Revised Code of Washington - RCW Title 48 Insurance - Chapter 48.44 Health Care Services

48.44.010 Definitions
For the purposes of this chapter: (1) "Health care services" means and includes medical, surgical, dental, chiropractic, hospital, optometric, podiatric, pharmaceutical, ambulance, custodial, mental health, ...

48.44.011 Agent -- Definition -- License required -- Application, issuance, renewal, fees -- Penalties involving license
(1) Agent, as used in this chapter, means any person appointed or authorized by a health care service contractor to solicit applications for health care ...

48.44.013 Filings with secretary of state -- Copy for commissioner
Health care service contractors and limited health care service contractors shall send a copy specifically for the office of the insurance commissioner to the secretary ...

48.44.015 Registration by health care service contractors required -- Penalty
(1) A person may not in this state, by mail or otherwise, act as or hold himself or herself out to be a health care ...

48.44.016 Unregistered activities -- Acts committed in this state -- Sanctions
(1) As used in this section, "person" has the same meaning as in RCW 48.01.070. (2) For the purpose of this section, an act is ...

48.44.017 Schedule of rates for individual contracts -- Loss ratio -- Remittance of premiums -- Definitions
(1) The definitions in this subsection apply throughout this section unless the context clearly requires otherwise. (a) "Claims" means the cost to the health care ...

48.44.020 Contracts for services -- Examination of contract forms by commissioner -- Grounds for disapproval -- Liability of participant
(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 ...

48.44.021 Calculation of premiums -- Members of a purchasing pool -- Adjusted community rating method -- Definitions
(1) Premiums for health benefit plans for individuals who purchase the plan as a member of a purchasing pool: (a) Consisting of five hundred or ...

48.44.022 Calculation of premiums -- Adjusted community rate -- Definitions
(1) Except for health benefit plans covered under RCW 48.44.021, premium rates for health benefit plans for individuals shall be subject to the following provisions: ...

48.44.023 Health plan benefits for small employers -- Coverage -- Exemption from statutory requirements -- Premium rates -- Requirements for providing coverage for small employers
(1)(a) A health care services contractor offering any health benefit plan to a small employer, either directly or through an association or member-governed group formed ...

48.44.024 Requirements for plans offered to small employers -- Definitions
(1) A health care service contractor may not offer any health benefit plan to any small employer without complying with RCW 48.44.023(3). (2) Employers purchasing ...

48.44.026 Payment for certain health care services
Checks in payment for claims pursuant to any health care service contract for health care services provided by persons licensed or regulated under chapters 18.25, ...

48.44.030 Underwriting of indemnity by insurance policy, bond, securities, or cash deposit
If any of the health care services which are promised in any such agreement are not to be performed by the health care service contractor, ...

48.44.033 Financial failure -- Supervision of commissioner -- Priority of distribution of assets
(1) Any rehabilitation, liquidation, or conservation of a health care service contractor shall be deemed to be the rehabilitation, liquidation, or conservation of an insurance ...

48.44.035 Limited health care service -- Uncovered expenditures -- Minimum net worth requirements
(1) For purposes of this section only, "limited health care service" means dental care services, vision care services, mental health services, chemical dependency services, pharmaceutical ...

48.44.037 Minimum net worth -- Requirement to maintain -- Determination of amount
(1) Except as provided in subsection (2) of this section, every health care service contractor must have and maintain a minimum net worth equal to ...

48.44.039 Minimum net worth -- Domestic or foreign health care service contractor
(1) For purposes of this section: (a) "Domestic health care service contractor" means a health care service contractor formed under the laws of this state; ...

48.44.040 Registration with commissioner -- Fee
Every health care service contractor who or which enters into agreements which require prepayment for health care services shall register with the insurance commissioner on ...

48.44.050 Rules and regulations
The insurance commissioner shall make reasonable regulations in aid of the administration of this chapter which may include, but shall not be limited to regulations ...

