Travel insurance

AN ACT Relating to travel insurance; amending RCW 48.17.060 and 1
48.43.005; adding a new section to chapter 48.43 RCW; adding a new 2
chapter to Title 48 RCW; and providing an effective date.3
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:4
NEW SECTION. Sec. 1. (1) The purpose of this chapter is to 5
promote the public welfare by creating a comprehensive legal 6
framework within which travel insurance may be sold in this state.7
(2) The requirements of this chapter: 8
(a) Apply to travel insurance that covers any resident of this 9
state, and is sold, solicited, negotiated, or offered in this state, 10
and policies and certificates that are delivered or issued for 11
delivery in this state; and 12
(b) Do not apply to cancellation fee waivers or travel assistance 13
services, except as expressly provided in this chapter.14
(3) All other applicable provisions of this state's insurance 15
laws continue to apply to travel insurance except that the specific 16
provisions of this chapter supersede any general provisions of law 17
that would otherwise be applicable to travel insurance.18
H-2436.1
HOUSE BILL 2087
State of Washington 69th Legislature 2026 Regular Session
By Representatives Ryu, McClintock, Reed, Zahn, Simmons, Santos,
Morgan, Reeves, and Graham
Prefiled 12/01/25. Read first time 01/12/26. Referred to Committee
on Consumer Protection & Business.
p. 1 HB 2087
NEW SECTION. Sec. 2. The definitions in this section apply 1
throughout this chapter unless the context clearly requires 2
otherwise.3
(1) "Aggregator site" means a website that provides access to 4
information regarding insurance products from more than one insurer, 5
including product and insurer information, for use in comparison 6
shopping. 7
(2) "Blanket travel insurance" means a policy of travel insurance 8
issued to any eligible group providing coverage for specific classes 9
of persons defined in the policy with coverage provided to all 10
members of the eligible group without a separate charge to individual 11
members of the eligible group. 12
(3) "Cancellation fee waiver" means a contractual agreement 13
between a supplier of travel services and its customer to waive some 14
or all of the nonrefundable cancellation fee provisions of the 15
supplier's underlying travel contract with or without regard to the 16
reason for the cancellation or form of reimbursement. A cancellation 17
fee waiver is not insurance. 18
(4) "Eligible group" means two or more persons who are engaged in 19
a common enterprise, or have an economic, educational, or social 20
affinity or relationship including, but not limited to, any of the 21
following: 22
(a) Any entity engaged in the business of providing travel or 23
travel services including, but not limited to: Tour operators, 24
lodging providers, vacation property owners, hotels and resorts, 25
travel clubs, travel agencies, property managers, cultural exchange 26
programs, and common carriers or the operator, owner, or lessor of a 27
means of transportation of passengers including, but not limited to, 28
airlines, cruise lines, railroads, steamship companies, and public 29
bus carriers, wherein with regard to any particular travel or type of 30
travel or travelers, all members or customers of the group must have 31
a common exposure to risk attendant to such travel;32
(b) Any college, school, or other institution of learning, 33
covering students, teachers, employees, or volunteers;34
(c) Any employer covering any group of employees, volunteers, 35
contractors, board of directors, dependents, or guests;36
(d) Any sports team, camp, or sponsor thereof, covering 37
participants, members, campers, employees, officials, supervisors, or 38
volunteers; 39
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(e) Any religious, charitable, recreational, educational, or 1
civic organization, or branch thereof, covering any group of members, 2
participants, or volunteers; 3
(f) Any financial institution or financial institution vendor, or 4
parent holding company, trustee, or agent of or designated by one or 5
more financial institutions or financial institution vendors, 6
including account holders, credit card holders, debtors, guarantors, 7
or purchasers; 8
(g) Any incorporated or unincorporated association, including 9
labor unions, having a common interest, constitution and bylaws, and 10
organized and maintained in good faith for purposes other than 11
obtaining insurance for members or participants of such association 12
covering its members; 13
(h) Any trust or the trustees of a fund established, created, or 14
maintained for the benefit of and covering members, employees, or 15
customers, subject to the commissioner permitting the use of a trust 16
and the state's premium tax provisions in section 4 of this act of 17
one or more associations meeting the requirements of (g) of this 18
subsection; 19
(i) Any entertainment production company covering any group of 20
participants, volunteers, audience members, contestants, or workers;21
(j) Any volunteer fire department, ambulance, rescue, police, 22
court, or any first aid, civil defense, or other such volunteer 23
group; 24
(k) Preschools, day care institutions for children or adults, and 25
senior citizen clubs; 26
(l) Any automobile or truck rental or leasing company covering a 27
group of individuals who may become renters, lessees, or passengers 28
defined by their travel status on the rented or leased vehicles, 29
subject to the requirement that the common carrier, operator, owner, 30
or lessor of a means of transportation, or the automobile or truck 31
rental or leasing company, is the policyholder under a policy to 32
which this chapter applies; or 33
(m) Any other group where the commissioner has determined that 34
the members are engaged in a common enterprise, or have an economic, 35
educational, or social affinity or relationship, and that issuance of 36
the policy would not be contrary to the public interest.37
(5) "Fulfillment materials" means documentation sent to the 38
purchaser of a travel protection plan confirming the purchase and 39
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providing the travel protection plan's coverage and assistance 1
details. 2
(6) "Group travel insurance" means travel insurance issued to any 3
eligible group. 4
(7) "Limited lines travel insurance producer" means a:5
(a) Licensed insurance producer, including a licensed limited 6
lines producer of travel insurance; or 7
(b) Travel administrator. 8
(8) "Offer and disseminate" means providing general information, 9
including a description of the coverage and price, as well as 10
