Embed Size (px)
Citation preview
1
Life and health insurance laws and rules Search by topics or keywords to find links to commonly referenced RCWs and WACs.
Tips for navigating this directory
Click on a letter below to go directly to that section of the directory.
A•B•C•D•E•F•G•H•I•J•K•L•M•N•O•P•Q•R•S•T•U•V•W•X•Y•Z • You can press “CTRL + F” to search for a keyword.
• Some links may not work in Internet Explorer. Use Google Chrome for the best experience.
• If you’re using a PDF reader (such as Adobe Reader or Adobe Acrobat), bookmarks should open automatically on the left. Click on any bookmark to go to that spot in the document.
• If you’re viewing the PDF in Google Chrome, you can use the bookmarks tool ( ) in the upper right corner of the browser. Click on a letter to see all entries under that letter.
A
[Back to Index]
TOPIC RCW WAC
Abortion coverage 48.43.073
Access plan 284-170-280
Acquisition or disposition of assets
48.43.205, 48.43.210, 48.43.215, 48.44.535, 48.44.540, 48.44.545, 48.46.605, 48.46.610, 48.46.615
Actual reason 284-30-570
Adjuster (defined) 48.17.010
Administrative procedures act Chapter 34.05 Chapter 10-08
2
TOPIC RCW WAC
Adopted child 48.01.180, 48.20.500, 48.21.280, 48.44.420, 48.46.490
Adverse Benefit Determination Process-Non-grandfathered
External review of adverse benefit determinations 48.43.005, 48.43.535
Internal review of adverse benefit determinations: 48.43.530
284-43
Expedited review 284-43-3170
Explanation of right to review 284-43-3050
External review of adverse benefit determinations 284-43-3210
Internal review of adverse benefit determinations 284-43-3110
Notice and explanation - General requirements 284-43-3070
Review of adverse benefit determinations – Generally 284-43-3030
Adverse notification requirements 284-30-770
Advertising Disability 48.30.040, 48.30.100
Health Care Services 48.44.110
Health Maintenance Organization 48.46.170, 48.46.400
Disability 284-50
Life 284-23-020, 284-23-060, 284-23-090
File to be maintained 284-50-200, 284-23-090
Identity of insurer 284-50-150, 284-23-060
3
TOPIC RCW WAC
Testimonials 284-50-100, 284-23-050(11)
Use of rating organization reports 284-30-660, 284-23-080, 284-50-190
Agent-producer (defined) 48.17.010
Producer fees 48.17.270
Producer must deliver policy, not hold 48.18.260
Producer must deliver policy, not hold 284-30-580
Agents-producers 48.17.065, 48.44.011, 48.44.164
Agent-producer records 48.17.470, 48.23.015(7) 284-12-080(8)
Ambulance services Exemption for air ambulance 48.01.280
Annuities Deferred payment upon surrender 48.23.360(5), 48.23.430(2)
Exemption of proceeds, commutation 48.18.430
Minimum non-forfeiture amounts 48.23.440
Application Attachment to policy 48.18.080
Effect of errors or misrepresentation 48.18.090
4
TOPIC RCW WAC
Assignment Exception Health Care Service Contractor 48.44.026
Group life policy, rights of insured 48.18.375
Life and disability policies 48.18.360
Payment per policy or assignment discharges insurer for life or disability 48.18.375
Association groups - see Groups, out of state
Association plans 48.44.024, 48.46.068
Average annual wage 50.04.355
B
[Back to Index]
TOPIC RCW WAC
Balance billing protection 48.49 284-43B999999
Birthday Rule (COB) 284-51-205(4)
Breast reconstruction - see Mastectomy
Burial insurance, minimum death benefit
284-23-550
C
[Back to Index]
5
TOPIC RCW WAC
Cancellation – reason for denying or cancellation must be given – see Actual Reason
Cancellation of individual health plans
48.43.039
Cancellation of group health plans
