Wash. Rev. Code § 48.41.010
Short title
This chapter shall be known and may be cited as the "Washington state health insurance coverage access act".
Revised Code of Washington Chapter 48.41 — Health Insurance Coverage Access Act
Washington · statute · Wash. Rev. Code ch. 48.41 · 26 active provisions
Wash. Rev. Code § 48.41.020
Intent
It is the purpose and intent of the legislature to provide access to health insurance coverage to all residents of Washington who are denied health insurance. It is the intent of the Washington state health insurance coverage access act to provide a mechanism to ensure the availability of comprehensive health insurance…
Wash. Rev. Code § 48.41.030
Definitions
The definitions in this section apply throughout this chapter unless the context clearly requires otherwise.(1) "Accounting year" means a twelve-month period determined by the board for purposes of recordkeeping and accounting. The first accounting year may be more or less than twelve months and, from time to time in s…
Wash. Rev. Code § 48.41.037
Washington state health insurance pool account
The Washington state health insurance pool account is created in the custody of the state treasurer. All receipts from moneys specifically appropriated to the account must be deposited in the account. Expenditures from this account shall be used to cover deficits incurred by the Washington state health insurance pool u…
Wash. Rev. Code § 48.41.040
Health insurance pool—Creation, membership, organization, operation, rules
(1) There is created a nonprofit entity to be known as the Washington state health insurance pool. All members in this state on or after May 18, 1987, shall be members of the pool. When authorized by federal law, all self-insured employers shall also be members of the pool.(2) Pursuant to chapter 34.05 RCW the commissi…
Wash. Rev. Code § 48.41.050
Operation plan—Contents
The plan of operation submitted by the board to the commissioner shall:(1) Establish procedures for the handling and accounting of assets and moneys of the pool;(2) Establish regular times and places for meetings of the board of directors;(3) Establish procedures for records to be kept of all financial transactions and…
Wash. Rev. Code § 48.41.060
Board powers and duties
(1) The board shall have the general powers and authority granted under the laws of this state to insurance companies, health care service contractors, and health maintenance organizations, licensed or registered to offer or provide the kinds of health coverage defined under this title. In addition thereto, the board s…
Wash. Rev. Code § 48.41.070
Examination and report
The pool shall be subject to examination by the commissioner as provided under chapter 48.03 RCW. The board of directors shall submit to the commissioner, not later than one hundred twenty days after the end of each accounting year, a financial report for the year in a form approved by the commissioner.
Wash. Rev. Code § 48.41.080
Pool administrator—Selection, term, duties, pay
The board shall select an administrator through a competitive bidding process to administer the pool.(1) The board shall evaluate bids based upon criteria established by the board, which shall include:(a) The administrator's proven ability to handle health coverage;(b) The efficiency of the administrator's claim-paying…
Wash. Rev. Code § 48.41.090
Financial participation in pool—Computation, deficit assessments
(1) Following the close of each accounting year, the pool administrator shall determine the total net cost of pool operation which shall include:(a) Net premium (premiums less administrative expense allowances), the pool expenses of administration, and incurred losses for the year, taking into account investment income…
Wash. Rev. Code § 48.41.100
Eligibility for coverage
(1)(a) The following persons who are residents of this state are eligible for pool coverage:(i) Any resident of the state not eligible for medicare coverage or medicaid coverage, and residing in a county where an individual health plan other than a catastrophic health plan as defined in RCW 48.43.005 is not offered to…
Wash. Rev. Code § 48.41.110
Policy coverage—Eligible expenses, cost containment, limits—Explanatory brochure
(1) The pool shall offer one or more care management plans of coverage. Such plans may, but are not required to, include point of service features that permit participants to receive in-network benefits or out-of-network benefits subject to differential cost shares. The pool may incorporate managed care features into e…
Wash. Rev. Code § 48.41.120
Comprehensive pool policy—Deductibles—Coinsurance—Carryover
(1) Subject to the limitation provided in subsection (3) of this section, the comprehensive pool policy offered under RCW 48.41.110(4) shall impose a deductible as provided in this subsection. Deductibles of five hundred dollars and one thousand dollars on a per person per calendar year basis shall initially be offered…
Wash. Rev. Code § 48.41.130
Policy forms—Approval required
All policy forms issued by the pool shall conform in substance to prototype forms developed by the pool, and shall in all other respects conform to the requirements of this chapter, and shall be filed with and approved by the commissioner before they are issued.
