Insurance statutes

AN ACT Relating to correcting obsolete or erroneous references in 1
statutes administered by the insurance commissioner, by repealing 2
defunct statutes and reports, aligning policy with federal law and 3
current interpretations, making timeline adjustments, protecting 4
patient data, and making technical corrections; amending RCW 5
42.56.400, 48.14.070, 48.19.460, 48.19.501, 48.19.540, 48.37.050, 6
48.38.010, 48.38.012, 48.43.0128, 48.43.115, 48.43.135, 48.43.743, 7
48.135.030, 48.140.040, 48.140.050, 48.150.100, and 48.160.020; 8
repealing RCW 48.02.230, 48.02.240, 48.19.500, 48.43.049, 48.43.650, 9
48.140.070, and 48.160.005; and providing an effective date.10
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:11
Sec. 1. RCW 42.56.400 and 2023 c 149 s 12 are each amended to 12
read as follows: 13
The following information relating to insurance and financial 14
institutions is exempt from disclosure under this chapter:15
(1) Records maintained by the board of industrial insurance 16
appeals that are related to appeals of crime victims' compensation 17
claims filed with the board under RCW 7.68.110; 18
(2) Information obtained and exempted or withheld from public 19
inspection by the health care authority under RCW 41.05.026, whether 20
retained by the authority, transferred to another state purchased 21
Z-0287.2
SENATE BILL 5262
State of Washington 69th Legislature 2025 Regular Session
By Senators Kauffman, J. Wilson, Nobles, Shewmake, and Trudeau; by
request of Insurance Commissioner
Read first time 01/14/25. Referred to Committee on Business,
Financial Services & Trade.
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health care program by the authority, or transferred by the authority 1
to a technical review committee created to facilitate the 2
development, acquisition, or implementation of state purchased health 3
care under chapter 41.05 RCW; 4
(3) The names and individual identification data of either all 5
owners or all insureds, or both, received by the insurance 6
commissioner under chapter 48.102 RCW; 7
(4) Information provided under RCW 48.30A.045 through 48.30A.060;8
(5) Information provided under RCW 48.05.510 through 48.05.535, 9
48.43.200 through 48.43.225, 48.44.530 through 48.44.555, and 10
48.46.600 through 48.46.625; 11
(6) Examination reports and information obtained by the 12
department of financial institutions from banks under RCW 30A.04.075, 13
from savings banks under RCW 32.04.220, from savings and loan 14
associations under RCW 33.04.110, from credit unions under RCW 15
31.12.565, from check cashers and sellers under RCW 31.45.030(3), and 16
from securities brokers and investment advisers under RCW 21.20.100, 17
information that could reasonably be expected to reveal the identity 18
of a whistleblower under RCW 21.40.090, and information received 19
under RCW 43.320.190, all of which are confidential and privileged 20
information; 21
(7) Information provided to the insurance commissioner under RCW 22
48.110.040(3); 23
(8) Documents, materials, or information obtained by the 24
insurance commissioner under RCW 48.02.065, all of which are 25
confidential and privileged; 26
(9) Documents, materials, or information obtained or provided by 27
the insurance commissioner under RCW 48.31B.015(2) (l) and (m), 28
48.31B.025, 48.31B.030, 48.31B.035, and 48.31B.036, all of which are 29
confidential and privileged; 30
(10) Data filed under RCW 48.140.020, 48.140.030, 48.140.050, and 31
7.70.140 that, alone or in combination with any other data, may 32
reveal the identity of a claimant, health care provider, health care 33
facility, insuring entity, or self-insurer involved in a particular 34
claim or a collection of claims. For the purposes of this subsection:35
(a) "Claimant" has the same meaning as in RCW 48.140.010(2).36
(b) "Health care facility" has the same meaning as in RCW 37
48.140.010(6). 38
(c) "Health care provider" has the same meaning as in RCW 39
48.140.010(7). 40
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(d) "Insuring entity" has the same meaning as in RCW 1
48.140.010(8). 2
(e) "Self-insurer" has the same meaning as in RCW 48.140.010(11);3
(11) Documents, materials, or information obtained by the 4
insurance commissioner under RCW 48.135.060; 5
(12) Documents, materials, or information obtained by the 6
insurance commissioner under RCW 48.37.060; 7
(13) Confidential and privileged documents obtained or produced 8
by the insurance commissioner and identified in RCW 48.37.080;9
(14) Documents, materials, or information obtained by the 10
insurance commissioner under RCW 48.37.140; 11
