INSURANCE REFORM
RCW 48.43
in effectContents
section48.43.001. Intent.section48.43.005. Definitions.section48.43.007. Availability of price and quality information — Transparency tools for members — Requirements.section48.43.008. Enrollment in employer-sponsored health plan — Person eligible for medical assistance.section48.43.009. Health care sharing ministries.section48.43.012. Health plans — Preexisting conditions — Rules.section48.43.016. Utilization management standards and criteria — Health carrier requirements — Definitions. (Effective until January 1, 2027.)section48.43.016. Utilization management standards and criteria — Requirements — Definitions. (Effective January 1, 2027.)section48.43.021. Personally identifiable health information — Restrictions on release.section48.43.022. Enrollee identification card — Social security number restriction.section48.43.023. Pharmacy identification cards — Rules.section48.43.028. Eligibility to purchase certain health benefit plans — Small employers and small groups.section48.43.035. Group health benefit plans — Guaranteed issue and continuity of coverage — Exceptions.section48.43.038. Individual health plans — Guarantee of continuity of coverage — Exceptions.section48.43.039. Grace period — Notification or information — Information concerning delinquencies or nonpayment of premiums — Defined.section48.43.041. Individual health benefit plans — Mandatory benefits.section48.43.043. Colorectal cancer examinations and laboratory tests — Required benefits or coverage.section48.43.045. Health plan requirements — Annual reports — Exemptions.section48.43.047. Health plans — Minimum coverage for preventive services — No cost-sharing requirements.section48.43.055. Procedures for review and adjudication of health care provider complaints — Requirements.section48.43.059. Payments made by a second-party payment process — Definition.section48.43.065. Right 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.section48.43.071. Health care information — Requirement to provide free copy to covered person appealing denial of social security benefits — Exceptions.section48.43.072. Required reproductive health care coverage — Restrictions on copayments, deductibles, and other form of cost sharing.section48.43.073. Required abortion coverage — Limitations.section48.43.074. Qualified health plans — Single invoice billing — Certification of compliance required in the segregation plan for premium amounts attributable to coverage of abortion services.section48.43.076. Digital breast examinations — Cost sharing.section48.43.078. Digital breast tomosynthesis — Intent to ensure women with access — Commissioner's and health care authority's duty to clarify mandates.section48.43.081. Anatomic pathology services — Payment for services — Definitions.section48.43.083. Chiropractor services — Participating provider agreement — Health carrier reimbursement.section48.43.085. Health carrier may not prohibit its enrollees from contracting for services outside the health care plan.section48.43.087. Contracting for services at enrollee's expense — Mental health care practitioner — Conditions — Exception.section48.43.091. Health carrier coverage of outpatient mental health services — Requirements.section48.43.093. Health carrier coverage of emergency medical services — Requirements — Conditions.section48.43.094. Pharmacist provided services — Health plan requirements. (Effective until June 30, 2027.)section48.43.094. Pharmacist provided services — Health plan requirements. (Effective June 30, 2027.)section48.43.096. Medication synchronization policy required for health plans covering prescription drugs — Requirements — Definitions.section48.43.097. Filing of financial statements — Every health carrier.section48.43.105. Preparation of documents that compare health carriers — Immunity — Due diligence.section48.43.115. Maternity services — Intent — Definitions — Patient preference — Clinical sovereignty of provider — Notice to policyholders — Application. (Effective until June 30, 2027.)section48.43.115. Maternity services — Intent — Definitions — Patient preference — Clinical sovereignty of provider — Notice to policyholders — Application. (Effective June 30, 2027.)section48.43.121. Ground ambulance services organizations — Coverage.section48.43.0122. Individual health benefit plans — Open enrollment and special enrollment periods — Rules — Enforcement.section48.43.0123. Health plans — Rescission of coverage — Rules.section48.43.0124. Health plans — Cost sharing for essential health benefits — Rules.section48.43.0125. Essential health benefits — Annual or lifetime dollar limits.section48.43.125. Coverage at a long-term care facility following hospitalization — Definition.section48.43.0126. Summary of benefits and explanation of coverage — Standards and requirements — Notice of modification — Fines — Standards for definitions of health insurance terms — Rules.section48.43.0127. Group health plans — Waiting period — Rules.section48.43.0128. Nongrandfathered health plans and plans issued or renewed on or after January 1, 2022 — Prohibited discrimination — Rules.section48.43.135. Hearing instruments — Coverage.section48.43.0161. Prior authorization practices — Carrier annual reporting requirements — Commissioner's standardized report.section48.43.176. Eosinophilic gastrointestinal associated disorder — Elemental formula.section48.43.180. Denturist services.section48.43.185. General anesthesia services for dental procedures.section48.43.190. Payment of chiropractic services — Parity.section48.43.195. Contraceptive drugs — Twelve-month refill coverage. (Effective until January 1, 2026.)section48.43.195. Contraceptive drugs — Twelve-month refill coverage. (Effective January 1, 2026.)section48.43.200. Disclosure of certain material transactions — Report — Information is confidential.section48.43.205. Material acquisitions or dispositions.section48.43.210. Asset acquisitions — Asset dispositions.section48.43.215. Report of a material acquisition or disposition of assets — Information required.section48.43.220. Material nonrenewals, cancellations, or revisions of ceded reinsurance agreements.section48.43.225. Report of a material nonrenewal, cancellation, or revision of ceded reinsurance agreements — Information required.section48.43.290. Coverage for prescribed durable medical equipment and mobility enhancing equipment — Sales and use taxes — Definitions.section48.43.300. Definitions.section48.43.305. Report of RBC levels — Distribution of report — Formula for determination — Commissioner may make adjustments.section48.43.310. Company action level event — Required RBC plan — Commissioner's review — Notification — Challenge by carrier.section48.43.315. Regulatory action level event — Required RBC plan — Commissioner's review — Notification — Challenge by carrier.section48.43.320. Authorized control level event — Commissioner's options.section48.43.325. Mandatory control level event — Commissioner's duty — Regulatory control.section48.43.330. Carrier's right to hearing — Request by carrier — Date set by commissioner.section48.43.335. Confidentiality of RBC reports and plans — Use of certain comparisons prohibited — Certain information intended solely for use by commissioner.section48.43.340. Powers or duties of commissioner not limited — Rules.section48.43.345. Foreign or alien carriers — Required RBC report — Commissioner may require RBC plan — Mandatory control level event.section48.43.350. No liability or cause of action against commissioner or department.section48.43.355. Notice by commissioner to carrier — When effective.section48.43.360. Initial RBC reports — Calculation of initial RBC levels — Subsequent reports.section48.43.366. Self-funded multiple employer welfare arrangements.section48.43.370. RBC standards not applicable to certain carriers.section48.43.400. Prescription drug utilization management — Definitions.section48.43.410. Prescription drug utilization management — Clinical review criteria — Requirement to be evidence-based and updated regularly. (Effective until January 1, 2027.)section48.43.410. Prescription drug utilization management — Clinical review criteria — Requirement to be evidence-based and updated regularly. (Effective January 1, 2027.)section48.43.420. Prescription drug utilization management — Exception request process — Conditions, requirements, and time frames for approval or denial of requests — Emergency fill coverage — Notice of new policies and procedures.section48.43.430. Prescription medication — Maximum charge at point of sale — Requirements.section48.43.435. Prescription medication — Cost-sharing calculation — Application — Rules.section48.43.440. Human immunodeficiency virus postexposure prophylaxis drugs — Cost sharing and prior authorization.section48.43.500. Intent — Purpose — 2000 c 5.section48.43.505. Enrollee's and protected individual's right to privacy and confidential services — Health carrier or insurer duties — Requests for confidential communications — Rules.section48.43.510. Carrier required to disclose health plan information — Marketing and advertising restrictions — Rules.section48.43.515. Access to appropriate health services — Enrollee options — Rules.section48.43.517. Enrollment of child participating in medical assistance program — Employer-sponsored health plan.section48.43.520. Requirement to maintain a documented utilization review program description and written utilization review criteria — Rules. (Effective until January 1, 2027.)section48.43.520. Requirement to maintain a documented utilization review program description and written utilization review and clinical review criteria — Rules. (Effective January 1, 2027.)section48.43.525. Prohibition against retrospective denial of health plan coverage — Rules.section48.43.530. Requirement for carriers to have comprehensive grievance and appeal processes — Carrier's duties — Procedures — Appeals — Rules.section48.43.535. Independent review of health care disputes — System for using certified independent review organizations — Rules. (Effective until January 1, 2027.)section48.43.535. Independent review of health care disputes — System for using certified independent review organizations — Rules. (Effective January 1, 2027.)section48.43.537. Health care disputes — Certifying independent review organizations — Application — Restrictions — Maximum fee schedule for conducting reviews — Rules.section48.43.540. Requirement to designate a licensed medical director — Exemption.section48.43.545. Standard