48.44.055 Plan for handling insolvency -- Commissioner's review
Each health care service contractor shall have a plan for handling insolvency that allows for continuation of benefits for the duration of the contract period ...

48.44.057 Insolvency -- Commissioner's duties -- Participants' options -- Allocation of coverage
(1)(a) In the event of insolvency of a health services contractor or health maintenance organization and upon order of the commissioner, all other carriers then ...

48.44.060 Penalty
Except as otherwise provided in this chapter, any person who violates any of the provisions of this chapter is guilty of a gross misdemeanor.[2003 c ...

48.44.070 Contracts to be filed with commissioner
(1) Forms of contracts between health care service contractors and participating providers shall be filed with the insurance commissioner prior to use. (2) Any contract ...

48.44.080 Master lists of contractor's participating providers -- Filing with commissioner -- Notice of termination or participation
Every health care service contractor shall file with its annual statement with the insurance commissioner a master list of the participating providers with whom or ...

48.44.090 Refusal to register corporate, etc., contractor if name confusing with existing contractor or insurance company
The insurance commissioner shall refuse to accept the registration of any corporation, cooperative group, or association seeking to act as a health care service contractor ...

48.44.095 Annual financial statement -- Filings -- Contents -- Fee -- Penalty for failure to file
(1) Every domestic health care service contractor shall annually, on or before the first day of March, file with the commissioner a statement verified by ...

48.44.100 Filing inaccurate financial statement prohibited
No person shall knowingly file with any public official or knowingly make, publish, or disseminate any financial statement of a health care service contractor which ...

48.44.110 False representation, advertising
No person shall knowingly make, publish, or disseminate any false, deceptive, or misleading representation or advertising in the conduct of the business of a health ...

48.44.120 Misrepresentations of contract terms, benefits, etc
No person shall knowingly make, issue, or circulate, or cause to be made, issued, or circulated, a misrepresentation of the terms of any contract, or ...

48.44.130 Future dividends or refunds -- When permissible
No health care service contractor nor any individual acting on behalf thereof shall guarantee or agree to the payment of future dividends or future refunds ...

48.44.140 Misleading comparisons to terminate or retain contract
No health care service contractor nor any person representing a health care service contractor shall by misrepresentation or misleading comparisons induce or attempt to induce ...

48.44.145 Examination of contractors -- Duties of contractor, powers of commissioner -- Independent audit reports
(1) The commissioner may make an examination of the operations of any health care service contractor as often as he deems necessary in order to ...

48.44.150 Certificate of registration not an endorsement -- Display in solicitation prohibited
The granting of a certificate of registration to a health care service contractor is permissive only, and shall not constitute an endorsement by the insurance ...

48.44.160 Revocation, suspension, refusal of registration -- Hearing -- Cease and desist orders, injunctive action -- Grounds
The insurance commissioner may, subject to a hearing if one is demanded pursuant to chapters 48.04 and 34.05 RCW, revoke, suspend, or refuse to accept ...

48.44.164 Notice of suspension, revocation, or refusal to be given contractor -- Authority of agents
Upon the suspension, revocation or refusal of a health care service contractor's registration, the commissioner shall give notice thereof to such contractor and shall likewise ...

48.44.166 Fine in addition to or in lieu of suspension, revocation, or refusal
After hearing or upon stipulation by the registrant and in addition to or in lieu of the suspension, revocation or refusal to renew any registration ...

48.44.170 Hearings and appeals
For the purposes of this chapter, the insurance commissioner shall be subject to and may avail himself of the provisions of chapter 48.04 RCW, which ...

48.44.180 Enforcement
For the purposes of this chapter, the insurance commissioner shall have the same powers and duties of enforcement as are provided in RCW 48.02.080.[1961 c ...

48.44.200 Individual health care service plan contracts -- Coverage of dependent child not to terminate because of developmental disability or physical handicap
An individual health care service plan contract, delivered or issued for delivery in this state more than one hundred twenty days after August 11, 1969, ...