48.43.035
Certificate of coverage - administration
48.21.080, 48.46.060(2) 284-44-050
Certificates of insurance 284-30-355
Certificate of registration (authority)
48.44.150, 48.46.030, 48.46.040
Chemical dependency 48.44.240, 48.44.245, 48.21.197, 48.46.350, 48.46.355, 48.21.160, 48.21.180, 48.21.190, 48.21.195
Defined 284-53-005
Parity in mental health and substance use disorder 284-43-7000
Standards/minimum dollar amounts 284-53-010
Chiropractic services 48.21.142, 48.43.045, 48.44.310
Group disability 48.21.142
HCSC 48.44.310
Individual disability 48.20.412
Licensing Ch. 18.25
Provider agreement 48.43.083
284-170-270
6
TOPIC RCW WAC
Clinical trials 284-43-850
Colorectal exams 48.43.043
Comparison of health carriers 48.43.105
Confidentiality of sensitive information
48.43.505, 48.43.5051
Congenital anomalies - newborns
48.21.155, 48.44.212, 48.46.250
Congenital anomalies - prenatal testing, prenatal diagnosis of congenital disorders
48.44.344, 48.46.375, 48.21.244
Conscience clause 48.43.065
Consumer Protection Act Ch. 19.86
Continuation of coverage 48.20.490, 48.44.400, 48.46.480
Continuation of coverage (Ineligible Person)
48.46.440, 48.44.360, 48.21.250
Continuity of coverage - group
48.43.035
Continuity of coverage - individual plans
48.43.038
Continuity of provider/patient care
284-170-360
Contraception coverage 48.43.195 284-43-5150
Contract format - clear, definitive language no misleading clauses, exceptions or conditions
48.44.020, 48.18.110, 48.46.060, 48.20.012
284-44-030, 284-50-030
Contract - construed in their entirety
48.18.520
7
TOPIC RCW WAC
Contract modification 48.44.040
Contract - provider 48.44.070, 48.44.080, 48.46.243
Contract standards, required 48.44.020 284-44-040
Conversion contracts Allowable expense 48.46.020, 48.21.200, 48.44.020, 48.46.060
Notice 48.21.260(3), 48.44.370(3), 48.46.450(3)
Reduction 48.20.350, 48.21.200
Allowable expense 284-51-050
Order of benefit determination 284-51-075, 284-51-185
Plan (defined) 284-51-040
Time limit 284-51-215
Coordination of benefits 284.51.205
Corporate name registration 48.44.090
Coverage Children over 18, continuation 48.20.420, 48.21.150, 48.44.200, 48.44.210, 48.46.060, 48.46.320
Adopted children 48.01.180, 48.20.500, 48.21.280, 48.44.420, 48.46.490
Custodial parent, right to information
48.01.235
D
[Back to Index]
TOPIC RCW WAC
Death benefits to premium-unfair practice defined (life insurance)
284-23-550
8
TOPIC RCW WAC
Deferred payment of life insurance loans
48.23.080(1)(a)
Delivery of policies 48.18.260 284-30-580
Denial - reason for denying or canceling must be given - see Actual Reason
Denturist services 48.43.180, 48.44.500, 48.46.570
Dependent children 48.44.200, 48.44.210, 48.44.212, 48.46.250, 48.46.320, 48.44.420, 48.46.490
Custodial parent – right to plan information 48.01.235
DSHS right to enroll child in group-plan coverage 48.43.517
Dependent child age 26 48.20.435, 48.21.157, 48.44.215, 48.46.325
Developmental disability 48.44.200, 48.44.210
Diabetes coverage 48.20.391, 48.21.143, 48.44.315, 48.46.272
Direct practice (reporting of complaints to legislature)
48.150.100(3)
Disability insurance (defined) 48.11.030
Exemption of proceeds 48.18.400
Reason for denial must be given 48.18.540
Replacement 284-50-430
Disclaimer (beneficiary), contents of
11.86.031
9
TOPIC RCW WAC
Disclosure of filings 48.02.120(3), 48.19.040
Discrimination 48.18.480, 48.30.300, 48.44.220, 48.46.110, 48.46.575
284-30-572
Discrimination - "Anti-discrimination Act"
49.60