processing the application and collecting premiums.11
(9) "Primary certificate holder" means an individual person who 12
elects and purchases travel insurance under a group policy.13
(10) "Primary policyholder" means an individual person who elects 14
and purchases individual travel insurance. 15
(11) "Travel administrator" means a person who directly or 16
indirectly underwrites, collects charges, collateral, or premiums 17
from, or adjusts or settles claims on residents of this state, in 18
connection with travel insurance, except that a person may not be 19
considered a travel administrator if that person's only actions that 20
would otherwise cause it to be considered a travel administrator are 21
among the following: 22
(a) A person working for a travel administrator to the extent 23
that the person's activities are subject to the supervision and 24
control of the travel administrator; 25
(b) An insurance producer selling insurance or engaged in 26
administrative and claims-related activities within the scope of the 27
producer's license; 28
(c) A travel retailer offering and disseminating travel insurance 29
and registered under the license of a limited lines travel insurance 30
producer in accordance with this chapter; 31
(d) An individual adjusting or settling claims in the normal 32
course of that individual's practice or employment as an attorney-at-33
law and who does not collect charges or premiums in connection with 34
insurance coverage; or 35
(e) A business entity that is affiliated with a licensed insurer 36
while acting as a travel administrator for the direct and assumed 37
insurance business of an insurer. 38
(12) "Travel assistance services" means noninsurance services for 39
which the consumer is not indemnified based on a fortuitous event, 40
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and where providing the service does not result in transfer or 1
shifting of risk that would constitute the business of insurance.2
(a) "Travel assistance services" include, but are not limited to: 3
Security advisories, destination information, vaccination and 4
immunization information services, travel reservation services, 5
entertainment, activity and event planning, translation assistance, 6
emergency messaging, international legal and medical referrals, 7
medical case monitoring, coordination of transportation arrangements, 8
emergency cash transfer assistance, medical prescription replacement 9
assistance, passport and travel document replacement assistance, lost 10
luggage assistance, concierge services, and any other service that is 11
furnished in connection with planned travel. 12
(b) "Travel assistance services" are not insurance and not 13
related to insurance. 14
(13)(a) "Travel insurance" means, except as excluded in (b) of 15
this subsection, insurance coverage for personal risks incident to 16
planned travel, including: 17
(i) Interruption or cancellation of trip or event;18
(ii) Loss of baggage or personal effects; 19
(iii) Damages to accommodations or rental vehicles;20
(iv) Sickness, accident, disability, or death occurring during 21
travel, provided that the health benefits are not offered on a stand-22
alone basis and are incidental to other coverage; 23
(v) Emergency evacuation; 24
(vi) Repatriation of remains; or 25
(vii) Any other contractual obligations to indemnify or pay a 26
specified amount to the traveler upon determinable contingencies 27
related to travel as approved by the commissioner.28
(b) "Travel insurance" does not include major medical plans that 29
provide comprehensive medical protection for travelers with trips 30
lasting longer than six months including, for example, those working 31
or residing overseas as an expatriate, or any other product that 32
requires a specific insurance producer license. 33
(14) "Travel protection plans" means plans that provide one or 34
more of the following: Travel insurance, travel assistance services, 35
and cancellation fee waivers. 36
(15) "Travel retailer" means a business entity that makes, 37
arranges, or offers planned travel and may offer and disseminate 38
travel insurance as a service to its customers on behalf of and under 39
the direction of a limited lines travel insurance producer.40
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NEW SECTION. Sec. 3. (1) In accordance with RCW 48.17.170, the 1
commissioner may issue a limited lines travel insurance producer 2
license to an individual or business entity that has filed with the 3
commissioner an application for a limited lines travel insurance 4
producer license in a form and manner prescribed by the commissioner. 5
Such limited lines travel insurance producer must be licensed to 6
sell, solicit, or negotiate travel insurance through an authorized 7
insurer. No person may act as a limited lines travel insurance 8
producer or travel insurance retailer unless properly licensed or 9
registered, respectively.10
(2) A travel retailer may offer and disseminate travel insurance 11
under a limited lines travel insurance producer business entity 12
license only if the following conditions are met: 13
(a) The limited lines travel insurance producer or travel 14
retailer provides to purchasers of travel insurance:15
(i) A description of the material terms or the actual material 16
terms of the insurance coverage; 17
(ii) A description of the process for filing a claim;18
(iii) A description of the review or cancellation process for the 19
travel insurance policy; and 20
(iv) The identity and contact information of the insurer and 21
limited lines travel insurance producer; 22
(b) At the time of licensure, the limited lines travel insurance 23
producer shall establish and maintain a register, on a form 24
prescribed by the commissioner, of each travel retailer that offers 25
travel insurance on the limited lines travel insurance producer's 26
behalf. The register must be maintained and updated by the limited 27
lines travel insurance producer and must include the name, address, 28
and contact information of the travel retailer and an officer or 29
person who directs or controls the travel retailer's operations, and 30
the travel retailer's federal tax identification number. The limited 31
lines travel insurance producer shall submit such register to the 32
state insurance department annually. The limited lines travel 33
insurance producer shall certify that the travel retailer registered 34
complies with 18 U.S.C. Sec. 1033. The grounds for the suspension, 35
revocation, and penalties applicable to resident insurance producers 36
under RCW 48.17.530 apply to the limited lines travel insurance 37