48.44.210 Group health care service plan contracts -- Coverage of dependent child not to terminate because of developmental disability or physical handicap
A group health care service plan contract, delivered or issued for delivery in this state more than one hundred twenty days after August 11, 1969, ...

48.44.212 Coverage of dependent children to include newborn infants and congenital anomalies from moment of birth -- Notification period
(1) Any health care service plan contract under this chapter delivered or issued for delivery in this state more than one hundred twenty days after ...

48.44.215 Option to cover dependents under age twenty-five
(1) Any individual health care service plan contract that provides coverage for a subscriber's dependent must offer the option of covering any unmarried dependent under ...

48.44.220 Discrimination prohibited
No health care service contractor shall deny coverage to any person solely on account of race, religion, national origin, or the presence of any sensory, ...

48.44.225 Podiatric physicians and surgeons not excluded
A health care service contractor which provides foot care services shall not exclude any individual doctor who is licensed to perform podiatric health care services ...

48.44.230 Individual health service plan contract -- Return within ten days of delivery -- Refunds -- Void from beginning -- Notice required
Every subscriber of an individual health care service plan contract issued after September 1, 1973, may return the contract to the health care service contractor ...

48.44.240 Chemical dependency benefits -- Provisions of group contracts delivered or renewed after January 1, 1988
Each group contract for health care services that is delivered or issued for delivery or renewed, on or after January 1, 1988, must contain provisions ...

48.44.241 Chemical dependency benefits -- RCW 48.21.160 through 48.21.190, 48.44.240 inapplicable, when
See RCW 48.21.190. ...

48.44.245 "Chemical dependency" defined
For the purposes of RCW 48.44.240, "chemical dependency" means an illness characterized by a physiological or psychological dependency, or both, on a controlled substance regulated ...

48.44.250 Payment of premium by employee in event of suspension of compensation due to labor dispute
Any employee whose compensation includes a health care services contract providing health care services expenses, the premiums for which are paid in full or in ...

48.44.260 Notice of reason for cancellation, denial, or refusal to renew contract
Every authorized health care service contractor, upon canceling, denying, or refusing to renew any individual health care service contract, shall, upon written request, directly notify ...

48.44.270 Immunity from libel or slander
With respect to health care service contracts as defined in RCW 48.44.260, there shall be no liability on the part of, and no cause of ...

48.44.290 Registered nurses or advanced registered nurses
Notwithstanding any provision of this chapter, for any health care service contract thereunder which is entered into or renewed after July 26, 1981, benefits shall ...

48.44.299 Legislative finding
The legislature finds and declares that there is a paramount concern that the right of the people to obtain access to health care in all ...

48.44.300 Podiatric medicine and surgery -- Benefits not to be denied
Benefits shall not be denied under a contract for any health care service performed by a holder of a license issued under chapter 18.22 RCW ...

48.44.305 When injury caused by intoxication or use of narcotics
A health care service contractor may not deny coverage for the treatment of an injury solely because the injury was sustained as a consequence of ...

48.44.309 Legislative finding
The legislature finds and declares that there is a paramount concern that the right of the people to obtain access to health care in all ...

48.44.310 Chiropractic care, coverage required, exceptions
(1) Each group contract for comprehensive health care service which is entered into, or renewed, on or after September 8, 1983, between a health care ...

48.44.315 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 ...

48.44.320 Home health care, hospice care, optional coverage required -- Standards, limitations, restrictions -- Rules -- Medicare supplemental contracts excluded
(1) Every health care service contractor entering into or renewing a group health care service contract governed by this chapter shall offer optional coverage for ...

48.44.325 Mammograms -- Insurance coverage
Each health care service contract issued or renewed after January 1, 1990, that provides benefits for hospital or medical care shall provide benefits for screening ...

48.44.327 Prostate cancer screening
(1) Each health care service contract issued or renewed after December 31, 2006, that provides coverage for hospital or medical expenses shall provide coverage for ...

48.44.330 Reconstructive breast surgery
(1) Each contract for health care entered into or renewed after July 24, 1983, between a health care services contractor and the person or persons ...

