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Topic WAC and RCW number(s)

A:

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Access plan 284.43.220    
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  
Adopted child 48.01.180 48.20.500 48.21.280
    48.44.420 48.46.490   
Advertising      
  Disability 48.30.040 48.30.100 284-50
  Health Care Services 48.44.110    
  Health Maintenance Organization 48.46.170 48.46.400  
  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  
  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 48.18.260 284-30-580  
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    
Anesthesia services, mandatory benefits 48.43.185    
Annuities      
  Deferred payment upon surrender 48.23.360(5)    
  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    
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:

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"Birthday Rule" (COB) 284-51-205(4)    
Breast reconstruction - See Mastectomy      
Burial insurance, minimum death benefit 284-23-550    

C:

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Cancellation - reason for denying or cancellation must be given - See Actual Reason      
Cancellation of riders 48.21.290 48.44.430 48.46.500
Certificate of coverage - administration 48.21.080 48.46.060(2) 284-44-050
Certifcates 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
  Standards/minimum dollar amounts 284-53-010    
Chiropractic services 48.21.142 48.43.045 48.44.310
    284-43-205    
  Group disability 48.21.142    
  HCSC 48.44.310    
  Individual disability 48.20.412    
  Licensing Ch. 18.25    
  Provider agreement    48.43.083    
Clinical trials 284.43.850    
Colorectal exams 48.43.043    
Comparison of health carriers 48.43.105    
Congenital anomalies - newborns 48.21.155 48.44.212 48.46.250
Congenital anomalies - prenatal testing 48.44.344 48.46.375  
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    
Contraception coverage - unfair practice 284-43-822    
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    
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
    48.46.060 284-51-050  
  Plan (defined) 284-51-040    
  Notice 48.21.260(3) 48.44.370(3) 48.46.450(3)
  Order of benefit determination 284-51-075 284-51-185  
  Reduction 48.20.350 48.21.200  
  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:

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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 25 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    
Disclosure of filings - See Public Disclosure 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    

E:

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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) 284.170.420    
  Preexisting condition limitations WAC 284.170.400    
  Individual market (on & off Exchange) special enrollment requirements 284.170.425

284.170.430

(exchange only)

 
  Notice requirements & effective dates of coverage 284.170.435    
Enrollment requirements small group plans, qualifying event 284.170.410    
  for small group qualified health plans 284.170.412    
Erin Act 48.43.115    
Essential community providers (exchange plans) - definition 284.43.221    
  for exchange plans - Network access 284.43.222    
Essential health benefits 284.43-878 48.43.715  
  Pediatric dental benefits 284.43.879 284.170.800 284.170.810
Every Category of Health Care Provider 48.43.045 284-43-205  
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:

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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 48.43.005(19)(i) 48.20.550 48.20.555
    48.21.370 48.21.375   48.20.580
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      
  Credit life and disability  284-34-250(1)(f)  
  Disability 48.20.013    
  Health Care Services 48.44.230    
  HMO 48.46.260    
  Annuity, fixed 284-23-350    
  Annuity, variable 48.18A.035    
  Life, individual policy 48.23.380    
  Life, variable 48.18A.035    
  Long-term care 48.83.060    
  Medicare supplement 48.66.120    
  Replacement of life and annuity policies 284-23-455(4)    
Funded reserve requirements 48.46.240    
Future dividends or refunds 48.44.130 48.46.300  

G:

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Gag Rule 284-43-320(5)(a)(b)  
Gender - mortality tables 48.46.070    
Governing body of HMO 48.46.070    
Grace period      
  Annuities, pure endowments 48.23.150    
  Disability 48.20.062    
  Group and blanket disability 48.21.070    
  Health Care Service Contractors 284-44-040(8)    
  Life 48.23.030    
  Long-term care 284-54-250 284-83-025(c)  
Grievance procedure requirements 48.43.055 48.46.100 284-43-620
Grounds for disapproval 48.44.020 48.46.060  
Groups - out of state 48.24.045 284-30-600 284-30-610
Guaranteed issue and continuity of coverage 48.43.035 48.43.038  
Guaranteed renewable 284-50-330(2) 284-60-030(9) 284-43-730

