43.71.005 – Finding—Intent.

RCW 43.71.005 Finding—Intent. (1) The legislature finds that the affordable care act requires the establishment of health benefit exchanges. The legislature intends to establish an exchange, including a governance structure. There are many policy decisions associated with establishing an exchange that need to be made that will take a great deal of effort and expertise. […]

43.71.010 – Definitions.

RCW 43.71.010 Definitions. The definitions in this section apply throughout this chapter unless the context clearly requires otherwise. Terms and phrases used in this chapter that are not defined in this section must be defined as consistent with implementation of a state health benefit exchange pursuant to applicable federal law. (1) “Authority” means the Washington […]

43.71.020 – Washington health benefit exchange.

RCW 43.71.020 Washington health benefit exchange. (1) The Washington health benefit exchange is established and constitutes a self-sustaining public-private partnership separate and distinct from the state, exercising functions delineated in chapter 317, Laws of 2011. By January 1, 2014, the exchange shall operate consistent with applicable federal law subject to statutory authorization. The exchange shall […]

43.71.030 – Exchange—Powers and duties—Annual report and plan.

RCW 43.71.030 Exchange—Powers and duties—Annual report and plan. (1) The exchange has the authority to: (a) Provide an application and enrollment portal for individual and small group health and dental insurance and state and federal health care programs; (b) Certify qualified health and dental plans to be offered for enrollment through the exchange; (c) Provide […]

43.71.060 – Health benefit exchange account.

RCW 43.71.060 Health benefit exchange account. (1) The health benefit exchange account is created in the state treasury. Moneys in the account may be spent only after appropriation. Expenditures from the account may only be used to fund the operation of the exchange and identification, collection, and distribution of premium taxes collected under RCW 48.14.0201(5)(b) […]

43.71.065 – Qualified health plans—Certification—Criteria stand-alone dental plans—Direct primary care medical home plans—Appeals.

RCW 43.71.065 Qualified health plans—Certification—Criteria stand-alone dental plans—Direct primary care medical home plans—Appeals. (1) The board shall certify a plan as a qualified health plan to be offered through the exchange if the plan is determined by the: (a) Insurance commissioner to meet the requirements of Title 48 RCW and rules adopted by the commissioner […]

43.71.067 – Qualified health plans—Prohibited marketing practices or benefit designs—Rules.

RCW 43.71.067 Qualified health plans—Prohibited marketing practices or benefit designs—Rules. (1) For qualified health plans, an issue [issuer] offering a qualified health plan may not employ marketing practices or benefit designs that have the effect of discouraging enrollment in the plan by individuals with significant health needs. (2) Unless preempted by federal law, the commissioner […]

43.71.070 – Rating system—Rating factors.

RCW 43.71.070 Rating system—Rating factors. The board shall establish a rating system consistent with applicable federal law, for qualified health plans to assist consumers in evaluating plan choices in the exchange. Rating factors established by the board may include, but are not limited to: (1) Affordability with respect to premiums, deductibles, and point-of-service cost-sharing; (2) […]

43.71.075 – Navigator not soliciting or negotiating insurance—Health care information—Protection—Disclosure—Notification.

RCW 43.71.075 Navigator not soliciting or negotiating insurance—Health care information—Protection—Disclosure—Notification. (1) A person or entity functioning as a navigator shall not be considered soliciting or negotiating insurance as stated under chapter 48.17 RCW. (2)(a) A person or entity functioning as a navigator may only request health care information that is relevant to the specific assessment […]

43.71.080 – Assessment to fund exchange—Generally—Stand-alone dental plans.

RCW 43.71.080 Assessment to fund exchange—Generally—Stand-alone dental plans. (1)(a) Beginning January 1, 2015, the exchange may require each issuer writing premiums for qualified health benefit plans or stand-alone pediatric dental plans offered through the exchange to pay an assessment in an amount necessary to fund the operations of the exchange, applicable to operational costs incurred […]

43.71.095 – Standardized health plans.

RCW 43.71.095 Standardized health plans. (1) The exchange, in consultation with the commissioner, the authority, an independent actuary, and other stakeholders, must establish up to three standardized health plans for each of the bronze, silver, and gold levels. (a) The standardized health plans must be designed to reduce deductibles, make more services available before the […]

43.71.100 – Access to information about exclusion of mandated benefits from qualified health plans—Exchange’s duties.

RCW 43.71.100 Access to information about exclusion of mandated benefits from qualified health plans—Exchange’s duties. (1) Beginning November 1, 2021, the exchange shall provide individuals seeking to enroll in coverage on its website with access to the information a health carrier must provide under RCW 48.43.725 for any qualified health plan the health carrier offers […]

43.71.110 – Premium assistance and cost-sharing reduction program.

RCW 43.71.110 Premium assistance and cost-sharing reduction program. (1) Subject to the availability of amounts appropriated for this specific purpose, a premium assistance and cost-sharing reduction program is hereby established to be administered by the exchange. (2) Premium assistance and cost-sharing reduction amounts must be established by the exchange within parameters established in the omnibus […]

43.71.120 – Applications to federal government for waivers and other flexibilities.

RCW 43.71.120 Applications to federal government for waivers and other flexibilities. (1) The exchange, in close consultation with the authority and the office of the insurance commissioner, must explore all opportunities to apply to the secretary of health and human services under 42 U.S.C. Sec. 18052 for a waiver or other available federal flexibilities to: […]

43.71.130 – State health care affordability account.

RCW 43.71.130 State health care affordability account. (1) The state health care affordability account is created in the state treasury. Expenditures from the account may only be used for premium and cost-sharing assistance programs established in RCW 43.71.110. (2) The following funds must be deposited in the account: (a) Any grants, donations, or contributions of […]

43.71.900 – Conflict with federal requirements—2011 c 317.

RCW 43.71.900 Conflict with federal requirements—2011 c 317. If any part of this act is found to be in conflict with federal requirements that are a prescribed condition to the allocation of federal funds to the state, the conflicting part of this act is inoperative solely to the extent of the conflict and with respect […]

43.71.901 – Spiritual care services—2012 c 87.

RCW 43.71.901 Spiritual care services—2012 c 87. Nothing in chapter 87, Laws of 2012 prohibits the offering of benefits for spiritual care services deductible under section 213(d) of the internal revenue code in health plans inside and outside of the exchange. [ 2012 c 87 § 14.]