48.44.335 Mastectomy, lumpectomy
No health care service contractor under this chapter may refuse to issue any contract or cancel or decline to renew the contract solely because of ...

48.44.341 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 ...

48.44.342 Mental health treatment -- Waiver of preauthorization for persons involuntarily committed
A health care service contractor providing hospital or medical services or benefits in this state shall waive a preauthorization from the contractor before an insured ...

48.44.344 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 health care services contract entered into or renewed that covers hospital, medical, or surgical expenses on a ...

48.44.350 Financial interests of health care service contractors, restricted -- Exceptions, regulations
(1) No person having any authority in the investment or disposition of the funds of a health care service contractor and no officer or director ...

48.44.360 Continuation option to be offered
Every health care service contractor that issues group contracts providing group coverage for hospital or medical expense shall offer the contract holder an option to ...

48.44.370 Conversion contract to be offered -- Exceptions, conditions
(1) Except as otherwise provided by this section, any group health care service contract entered into or renewed on or after January 1, 1985, that ...

48.44.380 Conversion contract -- Restrictions and requirements
(1) A health care service contractor shall not require proof of insurability as a condition for issuance of the conversion contract. (2) A conversion contract ...

48.44.390 Modification of basis of agreement, endorsement required
If an individual health care service agreement is issued on any basis other than as applied for, an endorsement setting forth such modification must accompany ...

48.44.400 Continuance provisions for former family members
After July 1, 1986, or on the next renewal date of the agreement, whichever is later, every health care service agreement issued, amended, or renewed ...

48.44.420 Coverage for adopted children
(1) Any health care service contract under this chapter delivered or issued for delivery in this state, which provides coverage for dependent children, as defined ...

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

48.44.440 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, ...

48.44.450 Neurodevelopmental therapies -- Employer-sponsored group contracts
(1) Each employer-sponsored group contract for comprehensive health care service which is entered into, or renewed, on or after twelve months after July 23, 1989, ...

48.44.460 Temporomandibular joint disorders -- Insurance coverage
(1) Except as provided in this section, a group health care service contract entered into or renewed after December 31, 1989, shall offer optional coverage ...

48.44.465 Prescriptions -- Preapproval of individual claims -- Subsequent rejection prohibited -- Written record required
Health care service contractors who through an authorized representative have first approved, by any means, an individual prescription claim as eligible may not reject that ...

48.44.470 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 ...

48.44.500 Denturist services
Notwithstanding any provision of any health care service contract covering dental care as provided for in this chapter, effective January 1, 1995, benefits shall not ...

48.44.530 Disclosure of certain material transactions -- Report -- Information is confidential
(1) Every health care service contractor domiciled in this state shall file a report with the commissioner disclosing material acquisitions and dispositions of assets or ...

48.44.535 Material acquisitions or dispositions
No acquisitions or dispositions of assets need be reported pursuant to RCW 48.44.530 if the acquisitions or dispositions are not material. For purposes of RCW ...

48.44.540 Asset acquisitions -- Asset dispositions
(1) Asset acquisitions subject to RCW 48.44.530 through 48.44.555 include every purchase, lease, exchange, merger, consolidation, succession, or other acquisition other than the construction or ...

48.44.545 Report of a material acquisition or disposition of assets -- Information required
The following information is required to be disclosed in any report of a material acquisition or disposition of assets: (1) Date of the transaction; (2) ...

48.44.550 Material nonrenewals, cancellations, or revisions of ceded reinsurance agreements
(1) No nonrenewals, cancellations, or revisions of ceded reinsurance agreements need be reported under RCW 48.44.530 if the nonrenewals, cancellations, or revisions are not material. ...

48.44.555 Report of a material nonrenewal, cancellation, or revision of ceded reinsurance agreements -- Information required
The following is required to be disclosed in any report of a material nonrenewal, cancellation, or revision of ceded reinsurance agreements: (1) The effective date ...