GroundRules
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- RCW 48.43.435 · Prescription medication—Cost-sharing calculation—Application—Rules.
- RCW 48.43.440 · Human immunodeficiency virus postexposure prophylaxis drugs—Cost sharing and prior authorization.
- RCW 48.43.500 · Intent—Purpose—2000 c 5.
- RCW 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 48.43.5051 · Requests for confidential communications—Monitoring and ensuring compliance—Standardized form for submission of requests—Rules.
- RCW 48.43.510 · Carrier required to disclose health plan information—Marketing and advertising restrictions—Rules.
- RCW 48.43.515 · Access to appropriate health services—Enrollee options—Rules.
- RCW 48.43.517 · Enrollment of child participating in medical assistance program—Employer-sponsored health plan.
- RCW 48.43.520 · Requirement to maintain a documented utilization review program description and written utilization review criteria—Rules. (Effective until January 1, 2027.)
- RCW 48.43.525 · Prohibition against retrospective denial of health plan coverage—Rules.
- RCW 48.43.530 · Requirement for carriers to have comprehensive grievance and appeal processes—Carrier's duties—Procedures—Appeals—Rules.
- RCW 48.43.535 · Independent review of health care disputes—System for using certified independent review organizations—Rules. (Effective until January 1, 2027.)
- RCW 48.43.537 · Health care disputes—Certifying independent review organizations—Application—Restrictions—Maximum fee schedule for conducting reviews—Rules.
- RCW 48.43.540 · Requirement to designate a licensed medical director—Exemption.
- RCW 48.43.545 · Standard of care—Liability—Causes of action—Defense—Exception.
- RCW 48.43.550 · Delegation of duties—Carrier accountability.
- RCW 48.43.600 · Overpayment recovery—Carrier. (Effective until January 1, 2027.)
- RCW 48.43.605 · Overpayment recovery—Health care provider.
- RCW 48.43.670 · Plan or contract renewal—Modification of wellness program.
- RCW 48.43.680 · Lifetime limit on transplants—Definition.
- RCW 48.43.690 · Assessments under RCW 70.290.040 considered medical expenses.
- RCW 48.43.700 · Exchange—Plans that a carrier must offer—Review—Rules.
- RCW 48.43.705 · Plans offered outside of exchange.
- RCW 48.43.710 · Certification as qualified health plan not an exemption.
- RCW 48.43.715 · Individual and small group market—Selection of benchmark plan—Minimum requirements—Criteria—List of state-mandated health benefits.
- RCW 48.43.720 · Reinsurance and risk adjustment programs—Affordable care act—Rules.
- RCW 48.43.725 · Exclusion of mandated benefits from health plan—Carrier requirements—Notice—Fees—Commissioner's duties.
- RCW 48.43.730 · Carrier must file provider contracts and compensation agreements with commissioner—Approval or disapproval—Confidentiality—Hearings—Rules—Definitions.
- RCW 48.43.731 · Health care benefit management contracts—Carrier filing requirements—Notice to enrollees—Confidentiality of filings.
- RCW 48.43.732 · Provider contracts—Public statements—Language.
- RCW 48.43.733 · Rates and forms of group health benefit plans—Timing of filings—Exceptions—Rules.
- RCW 48.43.734 · Health carrier rate filings—Review of surplus, capital, and profit levels.
- RCW 48.43.735 · Reimbursement of health care services provided through telemedicine or store and forward technology—Audio-only telemedicine.
- RCW 48.43.740 · Dental only plan—Emergency dental conditions—Definitions.
- RCW 48.43.743 · Dental only plan—Annual data statement—Contents—Public use—Definition.
- RCW 48.43.745 · Dental only plan—Denturist services.
- RCW 48.43.747 · Dental only plan—Coverage for same day procedures.
- RCW 48.43.748 · Dental only plan—Payments by credit card.
- RCW 48.43.750 · Health care provider credentialing applications—Use of electronic database by health carriers.
- RCW 48.43.755 · Health care provider credentialing applications—Use of electronic database by providers.
- RCW 48.43.757 · Health care provider credentialing applications—Reimbursement requirements.
- RCW 48.43.760 · Opioid use disorder—Coverage without prior authorization.
- RCW 48.43.761 · Withdrawal management services—Substance use disorder treatment services—Prior authorization—Utilization review—Medical necessity review.
- RCW 48.43.762 · Opioid overdose reversal medication bulk purchasing and distribution program.
- RCW 48.43.764 · Standard set of criteria—Authority review.
- RCW 48.43.765 · Health carrier network adequacy—Mental health and substance abuse treatment.
- RCW 48.43.766 · Mental health and substance use disorder services—Coverage—Utilization reviews. (Effective January 1, 2027.)