producers and travel retailers; 38
(c) The limited lines travel insurance producer has designated 39
one of its employees who is a licensed individual producer as the 40
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person responsible for the compliance with the travel insurance laws 1
and regulations applicable to the limited lines travel insurance 2
producer and its registrants; 3
(d) The employee designated under (c) of this subsection, 4
president, secretary, treasurer, and any other officer or person who 5
directs or controls the limited lines travel insurance producer's 6
insurance operations complies with the fingerprinting requirements 7
applicable to insurance producers in the resident state of the 8
limited lines travel insurance producer; 9
(e) The limited lines travel insurance producer has paid all 10
applicable licensing fees as set forth in applicable state law; and11
(f) The limited lines travel insurance producer requires each 12
employee and authorized representative of the travel retailer whose 13
duties include offering and disseminating travel insurance to receive 14
a program of instruction or training, which is subject, at the 15
discretion of the commissioner, to review and approval. The training 16
material must, at a minimum, contain adequate instructions on the 17
types of insurance offered, ethical sales practices, and required 18
disclosures to prospective customers. 19
(3) Any travel retailer offering or disseminating travel 20
insurance shall make available to prospective purchasers brochures or 21
other written materials that have been approved by the travel 22
insurer. Such materials must include information that, at a minimum:23
(a) Provides the identity and contact information of the insurer 24
and the limited lines travel insurance producer; 25
(b) Explains that the purchase of travel insurance is not 26
required in order to purchase any other product or service from the 27
travel retailer; and 28
(c) Explains that an unlicensed travel retailer is permitted to 29
provide only general information about the insurance offered by the 30
travel retailer, including a description of the coverage and price, 31
but is not qualified or authorized to answer technical questions 32
about the terms and conditions of the insurance offered by the travel 33
retailer or to evaluate the adequacy of the customer's existing 34
insurance coverage. 35
(4) A travel retailer employee or authorized representative who 36
is not licensed as an insurance producer may not: 37
(a) Evaluate or interpret the technical terms, benefits, and 38
conditions of the offered travel insurance coverage;39
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(b) Evaluate or provide advice concerning a prospective 1
purchaser's existing insurance coverage; or 2
(c) Hold himself or itself out as an authorized insurer, licensed 3
producer, or insurance expert. 4
(5) Notwithstanding any other provision in law, a travel retailer 5
whose insurance-related activities, and those of its employees and 6
authorized representatives, are limited to offering and disseminating 7
travel insurance on behalf of and under the direction of a limited 8
lines travel insurance producer meeting the conditions stated in this 9
chapter, is authorized to receive related compensation, upon 10
registration by the limited lines travel insurance producer as 11
described in subsection (2)(b) of this section. 12
(6) As the insurer's designee, the limited lines travel insurance 13
producer is responsible for the acts of the travel retailer and shall 14
ensure compliance by the travel retailer with this chapter.15
NEW SECTION. Sec. 4. (1) A travel insurer shall pay premium tax 16
as provided in RCW 48.14.020 on travel insurance premiums paid by any 17
of the following:18
(a) An individual primary policyholder who is a resident of this 19
state; 20
(b) A primary certificate holder who is a resident of this state 21
who elects coverage under a group travel insurance policy; or22
(c) A blanket travel insurance policyholder that is a resident 23
in, or has its principal place of business or the principal place of 24
business of an affiliate or subsidiary that has purchased blanket 25
travel insurance in this state for eligible blanket group members, 26
subject to any apportionment rules that apply to the insurer across 27
multiple taxing jurisdictions or that permit the insurer to allocate 28
premium on an apportioned basis in a reasonable and equitable manner 29
in those jurisdictions. 30
(2) A travel insurer shall: 31
(a) Document the state of residence or principal place of 32
business of the policyholder or certificate holder, as required in 33
subsection (1) of this section; and 34
(b) Report as premium only the amount allocable to travel 35
insurance and not any amounts received for travel assistance 36
services, cancellation fee waivers, or other noninsurance services.37
p. 8 HB 2087
NEW SECTION. Sec. 5. Travel protection plans may be offered for 1
one price for the combined features that the travel protection plan 2
offers in this state if:3
(1) The travel protection plan clearly discloses to the consumer, 4
at or prior to the time of purchase, that it includes travel 5
insurance, travel assistance services, and cancellation fee waivers 6
as applicable, and provides information and an opportunity, at or 7
prior to the time of purchase, for the consumer to obtain additional 8
information regarding the features and pricing of each; and9
(2) The fulfillment materials: 10
(a) Describe and delineate the travel insurance, travel 11
assistance services, and cancellation fee waivers in the travel 12
protection plan; and 13
(b) Include the travel insurance disclosures and the contact 14
information for persons providing travel assistance services, and 15
cancellation fee waivers, as applicable. 16
NEW SECTION. Sec. 6. (1) All persons offering travel insurance 17
to residents of this state are subject to chapter 48.30 RCW, except 18
as otherwise provided in this section. In the event of a conflict 19
between this chapter and other provisions of this title regarding the 20
sale and marketing of travel insurance and travel protection plans, 21
the provisions of this chapter control.22
(2) Pursuant to section 12 of this act, offering or selling a 23
travel insurance policy that could never result in payment of any 24
claims for any insured under the policy is an unfair trade practice 25
under chapter 48.30 RCW. 26
(3) The marketing requirements in this subsection apply to travel 27
insurance. 28
(a) All documents provided to consumers prior to the purchase of 29