(15) Documents, materials, or information obtained by the 12
insurance commissioner under RCW 48.17.595; 13
(16) Documents, materials, or information obtained by the 14
insurance commissioner under RCW 48.102.051(1) and 48.102.140 (3) and 15
(7)(a)(ii); 16
(17) Documents, materials, or information obtained by the 17
insurance commissioner in the commissioner's capacity as receiver 18
under RCW 48.31.025 and 48.99.017, which are records under the 19
jurisdiction and control of the receivership court. The commissioner 20
is not required to search for, log, produce, or otherwise comply with 21
the public records act for any records that the commissioner obtains 22
under chapters 48.31 and 48.99 RCW in the commissioner's capacity as 23
a receiver, except as directed by the receivership court;24
(18) Documents, materials, or information obtained by the 25
insurance commissioner under RCW 48.13.151; 26
(19) Data, information, and documents provided by a carrier 27
pursuant to section 1, chapter 172, Laws of 2010; 28
(20) Information in a filing of usage-based insurance about the 29
usage-based component of the rate pursuant to RCW 48.19.040(5)(b);30
(21) Data, information, and documents that are submitted to the 31
office of the insurance commissioner by an entity providing health 32
care coverage pursuant to RCW 28A.400.275; 33
(22) Data, information, and documents obtained by the insurance 34
commissioner under RCW 48.29.017; 35
(23) Information not subject to public inspection or public 36
disclosure under RCW 48.43.730(5); 37
(24) Documents, materials, or information obtained by the 38
insurance commissioner under chapter 48.05A RCW; 39
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(25) Documents, materials, or information obtained by the 1
insurance commissioner under RCW 48.74.025, 48.74.028, 48.74.100(6), 2
48.74.110(2) (b) and (c), and 48.74.120 to the extent such documents, 3
materials, or information independently qualify for exemption from 4
disclosure as documents, materials, or information in possession of 5
the commissioner pursuant to a financial conduct examination and 6
exempt from disclosure under RCW 48.02.065; 7
(26) Nonpublic personal health information obtained by, disclosed 8
to, or in the custody of the insurance commissioner, as provided in 9
RCW 48.02.068; 10
(27) ((Data, information, and documents obtained by the insurance 11
commissioner under RCW 48.02.230;12
(28))) Documents, materials, or other information, including the 13
corporate annual disclosure obtained by the insurance commissioner 14
under RCW 48.195.020; 15
(((29))) (28) Findings and orders disapproving acquisition of a 16
trust institution under RCW 30B.53.100(3); 17
(((30))) (29) All claims data, including health care and 18
financial related data received under RCW 41.05.890, received and 19
held by the health care authority; ((and20
(31))) (30) Documents, materials, or information obtained by the 21
insurance commissioner under RCW 48.150.100; and22
(31) Contracts not subject to public disclosure under RCW 23
48.200.040 and 48.43.731. 24
Sec. 2. RCW 48.14.070 and 2009 c 549 s 7056 are each amended to 25
read as follows: 26
In event any person has paid to the commissioner any tax, license 27
fee or other charge in error or in excess of that which he or she is 28
lawfully obligated to pay, the commissioner shall upon written 29
request ((made to him or her )) make a refund thereof. A person may 30
only request a refund of taxes within six years ((from the date the 31
taxes were paid)) of the end of the calendar year for which the taxes 32
are owed. A person may only request a refund of fees or charges other 33
than taxes within ((thirteen)) 13 months of the date the fees or 34
charges were paid. Refunds may be made either by crediting the amount 35
toward payment of charges due or to become due from such person, or 36
by making a cash refund. ((To facilitate such cash refunds the 37
commissioner may establish a revolving fund out of funds appropriated 38
by the legislature for his use.))39
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Sec. 3. RCW 48.19.460 and 2007 c 258 s 1 are each amended to 1
read as follows: 2
Any schedule of rates or rating plan for personal automobile 3
liability and physical damage insurance submitted to or filed with 4
the commissioner shall provide for an appropriate reduction in 5
premium charges except for underinsured motorist coverage for those 6
insureds who are ((fifty-five)) 55 years of age and older, for a two-7
year period after successfully completing a motor vehicle accident 8
prevention course meeting the criteria of the department of licensing 9