Wash. Rev. Code § 48.41.140
Coverage for children, dependents
(1) Coverage shall provide that health insurance benefits are applicable to children of the person in whose name the policy is issued including adopted and newly born natural children. Coverage shall also include necessary care and treatment of medically diagnosed congenital defects and birth abnormalities. If payment…
Wash. Rev. Code § 48.41.150
Medical supplement policy
(1) The board shall offer a medical supplement policy for persons receiving medicare parts A and B. The supplement policy shall provide benefits of one hundred percent of the deductible and copayment required under medicare and eighty percent of the charges for covered services under this chapter that are not paid by m…
Wash. Rev. Code § 48.41.160
Pool policy requirements—Continued coverage—Rate changes—Continuation—Statement of intent to discontinue pool coverage
(1) On or before December 31, 2007, the pool shall cancel all existing pool policies and replace them with policies that are identical to the existing policies except for the inclusion of a provision providing for a guarantee of the continuity of coverage consistent with this section. As a means to minimize the number…
Wash. Rev. Code § 48.41.170
Required rule making
The commissioner shall adopt rules pursuant to chapter 34.05 RCW that:(1) Provide for disclosure by the member of the availability of insurance coverage from the pool; and(2) Implement this chapter.
Wash. Rev. Code § 48.41.190
Civil and criminal immunity
The pool, members of the pool, board directors of the pool, officers of the pool, employees of the pool, the commissioner, the commissioner's representatives, and the commissioner's employees shall not be civilly or criminally liable and shall not have any penalty or cause of action of any nature arise against them for…
Wash. Rev. Code § 48.41.200
Rates—Standard risk and maximum
(1) The pool shall determine the standard risk rate by calculating the average individual standard rate charged for coverage comparable to pool coverage by the five largest members, measured in terms of individual market enrollment, offering such coverages in the state. In the event five members do not offer comparable…
Wash. Rev. Code § 48.41.210
Last payor of benefits
It is the express intent of this chapter that the pool be the last payor of benefits whenever any other benefit is available.(1) Benefits otherwise payable under pool coverage shall be reduced by all amounts paid or payable through any other health insurance, or health benefit plans, including but not limited to self-i…
Wash. Rev. Code § 48.41.220
Mental health services—Definition—Coverage required, when. (Effective until January 1, 2027.)
(1) For the purposes of this section, "mental health services" means:(a) For each health insurance policy issued or renewed by the pool before January 1, 2021, medically necessary outpatient and inpatient services provided to treat mental disorders covered by the diagnostic categories listed in the most current version…
Wash. Rev. Code § 48.41.240
Review of populations needing coverage through pool—Analysis and recommendations—Report
(1) The board shall review populations that may need ongoing access to coverage through the pool, with specific attention to those persons who may be excluded from or may receive inadequate coverage beginning January 1, 2014, such as persons with end-stage renal disease or HIV/AIDS, or persons not eligible for coverage…
Wash. Rev. Code § 48.41.250
Administration of risk management functions—Contract with commissioner authorized—Recommendations—Report to legislature
(1) The pool is authorized to contract with the commissioner to administer risk management functions if necessary, consistent with RCW 48.43.720, and consistent with P.L. 111-148 of 2010, as amended. Prior to entering into a contract, the pool may conduct preoperational and planning activities related to these programs…
Wash. Rev. Code § 48.41.900
Federal supremacy
If any part of this chapter is found to be in conflict with federal requirements which are a prescribed condition to the allocation of federal funds to the state, the conflicting part of this chapter is hereby declared to be inoperative solely to the extent of the conflict and with respect to the agencies directly affe…
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