Life and health insurance laws and rules

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Topic WAC and RCW number(s)

A:

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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

 
Adopted child

48.01.180

48.20.500

48.21.280

   

48.44.420

48.46.490 

 
Adverse Benefit Determination Process-Nongrandfathered 284-43    
  Expedited review 284-43-3170    
  Explanation of right to review 284-43-3050    
  External review of adverse benefit determinations 284-43-3210 48.43.005 48.43.535
  Internal review of adverse benefit determinations 284-43-3110 48.43.530  
  Notice and explanation - General requirements 284-43-3070    
  Review of adverse benefit determinations-Generally 284-43-3030    
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

   

284-170-270

   
  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

284-43-5150

   
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

   
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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Death benefits to premium-unfair practice defined (life insurance)

284-23-550

   
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

   
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

   
Durable Medical Equipment (must include sales tax)

48.43.290

   

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)

284-43-1080

   
  Preexisting condition limitations

284-43-5000

   
  Individual market (on & off Exchange) special enrollment requirements

284-43-1100

284-43-1120

(exchange only)

 
  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

   
  for exchange plans - Network access

284-170-300

   
Essential health benefits

284-43-5640

48.43.715

 
  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:

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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

284-170-421

 

 
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

   
  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

284-43-4040

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:

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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

   
  Death benefits to premiums-unfair practice defined

284-23-550

   
  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

284-43-7000

 
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

 
Mobility Enhancing Equipment (must include sales tax)

48.43.290

   

N:

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Network access- general standards

284-170-200

284-170-210

284-170-240

Network reports

284-170-280

   
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 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

284-43-5040

   
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

284-170-270

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

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

   
Presecription drugs requirements

284-43-5060

   
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

284-170-431

284-83-325

 
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

284-170-401-490

48.44.070

48.46.243

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:

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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

284-43-6040

   
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

284-43-6120

284-43-6140

 
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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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 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

284-43-0350

   

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

   
``

See also

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