travel insurance including, but not limited to, sales materials, 30
advertising materials, and marketing materials, must be consistent 31
with the travel insurance policy itself including, but not limited 32
to, forms, endorsements, policies, rate filings, and certificates of 33
insurance. 34
(b) For travel insurance policies or certificates that contain 35
preexisting condition exclusions, information and an opportunity to 36
learn more about the preexisting condition exclusions must be 37
provided any time prior to the time of purchase, and in the 38
coverage's fulfillment materials. 39
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(c) The fulfillment materials and the information described in 1
section 3 (2)(a) of this act must be provided to a policyholder or 2
certificate holder as soon as practicable, following the purchase of 3
a travel protection plan. Unless the insured has either started a 4
covered trip or filed a claim under the travel insurance coverage, a 5
policyholder or certificate holder may cancel a policy or certificate 6
for a full refund of the travel protection plan price from the date 7
of purchase of a travel protection plan until at least: (i) 15 days 8
following the date of delivery of the travel protection plan's 9
fulfillment materials by postal mail; or (ii) 10 days following the 10
date of delivery of the travel protection plan's fulfillment 11
materials by means other than postal mail. For the purposes of this 12
subsection, "delivery" means handing fulfillment materials to the 13
policyholder or certificate holder or sending fulfillment materials 14
by postal mail or electronic means to the policyholder or certificate 15
holder. 16
(d) The company shall disclose in the policy documentation and 17
fulfillment materials whether the travel insurance is primary or 18
secondary to other applicable coverage. 19
(e) Where travel insurance is marketed directly to a consumer 20
through an insurer's website or by others through an aggregator site, 21
it is not an unfair trade practice or other violation of law where an 22
accurate summary or short description of coverage is provided on the 23
web page, so long as the consumer has access to the full provisions 24
of the policy through electronic means. 25
(4) No person offering, soliciting, or negotiating travel 26
insurance or travel protection plans on an individual or group basis 27
may do so by using negative option or opt out, which would require a 28
consumer to take an affirmative action to deselect coverage, such as 29
unchecking a box on an electronic form, when the consumer purchases a 30
trip. 31
(5) Pursuant to section 12 of this act, it is an unfair trade 32
practice to market blanket travel insurance coverage as free.33
(6) Where a consumer's destination jurisdiction requires 34
insurance coverage, it is not an unfair trade practice to require 35
that a consumer choose between the following options as a condition 36
of purchasing a trip or travel package: 37
(a) Purchasing the coverage required by the destination 38
jurisdiction through the travel retailer or limited lines travel 39
insurance producer supplying the trip or travel package; or40
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(b) Agreeing to obtain and provide proof of coverage that meets 1
the destination jurisdiction's requirements prior to departure.2
NEW SECTION. Sec. 7. (1) Notwithstanding any other provisions 3
of this title, no person may act or represent itself as a travel 4
administrator for travel insurance in this state unless that person 5
is a licensed property and casualty insurance producer in this state 6
for activities permitted under that producer license.7
(2) A travel administrator and its employees are exempt from the 8
licensing requirements of RCW 48.17.060(2) for travel insurance it 9
administers. 10
(3) An insurer is responsible for the acts of a travel 11
administrator administering travel insurance underwritten by the 12
insurer, and is responsible for ensuring that the travel 13
administrator maintains all books and records relevant to the insurer 14
to be made available by the travel administrator to the commissioner 15
upon request. 16
NEW SECTION. Sec. 8. (1)(a) Subject to (b) and (c) of this 17
subsection, notwithstanding any other provision of this title, travel 18
insurance is classified and filed for purposes of rates and forms 19
under an inland marine line of insurance.20
(b) Travel insurance that provides coverage for sickness, 21
accident, disability, or death occurring during travel, either 22
exclusively, or in conjunction with related coverages of emergency 23
evacuation or repatriation of remains, or incidental limited property 24
and casualty benefits such as baggage or trip cancellation, may be 25
filed under either an accident and health line of insurance or an 26
inland marine line of insurance. 27
(c) The rates and forms filings per product may only be filed 28
under one line of insurance. 29
(2) Travel insurance may be in the form of an individual, group, 30
or blanket policy. 31
(3) Eligibility and underwriting standards for travel insurance 32
may be developed and provided based on travel protection plans 33
designed for individual or identified marketing or distribution 34
channels, provided those standards also meet the state's underwriting 35
standards for inland marine. 36
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NEW SECTION. Sec. 9. The commissioner may adopt rules as 1
necessary to implement and administer this chapter and shall repeal 2
existing rules pertaining to travel insurance that are inconsistent 3
with this chapter.4
NEW SECTION. Sec. 10. This chapter may be known and cited as 5
the Washington travel insurance act.6
NEW SECTION. Sec. 11. Sections 1 through 10 of this act 7
constitute a new chapter in Title 48 RCW.8
NEW SECTION. Sec. 12. A new section is added to chapter 48.43 9
RCW to read as follows: 10
In accordance with section 6 of this act, it is an unfair trade 11
practice to: 12
(1) Offer or sell a travel insurance policy that could never 13
result in payment of any claims for any insured under the policy; or14
(2) Market blanket travel insurance coverage as free.15
Sec. 13. RCW 48.17.060 and 2010 c 67 s 3 are each amended to 16
read as follows: 17
(1) A person shall not sell, solicit, or negotiate insurance in 18
this state for any line or lines of insurance unless the person is 19
licensed for that line of authority in accordance with this chapter.20
(2)(a) A person may not act as or hold himself or herself out to 21
be an adjuster in this state unless licensed by the commissioner or 22