of care — Liability — Causes of action — Defense — Exception.section48.43.550. Delegation of duties — Carrier accountability.section48.43.600. Overpayment recovery — Carrier. (Effective until January 1, 2027.)section48.43.600. Overpayment recovery — Carrier. (Effective January 1, 2027.)section48.43.605. Overpayment recovery — Health care provider.section48.43.670. Plan or contract renewal — Modification of wellness program.section48.43.680. Lifetime limit on transplants — Definition.section48.43.690. Assessments under RCW 70.290.040 considered medical expenses.section48.43.700. Exchange — Plans that a carrier must offer — Review — Rules.section48.43.705. Plans offered outside of exchange.section48.43.710. Certification as qualified health plan not an exemption.section48.43.715. Individual and small group market — Selection of benchmark plan — Minimum requirements — Criteria — List of state-mandated health benefits.section48.43.720. Reinsurance and risk adjustment programs — Affordable care act — Rules.section48.43.725. Exclusion of mandated benefits from health plan — Carrier requirements — Notice — Fees — Commissioner's duties.section48.43.0725. Reproductive health plan coverage — Immediate postpartum contraception devices.section48.43.730. Carrier must file provider contracts and compensation agreements with commissioner — Approval or disapproval — Confidentiality — Hearings — Rules — Definitions.section48.43.731. Health care benefit management contracts — Carrier filing requirements — Notice to enrollees — Confidentiality of filings.section48.43.732. Provider contracts — Public statements — Language.section48.43.733. Rates and forms of group health benefit plans — Timing of filings — Exceptions — Rules.section48.43.734. Health carrier rate filings — Review of surplus, capital, and profit levels.section48.43.735. Reimbursement of health care services provided through telemedicine or store and forward technology — Audio-only telemedicine.section48.43.740. Dental only plan — Emergency dental conditions — Definitions.section48.43.743. Dental only plan — Annual data statement — Contents — Public use — Definition.section48.43.745. Dental only plan — Denturist services.section48.43.747. Dental only plan — Coverage for same day procedures.section48.43.748. Dental only plan — Payments by credit card.section48.43.750. Health care provider credentialing applications — Use of electronic database by health carriers.section48.43.755. Health care provider credentialing applications — Use of electronic database by providers.section48.43.757. Health care provider credentialing applications — Reimbursement requirements.section48.43.760. Opioid use disorder — Coverage without prior authorization.section48.43.761. Withdrawal management services — Substance use disorder treatment services — Prior authorization — Utilization review — Medical necessity review.section48.43.762. Opioid overdose reversal medication bulk purchasing and distribution program.section48.43.764. Standard set of criteria — Authority review.section48.43.765. Health carrier network adequacy — Mental health and substance abuse treatment.section48.43.766. Mental health and substance use disorder services — Coverage — Utilization reviews. (Effective January 1, 2027.)section48.43.767. Behavioral health services — Network access.section48.43.770. Individual market health plan availability — Annual report.section48.43.775. Qualified health plan participation — Reimbursement rate for other health plans.section48.43.780. Cap on enrollee's required payment amount for specific drugs and equipment — Cost-sharing requirements.section48.43.785. COVID-19 personal protective equipment expenses — Health care provider reimbursement. (Contingent expiration date.)section48.43.790. Behavioral services — Next-day appointments.section48.43.795. Qualified health plans — Acceptance of premium and cost-sharing assistance.section48.43.800. Primary care expenditures reporting — Review.section48.43.805. Prescription drug upper payment limit — Rules.section48.43.810. Biomarker testing — Standards — Construction.section48.43.815. Donor human milk — Standards.section48.43.820. Consolidated appropriations act enforcement — Implementation of federal regulations.section48.43.825. Certified peer support specialist services — Network access standards.section48.43.830. Prior authorization. (Effective until January 1, 2027.)section48.43.830. Prior authorization. (Effective January 1, 2027.)section48.43.835. Physician assistants — Coverage.section48.43.840. Prosthetic limbs and custom orthotic braces — Coverage — Reporting.section48.43.845. Prescription hormone therapy — Coverage.section48.43.902. Effective date — 1996 c 312.section48.43.904. Construction — Chapter applicable to state registered domestic partnerships — 2009 c 521.section48.43.0961. Continuity of coverage for health plans covering prescription drugs for behavioral health.section48.43.01211. Health plans — Eligibility — Health status-related factors — Rules.section48.43.5051. Requests for confidential communications — Monitoring and ensuring compliance — Standardized form for submission of requests — Rules.
Source: WA Statutes (Official Site)URL: https://app.leg.wa.gov/RCW/default.aspx?cite=48.43&full=trueFetched: 6/29/2026