H:

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Handicap 48.30.300 48.18.480 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 48.21.220 48.21A.090 48.44.320
    18.71 70.126 70.127
    284-21 284-44-500 284-96-500

I:

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Immunity from libel or slander 48.44.270 48.46.390  
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      
  Statutory rate 19.52.010 19.52.020 19.52.025
  Policy settlements 48.23.300    
Intoxication, claim denial prohibited   48.21.125 48.44.305 48.46.580

L:

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Labor dispute - payment of premium 48.44.250 48.46.360  
Legal name - doing business as 48.05.190    
Life Insurance      
  Buyers Guide, illustrations - duties of insurers 284-23-230    
  Consent required 48.18.060    
  Deferred payment upon surrender (nonforfeiture & cash surrender) 48.76.020(6)    
  Disclosure form (other than term life insurance policies) 284.97.910    
  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    
  Small-policy minimum death benefit 284-23-550    
  Spouses rights in life insurance 48.18.440    
Life Settlements 48.102.100    
Limited HCSCs 48.44.035    
Long-term care      
  Benefit triggers 284-54-040    
  Denial of claims 48.83.090 48.83.170  
  Non forfeiture 284-83-130    
  Exclusions allowed 284-54-050    
  Gatekeeper clauses 284-54-040    
  Inflation, mandated offering of protection 284-54-270    
  Lapse, unintentional 284-54-253    
  Lapse or termination notice, nonpayment 284.83.025    
  Minimum standards, community-based care 284-54-210    
  Minimum standards, general and gatekeeping provisions 284-54-150 284-54-160  
  Partnership policies - minimum standards 284-83-410    
  Partnership policies - exchange or replacement 284-83-415    
  Partnership policies - DSHS rules 388-513-1400    
  Portability 284-54-200    
  Pre-existing conditions exclusion 48.83.040    
  Prohibited practice 48.83.050    
  Prohibited provisions 48.84.040    
  Prompt payment requirements 284.83.325    
  Replacement (per disability as defined in RCW 48.11.030) 284-50-430    

M:

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Mammography services 48.44.325 48.46.275 48.20.393
    48.21.225 284-44-046 284-50-270
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      
  Applicant completes medical history 48.66.140    
  Approval required - rates, contracts 48.66.035    
  Commissions - continuous 284-66-350(b)    
  Commissions - level 284-66-350(a)    
  Community-rated premiums 284-66-243(6)(a)  
  Definitions 48.66.020    
  Free look, 30 days 48.66.120    
  Guaranteed issue (Medsup to Medsup) 48.66.045    
  Guaranteed issue (core benefits) 48.66.055 284-66-063(2) 284-66-066(1)
  Issue age-level premiums 284-66-243(6)(b)  
  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    
  Open enrollment, six months 48.66.025    
  Portability, MedSup to MedSup 284-66-170    
  Pre-existing condition 48.66.130 48.66.055 284-66-063
  Rates - filed with and approved by Insurance Commissioner 284-66-243(2)    
  Replacement      
  Definition 284-66-030(11)  
  Guaranteed issue requirements 48.66.045    
  Rate on community-rated basis 48.66.045(3)    
  Renewability guaranteed 48.66.090 284-66-063(c)  
  Standard MedSup-plan specifications 284-66-066    
  Stacking, excessive insurance prohibited 284-66-340    
Mental health practitioners, contracting 48.43.087    
Mental health services (includes parity) 48.20.580 48.21.240 48.21.242
    48.21.241 (parity) 48.44.340 48.44.341 (parity)
    48.44.342 48.46.290 48.46.291 (parity)
    48.46.292 284-43-810  
MEWA - requirements 48.125    
Minimum standards authority HMO & HCSC 48.44.050 48.44.020 48.46.200
    48.46.060    
Misleading comparisons 48.44.140    
Misrepresentations 48.44.120 48.46.410  

