Revised Code of Washington - RCW Title 48 Insurance - Chapter 48.21 Group And Blanket Disability Insurance

48.21.010 "Group disability insurance" defined
Group disability insurance is that form of disability insurance, including stop loss insurance as defined in RCW 48.11.030, provided by a master policy issued to ...

48.21.015 "Group stop loss insurance" defined for the purpose of exemption -- Scope of application
Group stop loss insurance is exempt from all sections of this chapter and chapter 48.32A RCW except for RCW 48.21.010 and this section. For the ...

48.21.020 "Employees," "employer" defined
The term "employees" as used in this chapter shall be deemed to include as employees of a single employer, the compensated officers, managers, and employees ...

48.21.030 Health care groups
A policy of group disability insurance may be issued to a corporation, as policyholder, existing primarily for the purpose of assisting individuals who are its ...

48.21.040 "Blanket disability insurance" defined
(1) Any policy or contract of disability insurance which conforms with the description and complies with the requirements contained in one of the following six ...

48.21.045 Health plan benefits for small employers -- Coverage -- Exemption from statutory requirements -- Premium rates -- Requirements for providing coverage for small employers -- Definitions
(1)(a) An insurer offering any health benefit plan to a small employer, either directly or through an association or member-governed group formed specifically for the ...

48.21.047 Requirements for plans offered to small employers -- Definitions
(1) An insurer may not offer any health benefit plan to any small employer without complying with RCW 48.21.045(3). (2) Employers purchasing health plans provided ...

48.21.050 Standard provisions required
Every policy of group or blanket disability insurance shall contain in substance the provisions as set forth in RCW 48.21.060 to 48.21.090, inclusive, or provisions ...

48.21.060 The contract -- Representations
There shall be a provision that a copy of the application, if any, of the policyholder shall be attached to the policy when issued; that ...

48.21.070 Payment of premiums
There shall be a provision that all premiums due under the policy shall be remitted by the employer or employers of the persons insured, by ...

48.21.075 Payment of premiums by employee in event of suspension of compensation due to labor dispute
Any employee whose compensation includes group disability or blanket disability insurance providing health care services, the premiums for which are paid in full or in ...

48.21.080 Certificates of coverage
In group disability insurance policies there shall be a provision that the insurer shall issue to the employer, the policyholder, or other person or association ...

48.21.090 Age limitations
There shall be a provision specifying the ages, if any there be, to which the insurance provided therein shall be limited; and the ages, if ...

48.21.100 Examination and autopsy
There may be a provision that the insurer shall have the right and opportunity to examine the person of the insured employee, member or dependent ...

48.21.110 Payment of benefits
The benefits payable under any policy or contract of group or blanket disability insurance shall be payable to the employee or other insured member of ...

48.21.120 Readjustment of premiums -- Dividends
Any contract of group disability insurance may provide for the readjustment of the rate of premium based on the experience thereunder at the end of ...

48.21.125 When injury caused by intoxication or use of narcotics
An insurer may not deny coverage for the treatment of an injury solely because the injury was sustained as a consequence of the insured's being ...

48.21.130 Podiatric medicine and surgery
Notwithstanding any provision of any group disability insurance contract or blanket disability insurance contract, benefits shall not be denied thereunder for any medical or surgical ...

48.21.140 Optometry
Notwithstanding any provision of any group disability insurance contract or blanket disability insurance contract, benefits shall not be denied thereunder for any eye care service ...

48.21.141 Registered nurses or advanced registered nurses
Notwithstanding any provision of any group disability insurance contract or blanket disability insurance contract as provided for in this chapter, benefits shall not be denied ...

48.21.142 Chiropractic
Notwithstanding any provision of any group disability insurance contract or blanket disability insurance contract as provided for in this chapter, benefits shall not be denied ...

48.21.143 Diabetes coverage -- Definitions
The legislature finds that diabetes imposes a significant health risk and tremendous financial burden on the citizens and government of the state of Washington, and ...

48.21.144 Psychological services
Notwithstanding any provision of any group disability insurance contract or blanket disability insurance contract, benefits shall not be denied thereunder for any psychological service rendered ...

48.21.146 Dentistry
Notwithstanding any provision of any group disability insurance contract or blanket disability insurance contract as provided for in this chapter, benefits shall not be denied ...

48.21.148 Denturist services
Notwithstanding any provision of any group disability insurance contract or blanket disability insurance contract covering dental care as provided for in this chapter, effective January ...

48.21.150 Dependent child coverage -- Continuation for incapacity
Any group disability insurance contract or blanket disability insurance contract, providing health care services, delivered or issued for delivery in this state more than one ...

48.21.155 Dependent child coverage -- From moment of birth -- Congenital anomalies -- Notification of birth
(1) Any group disability insurance contract except blanket disability insurance contract, providing hospital and medical expenses and health care services, renewed, delivered or issued for ...

48.21.157 Option to cover dependents under age twenty-five
Any group disability insurance contract or blanket disability insurance contract that provides coverage for a participating member's dependent must offer each participating member the option ...

48.21.160 Chemical dependency benefits -- Legislative declaration
The legislature recognizes that chemical dependency is a disease and, as such, warrants the same attention from the health care industry as other similarly serious ...