with a minimum of eight hours, or additional hours as determined by 10
rule of the department of licensing. The classroom course may be 11
conducted by a public or private agency approved by the department. 12
An eight-hour course meeting the criteria of the department of 13
licensing may be offered via an alternative delivery method of 14
instruction, which may include internet, video, or other technology-15
based delivery methods. An agency seeking approval from the 16
department to offer an alternative delivery method course of 17
instruction is not required to conduct classroom courses under this 18
section. The department of licensing may adopt rules to ensure that 19
insureds who seek certification for taking a course offered via an 20
alternative delivery method have completed the course.21
Sec. 4. RCW 48.19.501 and 1989 c 11 s 21 are each amended to 22
read as follows: 23
Due consideration in making rates for motor vehicle insurance 24
shall be given to((:25
(1) Any anticipated change in losses that may be attributable to 26
the use of properly installed and maintained anti-theft devices in 27
the insured private passenger automobile. An exhibit detailing these 28
losses and any credits or discounts resulting from any such changes 29
shall be included in each filing pertaining to private passenger 30
automobile (or motor vehicle) insurance.31
(2) Any anticipated change in losses that may be attributable to 32
the use of lights and lighting devices that have been proven 33
effective in increasing the visibility of motor vehicles during 34
daytime or in poor visibility conditions and to the use of rear stop 35
lights that have been proven effective in reducing rear-end 36
collisions. An exhibit detailing these losses and any credits or 37
discounts resulting from any such changes shall be included in each 38
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filing pertaining to private passenger automobile (or motor vehicle) 1
insurance. 2
(3) Any)) any anticipated change in losses per vehicle covered 3
that may be attributable to the fact that the insured has more 4
vehicles covered under the policy than there are insured drivers in 5
the same household. An exhibit detailing these changes and any 6
credits or discounts resulting from any such changes shall be 7
included in each filing pertaining to private passenger automobile 8
(or motor vehicle) insurance. 9
Sec. 5. RCW 48.19.540 and 2019 c 455 s 4 are each amended to 10
read as follows: 11
(1) In making rates for the insurance coverage for dwelling 12
units, insurers shall consider the benefits of fire alarms and smoke 13
detection devices in their rate making. If the insurer determines a 14
separate rate factor is valid, then an exhibit supporting these 15
changes and any credits or discounts resulting from any such changes 16
must be included in the initial filing supporting such change. An 17
insurer need not file any exhibits or offer any related discounts if:18
(a) No changes are made to the credits or discounts already in 19
effect prior to July 28, 2019; 20
(b) It determines that there is no material anticipated change in 21
losses due to the use of such equipment; or 22
(c) Any potential credit or discount is not actuarially 23
supported. 24
(2) ((The commissioner shall report to the appropriate committees 25
of the legislature on any credits or discounts provided on insurance 26
premiums for fire alarms and smoke detection devices installed in 27
dwelling units. By December 31, 2020, and in compliance with RCW 28
43.01.036, the commissioner must submit a report to the appropriate 29
committees of the legislature that details the use of discounts prior 30
to and after July 28, 2019, and the type of fire alarm or smoke 31
detection device qualifying for a credit or discount.32
(3))) For the purposes of this section: 33
(a) "Dwelling unit" means a residential dwelling of any type, 34
including a single-family residence, apartment, condominium, or 35
cooperative unit. 36
(b) "Smoke detection device" or "smoke detection devices" means 37
an assembly incorporating in one unit a device which detects visible 38
or invisible particles of combustion, the control equipment, and the 39
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alarm-sounding device, operated from a power supply either in the 1
unit or obtained at the point of installation. 2
(c) "Fire alarm" or "fire alarms" means any mechanical, 3
electrical(([,])), or radio-controlled device that is designed to 4
emit a sound or transmit a signal or message when activated or any 5
such device that emits a sound and transmits a signal or message when 6
activated because of smoke, heat(([,])), or fire. 7