Durable Medical Equipment (must include sales tax)
48.43.290
E
[Back to Index]
TOPIC RCW WAC
Emergency medical services 48.43.093, 48.43.005
Endorsement - disability insurance
48.20.015
Endorsement of modifications for carrier agreements
48.44.390, 48.46.470
Enforcement powers 48.02.080
Enrollee information 48.43.515
Custodial parent - right to plan information 48.01.235(2)
Enrollment requirements individual market (off the Exchange)
284-43-1080
Preexisting condition limitations 284-43-5000
Individual market (on & off Exchange) special enrollment requirements 284-43-1100, 284-43-1120(exchange only)
10
TOPIC RCW WAC
Notice requirements & effective dates of coverage 284-43-1140
Enrollment requirements small group plans, qualifying event
284-43-1020
For small group qualified health plans 284-43-1040
Erin Act 48.43.115
Essential community providers (exchange plans) - definition
284-170-300
Essential health benefits 48.43.715 284-43-5640
Pediatric dental benefits 284-43-5700, 284-43-5720, 284-43-5760
Transplant waiting period 284-43-5640(3)(c)
Every category of health care provider
48.43.045 284-170-270
Examination of carriers 48.44.145, 48.46.120
Experimental and investigative services
284-96-015, 284-50-377, 284-44-043, 284-46-507
Exclusions, life insurance 48.23.260
Group life 48.24.210
F
[Back to Index]
11
TOPIC RCW WAC
Fair Conduct Act 48.30.010(7), 48.30.015
Financial interests of carrier personnel restricted
48.44.350, 48.46.270
Financial statements 48.44.095, 48.44.100, 48.46.080
Fixed-payment insurance - exceptions
48.20.550, 48.20.555, 48.20.580, 48.21.370, 48.21.375, 48.43.005(19)(i)
Forms to be filed (approved) 48.18.100
Grounds for disapproval 48.18.110, 48.44.020, 48.46.060
Exception – individual health 48.18.110(2)
Free look Annuity, variable 48.18A.035
Disability 48.20.013
Health care services 48.44.230
HMO 48.46.260
Life, individual policy 48.23.380
Life, variable 48.18A.035
Long-term care 48.83.060
Medicare supplement 48.66.120
Annuity, fixed 284-23-350
Credit life and disability 284-34-250(1)(f)
Replacement of life and annuity policies 284-23-455(4)
Funded reserve requirements 48.46.240
12
TOPIC RCW WAC
Future dividends or refunds 48.44.130, 48.46.300
G
[Back to Index]
TOPIC RCW WAC
Gag rule 284-170-421
Gender - mortality tables 48.46.070
Governing body of HMO 48.46.070
Grace period Annuities, pure endowments 48.23.150
Disability 48.20.06
Group and blanket disability 48.21.070
Life 48.23.030
Health Care Service Contractors 284-44-040(8)
Long-term care 284-54-250, 284-83-025(c)
Grievance procedure requirements
48.43.055, 48.46.100 284-43-4040
Grounds for disapproval 48.44.020, 48.46.060
Groups - out of state 48.24.04 284-30-60, 284-30-610
Guaranteed issue and continuity of coverage
48.43.035, 48.43.038
Guaranteed renewable 284-50-330(2), 284-60-030(9)
H
[Back to Index]
13
TOPIC RCW WAC
Handicap 48.18.480, 48.30.300, 49.60.030, 49.60.178
Handicap, disability 48.44.200, 48.46.320, 48.46.370
Health plan disclosure (benefits)
48.43.510 248-43-820
Health Questionnaire, requirement to complete
48.43.018
HIPAA Public Law 104-191, HIPAA of 1996 Public Law 104-191
Privacy and security protections 45 CFR 160 and Part 164, 45 CFR 160
Pre-emption of state laws sec 1178
Pre-existing condition limitation, portability, waiting period 45 CFR 152.20
HMO - employer duty to offer HMO
48.46.180
Home health and hospice care 18.71, 48.21.220, 48.21A.090, 48.44.320, 70.126, 70.127
284-21, 284-44-500, 284-96-500
I
[Back to Index]
TOPIC RCW WAC
Immunity from libel or slander