- RCW 48.43.767 · Behavioral health services—Network access.
- RCW 48.43.770 · Individual market health plan availability—Annual report.
- RCW 48.43.775 · Qualified health plan participation—Reimbursement rate for other health plans.
- RCW 48.43.780 · Cap on enrollee's required payment amount for specific drugs and equipment—Cost-sharing requirements.
- RCW 48.43.790 · Behavioral services—Next-day appointments.
- RCW 48.43.795 · Qualified health plans—Acceptance of premium and cost-sharing assistance.
- RCW 48.43.800 · Primary care expenditures reporting—Review.
- RCW 48.43.805 · Prescription drug upper payment limit—Rules.
- RCW 48.43.810 · Biomarker testing—Standards—Construction.
- RCW 48.43.815 · Donor human milk—Standards.
- RCW 48.43.820 · Consolidated appropriations act enforcement—Implementation of federal regulations.
- RCW 48.43.825 · Certified peer support specialist services—Network access standards.
- RCW 48.43.830 · Prior authorization—Standards—Denials—Application—Rules. (Effective until January 1, 2027.)
- RCW 48.43.835 · Physician assistants—Coverage.
- RCW 48.43.840 · Prosthetic limbs and custom orthotic braces—Coverage—Reporting.
- RCW 48.43.845 · Prescription hormone therapy—Coverage.
- RCW 48.43.850 · HIV antiviral drugs—Prior authorization.
- RCW 48.43.902 · Effective date—1996 c 312.
- RCW 48.43.904 · Construction—Chapter applicable to state registered domestic partnerships—2009 c 521.
- RCW 48.44.010 · Definitions.
- RCW 48.44.011 · Insurance producer—Definition—License required—Application, issuance, renewal, fees—Penalties involving license.
- RCW 48.44.013 · Filings with secretary of state—Copy for commissioner.
- RCW 48.44.015 · Registration by health care service contractors required—Penalty.
- RCW 48.44.016 · Unregistered activities—Acts committed in this state—Sanctions.
- RCW 48.44.017 · Schedule of rates for individual contracts—Loss ratio—Definitions.
- RCW 48.44.020 · Contracts for services—Examination of contract forms by commissioner—Grounds for disapproval—Liability of participant.
- RCW 48.44.021 · Calculation of premiums—Members of a purchasing pool—Adjusted community rating method—Definitions.
- RCW 48.44.022 · Calculation of premiums—Adjusted community rate—Definitions.
- RCW 48.44.023 · Health plan benefits for small employers—Coverage—Exemption from statutory requirements—Premium rates—Requirements for providing coverage for small employers.
- RCW 48.44.024 · Requirements for plans offered to small employers—Definitions.
- RCW 48.44.026 · Payment for certain health care services.
- RCW 48.44.030 · Underwriting of indemnity by insurance policy, bond, securities, or cash deposit.
- RCW 48.44.033 · Financial failure—Supervision of commissioner—Priority of distribution of assets.
- RCW 48.44.035 · Limited health care service—Uncovered expenditures—Minimum net worth requirements.
- RCW 48.44.037 · Minimum net worth—Requirement to maintain—Determination of amount.
- RCW 48.44.039 · Minimum net worth—Domestic or foreign health care service contractor.
- RCW 48.44.040 · Registration with commissioner—Fee.
- RCW 48.44.050 · Rules and regulations.
- RCW 48.44.055 · Plan for handling insolvency—Commissioner's review.
- RCW 48.44.057 · Insolvency—Commissioner's duties—Participants' options—Allocation of coverage.
- RCW 48.44.060 · Penalty.
- RCW 48.44.080 · Master lists of contractor's participating providers—Filing with commissioner—Notice of termination or participation.
- RCW 48.44.090 · Refusal to register corporate, etc., contractor if name confusing with existing contractor or insurance company.
- RCW 48.44.095 · Annual financial statement—Filings—Contents—Fee—Penalty for failure to file.
- RCW 48.44.100 · Filing inaccurate financial statement prohibited.
- RCW 48.44.110 · False representation, advertising.
- RCW 48.44.120 · Misrepresentations of contract terms, benefits, etc.
- RCW 48.44.130 · Future dividends or refunds—When permissible.
- RCW 48.44.140 · Misleading comparisons to terminate or retain contract.
- RCW 48.44.145 · Examination of contractors—Duties of contractor, powers of commissioner—Independent audit reports.
- RCW 48.44.150 · Certificate of registration not an endorsement—Display in solicitation prohibited.
- RCW 48.44.160 · Revocation, suspension, refusal of registration—Hearing—Cease and desist orders, injunctive action—Grounds.
- RCW 48.44.164 · Notice of suspension, revocation, or refusal to be given contractor—Authority of insurance producers.