otherwise authorized to act as an adjuster under this chapter.23
(b) In accordance with section 7 (2) of this act, a travel 24
administrator, as defined in section 2 of this act, and its employees 25
are exempt from the licensing requirements of this subsection (2) for 26
travel insurance it administers.27
(3) A person may not act as or hold himself or herself out to be 28
a crop adjuster in this state unless licensed by the commissioner or 29
otherwise authorized to act as a crop adjuster under this chapter.30
Sec. 14. RCW 48.43.005 and 2024 c 218 s 1 are each amended to 31
read as follows: 32
Unless otherwise specifically provided, the definitions in this 33
section apply throughout this chapter. 34
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(1) "Adjusted community rate" means the rating method used to 1
establish the premium for health plans adjusted to reflect 2
actuarially demonstrated differences in utilization or cost 3
attributable to geographic region, age, family size, and use of 4
wellness activities. 5
(2) "Adverse benefit determination" means a denial, reduction, or 6
termination of, or a failure to provide or make payment, in whole or 7
in part, for a benefit, including a denial, reduction, termination, 8
or failure to provide or make payment that is based on a 9
determination of an enrollee's or applicant's eligibility to 10
participate in a plan, and including, with respect to group health 11
plans, a denial, reduction, or termination of, or a failure to 12
provide or make payment, in whole or in part, for a benefit resulting 13
from the application of any utilization review, as well as a failure 14
to cover an item or service for which benefits are otherwise provided 15
because it is determined to be experimental or investigational or not 16
medically necessary or appropriate. 17
(3) "Air ambulance service" has the same meaning as defined in 18
section 2799A-2 of the public health service act (42 U.S.C. Sec. 19
300gg-112) and implementing federal regulations in effect on March 20
31, 2022. 21
(4) "Allowed amount" means the maximum portion of a billed charge 22
a health carrier will pay, including any applicable enrollee cost-23
sharing responsibility, for a covered health care service or item 24
rendered by a participating provider or facility or by a 25
nonparticipating provider or facility. 26
(5) "Applicant" means a person who applies for enrollment in an 27
individual health plan as the subscriber or an enrollee, or the 28
dependent or spouse of a subscriber or enrollee. 29
(6) "Balance bill" means a bill sent to an enrollee by a 30
nonparticipating provider or facility for health care services 31
provided to the enrollee after the provider or facility's billed 32
amount is not fully reimbursed by the carrier, exclusive of permitted 33
cost-sharing. 34
(7) "Basic health plan" means the plan described under chapter 35
70.47 RCW, as revised from time to time. 36
(8) "Basic health plan model plan" means a health plan as 37
required in RCW 70.47.060(2)(e). 38
(9) "Basic health plan services" means that schedule of covered 39
health services, including the description of how those benefits are 40
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to be administered, that are required to be delivered to an enrollee 1
under the basic health plan, as revised from time to time.2
(10) "Behavioral health emergency services provider" means 3
emergency services provided in the following settings:4
(a) A crisis stabilization unit as defined in RCW 71.05.020;5
(b) A 23-hour crisis relief center as defined in RCW 71.24.025;6
(c) An evaluation and treatment facility that can provide 7
directly, or by direct arrangement with other public or private 8
agencies, emergency evaluation and treatment, outpatient care, and 9
timely and appropriate inpatient care to persons suffering from a 10
mental disorder, and which is licensed or certified as such by the 11
department of health; 12
(d) An agency certified by the department of health under chapter 13
71.24 RCW to provide outpatient crisis services; 14
(e) An agency certified by the department of health under chapter 15
71.24 RCW to provide medically managed or medically monitored 16
withdrawal management services; or 17
(f) A mobile rapid response crisis team as defined in RCW 18
71.24.025 that is contracted with a behavioral health administrative 19
services organization operating under RCW 71.24.045 to provide crisis 20
response services in the behavioral health administrative services 21
organization's service area. 22
(11) "Board" means the governing board of the Washington health 23
benefit exchange established in chapter 43.71 RCW.24
(12)(a) For grandfathered health benefit plans issued before 25
January 1, 2014, and renewed thereafter, "catastrophic health plan" 26
means: 27
(i) In the case of a contract, agreement, or policy covering a 28
single enrollee, a health benefit plan requiring a calendar year 29
deductible of, at a minimum, $1,750 and an annual out-of-pocket 30
expense required to be paid under the plan (other than for premiums) 31
for covered benefits of at least $3,500, both amounts to be adjusted 32
annually by the insurance commissioner; and 33
(ii) In the case of a contract, agreement, or policy covering 34
more than one enrollee, a health benefit plan requiring a calendar 35
year deductible of, at a minimum, $3,500 and an annual out-of-pocket 36
expense required to be paid under the plan (other than for premiums) 37
for covered benefits of at least $6,000, both amounts to be adjusted 38
annually by the insurance commissioner. 39
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(b) In July 2008, and in each July thereafter, the insurance 1
commissioner shall adjust the minimum deductible and out-of-pocket 2
expense required for a plan to qualify as a catastrophic plan to 3
reflect the percentage change in the consumer price index for medical 4
care for a preceding 12 months, as determined by the United States 5
department of labor. For a plan year beginning in 2014, the out-of-6
pocket limits must be adjusted as specified in section 1302 (c)(1) of 7
P.L. 111-148 of 2010, as amended. The adjusted amount shall apply on 8
the following January 1st. 9
(c) For health benefit plans issued on or after January 1, 2014, 10
"catastrophic health plan" means: 11
(i) A health benefit plan that meets the definition of 12
catastrophic plan set forth in section 1302 (e) of P.L. 111-148 of 13
2010, as amended; or 14
(ii) A health benefit plan offered outside the exchange 15
marketplace that requires a calendar year deductible or out-of-pocket 16