48.44.270, 48.46.390
14
TOPIC RCW WAC
Incontestability Disability 48.20.052
Life 48.23.050
Independent review of health care disputes
48.43.535
Individual 10-day return of policy
48.20.013, 48.44.230, 48.46.260, 48.46.340
Individual health plan requirements
48.44.022, 48.44.230, 48.46.064, 48.46.260, 48.46.340
Insolvency, financial failure 48.44.033, 48.44.055, 48.44.057, 48.46.225, 48.46.245, 48.46.247
Insurable interest 48.18.030, 48.18.060
Insurance - defined 48.01.040
Insurance transaction - defined
48.01.060
Insured liable for premium while policy in force
48.18.300(2)
Interest Policy settlements 48.23.300
Statutory rate 19.52.010, 19.52.020, 19.52.025
Intoxication, claim denial prohibited
48.21.125, 48.44.305, 48.46.580
L
[Back to Index]
15
TOPIC RCW WAC
Labor dispute - payment of premium
48.44.250, 48.46.360
Legal name - doing business as
48.05.190
Life insurance Consent required 48.18.060
Deferred payment upon surrender (non-forfeiture & cash surrender) 48.76.020(6)
Divorce voids spouse as beneficiary Chapter 11.07.010
Exemption of proceeds 48.18.410
Exemption of proceeds - group life 48.18.420
Lawful travel destinations 48.18.570
Notice to owners of policies 48.102.100
Right to convert 48.24.190
Spouses rights in life insurance 48.18.440
Buyers Guide, illustrations - duties of insurers 284-23-230
Death benefits to premiums-unfair practice defined 284-23-550
Disclosure form (other than term life insurance policies) 284-97-910
Small-policy minimum death benefit 284-23-550
Life settlements 48.102.100
Limited HCSCs 48.44.035
Long-term care Denial of claims 48.83.090, 48.83.170
Benefit triggers 284-54-040
16
TOPIC RCW WAC
Pre-existing conditions exclusion 48.83.040
Prohibited practice 48.83.050
Prohibited provisions 48.84.040
Exclusions allowed 284-54-050
Gatekeeper clauses 284-54-040
Inflation, mandated offering of protection 284-54-270
Lapse or termination notice, nonpayment 284-83-025
Lapse, unintentional 284-54-253
Minimum standards, community-based care 284-54-210
Minimum standards, general and gatekeeping provisions 284-54-150, 284-54-160
Non-forfeiture 284-83-130
Partnership policies - DSHS rules 388-513-1400
Partnership policies - exchange or replacement 284-83-415
Partnership policies - minimum standards 284-83-410
Portability 284-54-200
Prompt payment requirements 284-83-325
17
TOPIC RCW WAC
Replacement (per disability as defined in RCW 48.11.030) 284-50-430
M
[Back to Index]
TOPIC RCW WAC
Mammography services 48.20.393, 48.21.225, 48.44.325, 48.46.275
284-44-046, 284-50-270
Mastectomy, lumpectomy 48.44.335, 48.46.285
Material transactions disclosure
48.43.200, 48.44.530, 48.46.600
Maternity, mandated benefits 48.43.041
Maternity services 48.43.115
Med Evac 48.01.280
Medical records, patient examination and copying rights
70.02.080
Medicare Supplement (Medigap)
Applicant completes medical history 48.66.140
Approval required - rates, contracts 48.66.035
Definitions 48.66.020
Free look, 30 days 48.66.120
Commissions – continuous 284-66-350(b)
Commissions – level 284-66-350(a)
Community-rated premiums 284-66-243(6)(a)
Guaranteed issue (core benefits) 284-66-063(2), 284-66-066(1)
Issue age-level premiums 284-66-243(6)(b)
18
TOPIC RCW WAC
Guaranteed issue (Medsup to Medsup) 48.66.045
Guaranteed issue (core benefits) 48.66.055
Guaranteed issue requirements 48.66.045
Open enrollment, six months 48.66.025
Pre-existing condition 48.66.055, 48.66.130
Rate on community-rated basis 48.66.045(3)
Renewability guaranteed 48.66.090
Loss ratio and rating standards 284-66-203
