For Consumers

Life and health insurance laws and rules

Title 284 WAC (Washington Administrative Code) (leg.wa.gov) and Title 48 RCW (Revised Code of Washington) (leg.wa.gov) are the laws and rules that define and explain our state's insurance standards and requirements for insurers, producers and other regulated entities. Below is a list of frequently used life and health insurance laws and rules. Note: All WAC and RCW links below go to the Washington state Legislature's website (leg.wa.gov).

A - Z index

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

 

TopicWAC 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-Nongrandfathered284-43  
 Expedited review284-43-3170  
 Explanation of right to review284-43-3050  
 External review of adverse benefit determinations284-43-321048.43.00548.43.535
 Internal review of adverse benefit determinations284-43-311048.43.530 
 Notice and explanation - General requirements284-43-3070  
 Review of adverse benefit determinations-Generally284-43-3030  
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

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

  
 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

  
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

  
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)

 

284.170.250

  
"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 § 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

  

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