expenses under the plan, other than for premiums, for covered 17
benefits, that meets or exceeds the commissioner's annual adjustment 18
under (b) of this subsection. 19
(13) "Certification" means a determination by a review 20
organization that an admission, extension of stay, or other health 21
care service or procedure has been reviewed and, based on the 22
information provided, meets the clinical requirements for medical 23
necessity, appropriateness, level of care, or effectiveness under the 24
auspices of the applicable health benefit plan. 25
(14) "Concurrent review" means utilization review conducted 26
during a patient's hospital stay or course of treatment.27
(15) "Covered person" or "enrollee" means a person covered by a 28
health plan including an enrollee, subscriber, policyholder, 29
beneficiary of a group plan, or individual covered by any other 30
health plan. 31
(16) "Dependent" means, at a minimum, the enrollee's legal spouse 32
and dependent children who qualify for coverage under the enrollee's 33
health benefit plan. 34
(17) "Emergency medical condition" means a medical, mental 35
health, or substance use disorder condition manifesting itself by 36
acute symptoms of sufficient severity including, but not limited to, 37
severe pain or emotional distress, such that a prudent layperson, who 38
possesses an average knowledge of health and medicine, could 39
reasonably expect the absence of immediate medical, mental health, or 40
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substance use disorder treatment attention to result in a condition 1
(a) placing the health of the individual, or with respect to a 2
pregnant woman, the health of the woman or her unborn child, in 3
serious jeopardy, (b) serious impairment to bodily functions, or (c) 4
serious dysfunction of any bodily organ or part. 5
(18) "Emergency services" means: 6
(a)(i) A medical screening examination, as required under section 7
1867 of the social security act (42 U.S.C. Sec. 1395dd), that is 8
within the capability of the emergency department of a hospital, 9
including ancillary services routinely available to the emergency 10
department to evaluate that emergency medical condition;11
(ii) Medical examination and treatment, to the extent they are 12
within the capabilities of the staff and facilities available at the 13
hospital, as are required under section 1867 of the social security 14
act (42 U.S.C. Sec. 1395dd) to stabilize the patient. Stabilize, with 15
respect to an emergency medical condition, has the meaning given in 16
section 1867 (e)(3) of the social security act (42 U.S.C. Sec. 17
1395dd(e)(3)); and 18
(iii) Covered services provided by staff or facilities of a 19
hospital after the enrollee is stabilized and as part of outpatient 20
observation or an inpatient or outpatient stay with respect to the 21
visit during which screening and stabilization services have been 22
furnished. Poststabilization services relate to medical, mental 23
health, or substance use disorder treatment necessary in the short 24
term to avoid placing the health of the individual, or with respect 25
to a pregnant woman, the health of the woman or her unborn child, in 26
serious jeopardy, serious impairment to bodily functions, or serious 27
dysfunction of any bodily organ or part; or 28
(b)(i) A screening examination that is within the capability of a 29
behavioral health emergency services provider including ancillary 30
services routinely available to the behavioral health emergency 31
services provider to evaluate that emergency medical condition;32
(ii) Examination and treatment, to the extent they are within the 33
capabilities of the staff and facilities available at the behavioral 34
health emergency services provider, as are required under section 35
1867 of the social security act (42 U.S.C. Sec. 1395dd) or as would 36
be required under such section if such section applied to behavioral 37
health emergency services providers, to stabilize the patient. 38
Stabilize, with respect to an emergency medical condition, has the 39
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meaning given in section 1867 (e)(3) of the social security act (42 1
U.S.C. Sec. 1395dd(e)(3)); and 2
(iii) Covered behavioral health services provided by staff or 3
facilities of a behavioral health emergency services provider after 4
the enrollee is stabilized and as part of outpatient observation or 5
an inpatient or outpatient stay with respect to the visit during 6
which screening and stabilization services have been furnished. 7
Poststabilization services relate to mental health or substance use 8
disorder treatment necessary in the short term to avoid placing the 9
health of the individual, or with respect to a pregnant woman, the 10
health of the woman or her unborn child, in serious jeopardy, serious 11
impairment to bodily functions, or serious dysfunction of any bodily 12
organ or part. 13
(19) "Employee" has the same meaning given to the term, as of 14
January 1, 2008, under section 3 (6) of the federal employee 15
retirement income security act of 1974. 16
(20) "Enrollee point-of-service cost-sharing" or "cost-sharing" 17
means amounts paid to health carriers directly providing services, 18
health care providers, or health care facilities by enrollees and may 19
include copayments, coinsurance, or deductibles. 20
(21) "Essential health benefit categories" means:21
(a) Ambulatory patient services; 22
(b) Emergency services; 23
(c) Hospitalization; 24
(d) Maternity and newborn care; 25
(e) Mental health and substance use disorder services, including 26
behavioral health treatment; 27
(f) Prescription drugs; 28
(g) Rehabilitative and habilitative services and devices;29
(h) Laboratory services; 30
(i) Preventive and wellness services and chronic disease 31
management; and 32
(j) Pediatric services, including oral and vision care.33
(22) "Exchange" means the Washington health benefit exchange 34
established under chapter 43.71 RCW. 35
(23) "Final external review decision" means a determination by an 36
independent review organization at the conclusion of an external 37
review. 38
(24) "Final internal adverse benefit determination" means an 39
adverse benefit determination that has been upheld by a health plan 40
p. 17 HB 2087
or carrier at the completion of the internal appeals process, or an 1
adverse benefit determination with respect to which the internal 2
appeals process has been exhausted under the exhaustion rules 3
described in RCW 48.43.530 and 48.43.535. 4
(25) "Grandfathered health plan" means a group health plan or an 5