Marketing/sales standards 284-66-330
Medical assistance - suspension of benefits/premium 284-66-063(1)(e)
Medicare SELECT standards 284-66-073
Notice, 30 days prior to rate or contract change 284-66-160
Portability, MedSup to MedSup 284-66-170
Pre-existing condition 284-66-063
Rates - filed with and approved by Insurance Commissioner 284-66-243(2)
Replacement definition 284-66-030(12)
Renewability guaranteed 284-66-063(c)
Standard MedSup-plan specifications 284-66-066
Stacking, excessive insurance prohibited 284-66-340
Mental health practitioners, contracting
48.43.087
19
TOPIC RCW WAC
Mental health services (includes parity)
48.20.580, 48.21.240, 48.21.241(parity), 48.21.242, 48.44.340, 48.44.341(parity), 48.44.342, 48.46.290, 48.46.291(parity), 48.46.292, 48.43.765 (disclosure requirements, see also chemical dependency)
Parity in mental health and substance use disorder 284-43-7000
MEWA - requirements 48.125
Minimum standards authority HMO & HCSC
48.44.020, 48.44.050, 48.46.060, 48.46.200
Misleading comparisons 48.44.140
Misrepresentations 48.44.120, 48.46.410
Mobility Enhancing Equipment (must include sales tax)
48.43.290
N
[Back to Index]
TOPIC RCW WAC
Network access - general standards
284-170-200, 284-170-210, 284-170-240
Network reports 284-170-280
Neurodevelopmental therapies
48.21.310, 48.44.450, 48.46.520
Newborn children - see Congenital Anomalies
Newborn infants 48.21.155, 48.44.212, 48.46.250
Non-complying forms (validity)
48.15.030, 48.18.510
20
TOPIC RCW WAC
Notice for cancellation, denial or refusal to renew contract
48.44.260, 48.46.380
Notification period for newborn and adoptive children
48.20.420, 48.20.500, 48.21.155, 48.21.280, 48.44.212, 48.44.420, 48.46.250, 48.46.490
Nurses 48.44.290
O
[Back to Index]
TOPIC RCW WAC
Off-label drugs 284-30-450
OIC employees - financial interest
48.02.090(5)
Open public meetings Chapter 42.30
Out-of-state groups 48.24.045, 48.24.045 284-30-400(a)(b), 284-30-600(2)(b)
Over insurance 48.30.260(3)(f)
Overpayment recovery Carrier 48.43.600
Provider 48.43.605
P
[Back to Index]
TOPIC RCW WAC
Participation requirement - percentage for groups
48.44.023(5)(a), 48.46.066, 48.21.045(5)
21
TOPIC RCW WAC
Partnerships Title 25
Payment for certain health care services - checks
48.44.026
Payment of premium due to labor dispute
48.21.075, 48.44.250, 48.46.360
Payroll deductions for capitation payments to HMOs
48.46.190
Person (defined) 48.01.070
Pharmacy services, alternate use (also "off- label")
284-30-450
PKU (phenylketonuria) formula
48.20.520, 48.21.300, 48.44.440, 48.46.510
284-44-450, 284-46-100, 284-50-260
Podiatrist services 18.22, 48.20.390, 48.21.130, 48.43.045, 48.44.220, 48.44.225, 48.44.299, 48.44.300
284-170-270
Policy Defined 48.18.140(1)
Entire contract, must contain 48.18.190
State jurisdiction 48.18.200
Portability 48.43.015
Portability for disenrollment in Medicare+Choice and other plans
48.66.055
Pre-existing conditions 48.43.025
Premium financing Chapter 48.56
Premium: includes fees 48.18.170, 48.18.180, 48.30.157
22
TOPIC RCW WAC
Prescription drug, ID card 48.43.023
Prescription drug, mandatory benefits & disclosures
48.43.041 284-43-5170
Prescription drugs, pharmacies
48.44.465, 48.44.470, 48.46.535, 48.46.540
Prescription drugs requirements
284-43-5060
Prescription drugs, off-label use - see Off-label Drugs or Pharmacy Services, alternate use
Prescriptions - preapproval 48.20.525
Prior authorization processes 48.43.016 284-43-2050
Proceeds Annuities, exempt from debt up to $250 a month 48.18.430