N:

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Network access- general standards 284-43-200 284.43.201 284.43.203
Network reports 284-43-220    
Neurodevelopmental therapies 48.44.450 48.46.520 48.21.310
Newborn children - See congenital anomalies      
Newborn infants - see "well-baby" 48.21.155 48.44.212 48.46.250
Non-complying forms (validity) 48.15.030 48.18.510  
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:

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Off-label drugs 284-30-450    
OIC employees - financial interest 48.02.090(5)    
Open enrollment 284-170-400    
Open public meetings Chapter 42.30    
Out-of-state groups 48.24.045 48.42.040 284-30-600(2)(b)
  284-30-400(a)(b)    
Over insurance 48.30.260(3)(f)    
Overpayment recovery      
  Carrier 48.43.600    
  Provider 48.43.605    

P:

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Participation requirement - percentage for groups 48.44.023(5)(a) 48.46.066  
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     
Pharmacy services, coverage of 284-43-815    
PKU (phenylketonuria) formula 48.44.440 48.46.510 48.20.520
    48.21.300 284-44-450 284-46-100
    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 48.44.300 284-43-205
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
Prescription drug, ID card 48.43.023    
Prescription drug, mandatory benefits & disclosures 48.43.041 284.43.825  
Prescription drugs, pharmacies 48.44.465 48.44.470 48.46.535
    48.46.540    
Presecription drugs requirements 284.43.816    
Prescription drugs, off-label use - See off-label drugs or pharmacy services, alternate use      
Prescriptions - preapproval 48.20.525    
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 284-43-321    
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 284-43-300 - 340 48.44.070 48.46.243
Provider directories 284.43.204    
Provider Networks      
  Assessment of provider network access 284.43.230    
  Access to emergency services (hospital emergency service) 284.43.252    
  Tiered provider networks 284.43.229    

Q:

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Qualified Medical Child Support Order 48.01.235  
Quality health care provided 48.43.500    

R:

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Rating      
  Community individual plans 48.44.022    
  Community small-group plans 48.44.023    
  Geographic rating area, factor development (nongrandfathered individual plans or small group    
"Reasonable" benefit provided 284-43-915    
Records

48.05.280

48.17.470

48.23.015(7) 284.12.080(8)
Refunds      
  Request from companies for overpayment to physicians 48.43.600    
  From health care providers 48.43.605    
Registered nurse services 18.88A 18.71 48.21.141
    48.44.290 284-50-315 284-44-045
Registration 48.44.040 48.46.310  
Registration by carrier required 48.44.015 48.44.040 48.46.027
Reinsurance (Transitional) Program 284.170.001 48.43.720  
Replacement      
  Definition 284-23-410    
  Disability 284-50-430    
  Duties of insurers 284-23-450 284-23-455 284-23-460
Requirement to file 284-43-920    
Experience 284-43-935 284-43-940  
Trade secrets 48.02.120    
Respond to Commissioner 284-30-360(2) 284-30-650  
Retrospective denial, prohibition 48.43.525    
Right of enrollees to contract outside the health care plan 48.43.085    

S:

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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 ยง 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    
Surrender of life insurance policy - required to make a claim 48.23.130    

T:

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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
    284-96-020 284-44-042 284-46-506
Transaction of insurance in another state 48.07.150(3)    
Transfer of insurance contracts 284.95.050    
Transition (Market) rules 284.170.    

U:

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Underwriting of HCSC indemnity 48.44.030    
Unfair discrimination 48.30.300    
Unfair practices - see Consumer Protection Act 48.30.010 284-30-330  

V:

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Validity - noncomplying forms 48.15.030 48.18.510  
Victims of domestic abuse - denial prohibited 48.18.550    

W:

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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    
``

Updated 05/30/2014

See also

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