individual health plan that under section 1251 of the patient 6
protection and affordable care act, P.L. 111 -148 (2010) and as 7
amended by the health care and education reconciliation act, P.L. 8
111-152 (2010) is not subject to subtitles A or C of the act as 9
amended. 10
(26) "Grievance" means a written complaint submitted by or on 11
behalf of a covered person regarding service delivery issues other 12
than denial of payment for medical services or nonprovision of 13
medical services, including dissatisfaction with medical care, 14
waiting time for medical services, provider or staff attitude or 15
demeanor, or dissatisfaction with service provided by the health 16
carrier. 17
(27) "Ground ambulance services" means: 18
(a) The rendering of medical treatment and care at the scene of a 19
medical emergency or while transporting a patient from the scene to 20
an appropriate health care facility or behavioral health emergency 21
services provider when the services are provided by one or more 22
ground ambulance vehicles designed for this purpose; and23
(b) Ground ambulance transport between hospitals or behavioral 24
health emergency services providers, hospitals or behavioral health 25
emergency services providers and other health care facilities or 26
locations, and between health care facilities when the services are 27
medically necessary and are provided by one or more ground ambulance 28
vehicles designed for this purpose. 29
(28) "Ground ambulance services organization" means a public or 30
private organization licensed by the department of health under 31
chapter 18.73 RCW to provide ground ambulance services. For purposes 32
of this chapter, ground ambulance services organizations are not 33
considered providers. 34
(29) "Health care facility" or "facility" means hospices licensed 35
under chapter 70.127 RCW, hospitals licensed under chapter 70.41 RCW, 36
rural health care facilities as defined in RCW 70.175.020, 37
((psychiatric)) behavioral health hospitals licensed under chapter 38
71.12 RCW, nursing homes licensed under chapter 18.51 RCW, community 39
mental health centers licensed under chapter 71.05 or 71.24 RCW, 40
p. 18 HB 2087
kidney disease treatment centers licensed under chapter 70.41 RCW, 1
ambulatory diagnostic, treatment, or surgical facilities licensed 2
under chapter 70.41 or 70.230 RCW, drug and alcohol treatment 3
facilities licensed under chapter 70.96A RCW, and home health 4
agencies licensed under chapter 70.127 RCW, and includes such 5
facilities if owned and operated by a political subdivision or 6
instrumentality of the state and such other facilities as required by 7
federal law and implementing regulations. 8
(30) "Health care provider" or "provider" means:9
(a) A person regulated under Title 18 or chapter 70.127 RCW, to 10
practice health or health-related services or otherwise practicing 11
health care services in this state consistent with state law; or12
(b) An employee or agent of a person described in (a) of this 13
subsection, acting in the course and scope of his or her employment.14
(31) "Health care service" means that service offered or provided 15
by health care facilities and health care providers relating to the 16
prevention, cure, or treatment of illness, injury, or disease.17
(32) "Health carrier" or "carrier" means a disability insurer 18
regulated under chapter 48.20 or 48.21 RCW, a health care service 19
contractor as defined in RCW 48.44.010, or a health maintenance 20
organization as defined in RCW 48.46.020, and includes "issuers" as 21
that term is used in the patient protection and affordable care act 22
(P.L. 111-148). 23
(33) "Health plan" or "health benefit plan" means any policy, 24
contract, or agreement offered by a health carrier to provide, 25
arrange, reimburse, or pay for health care services except the 26
following: 27
(a) Long-term care insurance governed by chapter 48.84 or 48.83 28
RCW; 29
(b) Medicare supplemental health insurance governed by chapter 30
48.66 RCW; 31
(c) Coverage supplemental to the coverage provided under chapter 32
55, Title 10, United States Code; 33
(d) Limited health care services offered by limited health care 34
service contractors in accordance with RCW 48.44.035;35
(e) Disability income; 36
(f) Coverage incidental to a property/casualty liability 37
insurance policy such as automobile personal injury protection 38
coverage and homeowner guest medical; 39
(g) Workers' compensation coverage; 40
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(h) Accident only coverage; 1
(i) Specified disease or illness -triggered fixed payment 2
insurance, hospital confinement fixed payment insurance, or other 3
fixed payment insurance offered as an independent, noncoordinated 4
benefit; 5
(j) Employer-sponsored self-funded health plans;6
(k) Dental only and vision only coverage; 7
(l) Plans deemed by the insurance commissioner to have a short-8
term limited purpose or duration, or to be a student-only plan that 9
is guaranteed renewable while the covered person is enrolled as a 10
regular full-time undergraduate or graduate student at an accredited 11
higher education institution, after a written request for such 12
classification by the carrier and subsequent written approval by the 13
insurance commissioner; 14
(m) Civilian health and medical program for the veterans affairs 15
administration (CHAMPVA); ((and))16
(n) Stand-alone prescription drug coverage that exclusively 17
supplements medicare part D coverage provided through an employer 18
group waiver plan under federal social security act regulation 42 19
C.F.R. Sec. 423.458(c); and20
(o) Beginning January 1, 2027, travel insurance as defined in 21
section 2 of this act. 22
(34) "Individual market" means the market for health insurance 23
coverage offered to individuals other than in connection with a group 24
health plan. 25
(35) "In-network" or "participating" means a provider or facility 26
that has contracted with a carrier or a carrier's contractor or 27
subcontractor to provide health care services to enrollees and be 28
reimbursed by the carrier at a contracted rate as payment in full for 29
the health care services, including applicable cost-sharing 30
obligations. 31
(36) "Local governmental entity" means any entity that is 32
authorized to establish or provide ground ambulance services or set 33
rates for ground ambulance services, including those as authorized in 34
RCW 35.27.370, 35.23.456, 52.12.135, chapter 35.21 RCW, or as 35
authorized under any state law. 36
(37) "Material modification" means a change in the actuarial 37
value of the health plan as modified of more than five percent but 38