Disability policies, exempt from debt 48.18.400
Group life, exempt from debt 48.18.420
Life policies, exempt from debt 48.18.410
Prompt payment 284-83-325, 284-170-431
Proprietary information in form/rate filing
48.02.120(3)
Prostate screening 48.20.392, 48.21.227, 48.44.327, 48.46.277, 48.125.200
Provider contracts 48.44.070, 48.46.243 284-170-(401-490) 284-170-421
23
TOPIC RCW WAC
Provider directories 284-170-260
Provider networks Assessment of provider network access 284-170-340
Access to emergency services (hospital emergency service) 284-170-370
Tiered provider networks 284-170-330
Q
[Back to Index]
TOPIC RCW WAC
Qualified medical child support order
48.01.235
Quality health care provided 48.43.500
R
[Back to Index]
TOPIC RCW WAC
Rating Community individual plans 48.44.022
Community small-group plans 48.44.023
Geographic rating area, factor development (non-grandfathered individual plans or small group) 284.170.250
"Reasonable" benefit provided
284-43-6040
24
TOPIC RCW WAC
Rebating exception, wellness & policy holder expenses (eff. 7-1-2020)
48.48.130
Records 48.05.280, 48.17.470, 48.23.015(7)
284.12.080(8)
Refunds From health care providers 48.43.605
Request from companies for overpayment to physicians 48.43.600
Registered nurse services 18.71, 18.88A, 48.21.141, 48.44.290
284-44-045, 284-50-315
Registration 48.44.040, 48.46.310
Registration by carrier required
48.44.015, 48.44.040, 48.46.027
Reinsurance (Transitional) Program
48.43.720 284.170.001
Replacement Definition 284-23-410
Disability 284-50-430
Duties of insurers 284-23-450, 284-23-455, 284-23-460
Requirement to file Trade secrets 48.02.120
284-43-920
Experience 284-43-6120, 284-43-6140
Respond to Commissioner 284-30-360(2), 284-30-650
Retrospective denial, prohibition
48.43.525
25
TOPIC RCW WAC
Right of enrollees to contract outside the health care plan
48.43.085
S
[Back to Index]
TOPIC RCW WAC
Sales tax (Durable Medical Equipment)
48.43.290
Security breach notification 284.04.625
Small-claims court 12.40
Small-group health plan requirements
48.44.023, 48.46.066
Small-group insurance - new law
48.21.045, 48.44.023, 48.46.066
See also 45 CFR § 147.104
284-49
Social Security number, limited use of
48.43.022
Special enrollment – see Enrollment
Standard of care, failure to comply
48.43.545
Statute of limitations on contracts
4.16.040
Stop loss (defined) 48.21.015
Substance use disorder 48.43.765 (see also chemical dependency)
26
TOPIC RCW WAC
Surrender of life insurance policy - required to make a claim
48.23.130
T
[Back to Index]
TOPIC RCW WAC
Telemedicine 48.43.735
Termination of coverage (disabled child)
48.44.200, 48.46.320
Time limit - accidental injury or death
284-30-620
Temporomandibular joint (TMJ) requirements
48.21.320, 48.44.460, 48.46.530 284-44-042, 284-46-506, 284-96-020
Transaction of insurance in another state
48.07.150(3)
Transfer of insurance contracts
284.95.050
Transition (Market) rules 284-43-0350
U
[Back to Index]
TOPIC RCW WAC
Underwriting of HCSC indemnity
48.44.030
Unfair discrimination 48.30.300
Unfair practices - see Consumer Protection Act
48.30.010 284-30-330
27
V
[Back to Index]
TOPIC RCW WAC
Validity - noncomplying forms
48.15.030, 48.18.510
Victims of domestic abuse - denial prohibited
48.18.550
W
[Back to Index]
TOPIC RCW WAC
Washington Life & Disability Guarantee Association -prohibited use in advertising
48.32A.185
Waiting period - to receive life insurance policy, cash value or loan
48.23.080(4), 48.76.020
Women's health care 48.42.100
Rev. 3.24.2020
