c 303 § 2; 2008 c 217 § 51; 2000 c 79 § 28; 1990 c 120 § 5; 1986 c 223 § 2; 1985 c 283 § 1; 1983 c 286 § 4; 1973 1st ex.s. c 65 § 1; 1969 c 115 § 1; 1961 c 197 § 2; 1947 c 268 § 2; Rem. Supp. 1947 § 6131-11.]
NOTES:
Reviser's note: This section was amended by 2008 c 217 § 51 and by 2008 c 303 § 2, each without reference to the other. Both amendments are incorporated in the publication of this section under RCW 1.12.025(2). For rule of construction, see RCW 1.12.025(1).
Severability -- Effective date -- 2008 c 217: See notes following RCW 48.03.020.
Effective date -- Severability -- 2000 c 79: See notes following RCW 48.04.010.
Severability -- 1983 c 286: See note following RCW 48.44.309.