less than fifteen percent. 39
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(38) "Nonemergency health care services performed by 1
nonparticipating providers at certain participating facilities" means 2
covered items or services other than emergency services with respect 3
to a visit at a participating health care facility, as provided in 4
section 2799A-1 (b) of the public health service act (42 U.S.C. Sec. 5
300gg-111(b)), 45 C.F.R. Sec. 149.30, and 45 C.F.R. Sec. 149.120 as 6
in effect on March 31, 2022. 7
(39) "Open enrollment" means a period of time as defined in rule 8
to be held at the same time each year, during which applicants may 9
enroll in a carrier's individual health benefit plan without being 10
subject to health screening or otherwise required to provide evidence 11
of insurability as a condition for enrollment. 12
(40) "Out-of-network" or "nonparticipating" means a provider or 13
facility that has not contracted with a carrier or a carrier's 14
contractor or subcontractor to provide health care services to 15
enrollees. 16
(41) "Out-of-pocket maximum" or "maximum out-of-pocket" means the 17
maximum amount an enrollee is required to pay in the form of cost-18
sharing for covered benefits in a plan year, after which the carrier 19
covers the entirety of the allowed amount of covered benefits under 20
the contract of coverage. 21
(42) "Preexisting condition" means any medical condition, 22
illness, or injury that existed any time prior to the effective date 23
of coverage. 24
(43) "Premium" means all sums charged, received, or deposited by 25
a health carrier as consideration for a health plan or the 26
continuance of a health plan. Any assessment or any "membership," 27
"policy," "contract," "service," or similar fee or charge made by a 28
health carrier in consideration for a health plan is deemed part of 29
the premium. "Premium" shall not include amounts paid as enrollee 30
point-of-service cost-sharing. 31
(44)(a) "Protected individual" means: 32
(i) An adult covered as a dependent on the enrollee's health 33
benefit plan, including an individual enrolled on the health benefit 34
plan of the individual's registered domestic partner; or35
(ii) A minor who may obtain health care without the consent of a 36
parent or legal guardian, pursuant to state or federal law.37
(b) "Protected individual" does not include an individual deemed 38
not competent to provide informed consent for care under RCW 39
11.88.010(1)(e). 40
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(45) "Review organization" means a disability insurer regulated 1
under chapter 48.20 or 48.21 RCW, health care service contractor as 2
defined in RCW 48.44.010, or health maintenance organization as 3
defined in RCW 48.46.020, and entities affiliated with, under 4
contract with, or acting on behalf of a health carrier to perform a 5
utilization review. 6
(46) "Sensitive health care services" means health services 7
related to reproductive health, sexually transmitted diseases, 8
substance use disorder, gender dysphoria, gender-affirming care, 9
domestic violence, and mental health. 10
(47) "Small employer" or "small group" means any person, firm, 11
corporation, partnership, association, political subdivision, sole 12
proprietor, or self-employed individual that is actively engaged in 13
business that employed an average of at least one but no more than 50 14
employees, during the previous calendar year and employed at least 15
one employee on the first day of the plan year, is not formed 16
primarily for purposes of buying health insurance, and in which a 17
bona fide employer-employee relationship exists. In determining the 18
number of employees, companies that are affiliated companies, or that 19
are eligible to file a combined tax return for purposes of taxation 20
by this state, shall be considered an employer. Subsequent to the 21
issuance of a health plan to a small employer and for the purpose of 22
determining eligibility, the size of a small employer shall be 23
determined annually. Except as otherwise specifically provided, a 24
small employer shall continue to be considered a small employer until 25
the plan anniversary following the date the small employer no longer 26
meets the requirements of this definition. A self-employed individual 27
or sole proprietor who is covered as a group of one must also: (a) 28
Have been employed by the same small employer or small group for at 29
least twelve months prior to application for small group coverage, 30
and (b) verify that he or she derived at least 75 percent of his or 31
her income from a trade or business through which the individual or 32
sole proprietor has attempted to earn taxable income and for which he 33
or she has filed the appropriate internal revenue service form 1040, 34
schedule C or F, for the previous taxable year, except a self-35
employed individual or sole proprietor in an agricultural trade or 36
business, must have derived at least 51 percent of his or her income 37
from the trade or business through which the individual or sole 38
proprietor has attempted to earn taxable income and for which he or 39
p. 22 HB 2087
she has filed the appropriate internal revenue service form 1040, for 1
the previous taxable year. 2
(48) "Special enrollment" means a defined period of time of not 3
less than thirty-one days, triggered by a specific qualifying event 4
experienced by the applicant, during which applicants may enroll in 5
the carrier's individual health benefit plan without being subject to 6
health screening or otherwise required to provide evidence of 7
insurability as a condition for enrollment. 8
(49) "Standard health questionnaire" means the standard health 9
questionnaire designated under chapter 48.41 RCW. 10
(50) "Utilization review" means the prospective, concurrent, or 11
retrospective assessment of the necessity and appropriateness of the 12
allocation of health care resources and services of a provider or 13
facility, given or proposed to be given to an enrollee or group of 14
enrollees. 15
(51) "Wellness activity" means an explicit program of an activity 16
consistent with department of health guidelines, such as, smoking 17
cessation, injury and accident prevention, reduction of alcohol 18
misuse, appropriate weight reduction, exercise, automobile and 19
motorcycle safety, blood cholesterol reduction, and nutrition 20
education for the purpose of improving enrollee health status and 21
reducing health service costs. 22
NEW SECTION. Sec. 15. Sections 1 through 13 of this act take 23
effect January 1, 2027.24
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