48.43.902 – Effective date—1996 c 312.
RCW 48.43.902 Effective date—1996 c 312. This act shall take effect July 1, 1996. [ 1996 c 312 § 8.]
48.43.505 – Enrollee’s and protected individual’s right to privacy and confidential services—Health carrier or insurer duties—Requests for confidential communications—Rules.
RCW 48.43.505 Enrollee’s and protected individual’s right to privacy and confidential services—Health carrier or insurer duties—Requests for confidential communications—Rules. (1) Health carriers and insurers shall adopt policies and procedures that conform administrative, business, and operational practices to protect an enrollee’s and protected individual’s right to privacy or right to confidential health care services granted under […]
48.43.5051 – Requests for confidential communications—Monitoring and ensuring compliance—Standardized form for submission of requests—Rules.
RCW 48.43.5051 Requests for confidential communications—Monitoring and ensuring compliance—Standardized form for submission of requests—Rules. (1) The commissioner shall: (a) Develop a process for the regular collection of information from carriers on requests for confidential communications pursuant to RCW 48.43.505 for the purposes of monitoring compliance, including monitoring: (i) The effectiveness of the process described in […]
48.43.510 – Carrier required to disclose health plan information—Marketing and advertising restrictions—Rules.
RCW 48.43.510 Carrier required to disclose health plan information—Marketing and advertising restrictions—Rules. (1) A carrier that offers a health plan may not offer to sell a health plan to an enrollee or to any group representative, agent, employer, or enrollee representative without first offering to provide, and providing upon request, the following information before purchase […]
48.43.515 – Access to appropriate health services—Enrollee options—Rules.
RCW 48.43.515 Access to appropriate health services—Enrollee options—Rules. (1) Each enrollee in a health plan must have adequate choice among health care providers. (2) Each carrier must allow an enrollee to choose a primary care provider who is accepting new enrollees from a list of participating providers. Enrollees also must be permitted to change primary […]
48.43.400 – Prescription drug utilization management—Definitions.
RCW 48.43.400 Prescription drug utilization management—Definitions. The definitions in this section apply throughout this section and RCW 48.43.410 and 48.43.420 unless the context clearly requires otherwise. (1) “Clinical practice guidelines” means a systemically developed statement to assist decision making by health care providers and patients about appropriate health care for specific clinical circumstances and conditions. […]
48.43.410 – Prescription drug utilization management—Clinical review criteria—Requirement to be evidence-based and updated regularly.
RCW 48.43.410 Prescription drug utilization management—Clinical review criteria—Requirement to be evidence-based and updated regularly. For health plans delivered, issued for delivery, or renewed on or after January 1, 2021, clinical review criteria used to establish a prescription drug utilization management protocol must be evidence-based and updated on a regular basis through review of new evidence, […]
48.43.420 – 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.
RCW 48.43.420 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. For health plans delivered, issued for delivery, or renewed on or after January 1, 2021: (1) When coverage of a prescription drug for the treatment of any medical condition is […]
48.43.430 – Prescription medication—Maximum charge at point of sale—Requirements.
RCW 48.43.430 Prescription medication—Maximum charge at point of sale—Requirements. (1) Beginning January 1, 2021, the maximum amount a health carrier or pharmacy benefit manager may require a person to pay at the point of sale for a covered prescription medication is the lesser of: (a) The applicable cost sharing for the prescription medication; or (b) […]
48.43.435 – Prescription medication—Cost-sharing calculation—Application—Rules.
RCW 48.43.435 Prescription medication—Cost-sharing calculation—Application—Rules. (1)(a) Except as provided in (b) of this subsection, when calculating an enrollee’s contribution to any applicable cost-sharing or out-of-pocket maximum, a health carrier offering a nongrandfathered health plan with a pharmacy benefit, or a health care benefit manager administering benefits for the health carrier, shall include any cost-sharing amounts […]