48.21.180 Chemical dependency benefits -- Contracts issued or renewed after January 1, 1988
Each group disability insurance contract which is delivered or issued for delivery or renewed, on or after January 1, 1988, and which insures for hospital ...

48.21.190 Chemical dependency benefits -- RCW 48.21.160 through 48.21.190, 48.44.240 inapplicable, when
RCW 48.21.160 through 48.21.190 and 48.44.240 as now or hereafter amended shall not apply to the renewal of a contract in force prior to the ...

48.21.195 "Chemical dependency" defined
For the purposes of RCW 48.21.160 and 48.21.180 "chemical dependency" means an illness characterized by a physiological or psychological dependency, or both, on a controlled ...

48.21.197 Chemical dependency benefits -- Rules
By September 1, 1987, the insurance commissioner shall adopt rules governing benefits for treatment of chemical dependency under medical plans issued under chapters 48.21, 48.44, ...

48.21.200 Individual or group disability, health care service contract, health maintenance agreement -- Reduction of benefits on basis of other existing coverages
(1) No individual or group disability insurance policy, health care service contract, or health maintenance agreement providing hospital, medical or surgical expense benefits and which ...

48.21.220 Home health care, hospice care, optional coverage required -- Standards, limitations, restrictions -- Rules -- Medicare supplemental contracts excluded
(1) Every insurer entering into or renewing group or blanket disability insurance policies governed by this chapter shall offer optional coverage for home health care ...

48.21.225 Mammograms -- Insurance coverage
Each group disability insurance policy issued or renewed after January 1, 1990, that provides coverage for hospital or medical expenses shall provide coverage for screening ...

48.21.227 Prostate cancer screening
(1) Each group disability insurance policy issued or renewed after December 31, 2006, that provides coverage for hospital or medical expenses shall provide coverage for ...

48.21.230 Reconstructive breast surgery
(1) Each group disability insurance contract issued or renewed after July 24, 1983, which insures for hospital or medical care shall provide coverage for reconstructive ...

48.21.235 Mastectomy, lumpectomy
No person engaged in the business of insurance under this chapter may refuse to issue any contract of insurance or cancel or decline to renew ...

48.21.241 Mental health services -- Group health plans -- Definition -- Coverage required, when
(1) For the purposes of this section, "mental health services" means medically necessary outpatient and inpatient services provided to treat mental disorders covered by the ...

48.21.242 Mental health treatment -- Waiver of preauthorization for persons involuntarily committed
An insurer providing group disability insurance coverage for health care in this state shall waive a preauthorization requirement from the insurer before an insured or ...

48.21.244 Benefits for prenatal diagnosis of congenital disorders -- Contracts entered into or renewed on or after January 1, 1990
On or after January 1, 1990, every group disability contract entered into or renewed that covers hospital, medical, or surgical expenses on a group basis, ...

48.21.250 Continuation option to be offered
Every insurer that issues policies providing group coverage for hospital or medical expense shall offer the policyholder an option to include a policy provision granting ...

48.21.260 Conversion policy to be offered -- Exceptions, conditions
(1) Except as otherwise provided by this section, any group disability insurance policy issued, renewed, or amended on or after January 1, 1985, that provides ...

48.21.270 Conversion policy -- Restrictions and requirements
(1) An insurer shall not require proof of insurability as a condition for issuance of the conversion policy. (2) A conversion policy may not contain ...

48.21.280 Coverage for adopted children
(1) Any group disability insurance contract, except a blanket disability insurance contract, providing hospital and medical expenses and health care services, delivered or issued for ...

48.21.290 Cancellation of rider
Upon application by an insured, a rider shall be canceled if at least five years after its issuance, no health care services have been received ...

48.21.300 Phenylketonuria
(1) The legislature finds that: (a) Phenylketonuria is a rare inherited genetic disorder. (b) Children with phenylketonuria are unable to metabolize an essential amino acid, ...

48.21.310 Neurodevelopmental therapies -- Employer-sponsored group contracts
(1) Each employer-sponsored group policy for comprehensive health insurance which is entered into, or renewed, on or after twelve months after July 23, 1989, shall ...

48.21.320 Temporomandibular joint disorders -- Insurance coverage
(1) Except as provided in this section, a group disability policy entered into or renewed after December 31, 1989, shall offer optional coverage for the ...

48.21.325 Prescriptions -- Preapproval of individual claims -- Subsequent rejection prohibited -- Written record required
Group disability insurance companies who through an authorized representative have first approved, by any means, an individual prescription claim as eligible may not reject that ...

48.21.330 Nonresident pharmacies
For the purposes of this chapter, a nonresident pharmacy is defined as any pharmacy located outside this state that ships, mails, or delivers, in any ...

48.21.370 Fixed payment insurance -- Standard disclosure form
The commissioner shall adopt rules setting forth the content of a standard disclosure form to be delivered to all applicants for group illness-triggered fixed payment ...

48.21.375 Fixed payment insurance -- Benefit restrictions
Illness-triggered fixed payment insurance, hospital confinement fixed payment insurance, or other fixed payment insurance policies are not considered to provide coverage for hospital or medical ...