(((4))) (3) This section applies to rate filings for coverage for 8
dwelling units filed on or after January 1, 2020. 9
Sec. 6. RCW 48.37.050 and 2007 c 82 s 7 are each amended to read 10
as follows: 11
(1) Market conduct actions shall be taken as a result of market 12
analysis and shall focus on the general business practices and 13
compliance activities of insurers, rather than identifying obviously 14
infrequent or unintentional random errors that do not cause 15
significant consumer harm. 16
(2)(a) The commissioner is authorized to determine the frequency 17
and timing of such market conduct actions. The timing shall depend 18
upon the specific market conduct action to be initiated, unless 19
extraordinary circumstances indicating a risk to consumers require 20
immediate action. 21
(b) If the commissioner has information that more than one 22
insurer is engaged in common practices that may violate statutes or 23
rules, the commissioner may schedule and coordinate multiple 24
examinations simultaneously. 25
(3) The insurer shall be given reasonable opportunity to resolve 26
matters that arise as a result of a market analysis to the 27
satisfaction of the commissioner before any additional market conduct 28
actions are taken against the insurer. 29
(4) The commissioner shall adopt by rule, under chapter 34.05 30
RCW, procedures and documents that are substantially similar to the 31
NAIC work products defined or referenced in this chapter. Market 32
analysis, market conduct actions, and market conduct examinations 33
shall be performed in accordance with the rule. 34
(((5) At the beginning of the next legislative session after the 35
adoption of the rules adopted under the authority of this section, 36
the commissioner shall report to the appropriate policy committees of 37
the legislature what rules were adopted; what statutory policies 38
these rules were intended to implement; and such other matters as are 39
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indicated for the legislature's understanding of the role played by 1
the NAIC in regulation of the insurance industry of Washington.))2
Sec. 7. RCW 48.38.010 and 2012 c 211 s 5 are each amended to 3
read as follows: 4
The commissioner may grant a certificate of exemption to any 5
insurer or educational, religious, charitable, or scientific 6
institution conducting a charitable gift annuity business that:7
(1) ((Which is)) Is organized and operated exclusively as, or for 8
the purpose of aiding, an educational, religious, charitable, or 9
scientific institution which is organized as a nonprofit organization 10
without profit to any person, firm, partnership, association, 11
corporation, or other entity; 12
(2) ((Which possesses )) Possesses a current tax exempt status 13
under the laws of the United States; 14
(3) ((Which serves )) Serves such purpose by issuing charitable 15
gift annuity contracts only for the benefit of such educational, 16
religious, charitable, or scientific institution; 17
(4) ((Which appoints)) Appoints the insurance commissioner as its 18
true and lawful attorney upon whom may be served lawful process in 19
any action, suit, or proceeding in any court, which appointment is 20
irrevocable, binds the insurer or institution or any successor in 21
interest, remains in effect as long as there is in force in this 22
state any contract made or issued by the insurer or institution, or 23
any obligation arising therefrom, and must be processed in accordance 24
with RCW 48.05.200; 25
(5) ((Which is)) Is fully and legally organized and qualified to 26
do business and has been actively doing business under the laws of 27
the state of its domicile for a period of at least three years prior 28
to its application for a certificate of exemption;29
(6) ((Which has)) Has and maintains minimum ((unrestricted)) net 30
assets without donor restrictions of ((five hundred thousand 31
dollars)) $500,000. " ((Unrestricted net )) Net assets without donor 32
restrictions" means the excess of total assets over total liabilities 33
that are neither permanently restricted nor temporarily restricted by 34
donor-imposed stipulations; 35
(7) ((Which files )) Files with the insurance commissioner its 36
application for a certificate of exemption showing:37
(a) Its name, location, and organization date;38
(b) The kinds of charitable annuities it proposes to offer;39
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(c) A statement of the financial condition, management, and 1
affairs of the organization and any affiliate thereof, as that term 2
is defined in RCW 48.31B.005, on a form satisfactory to, or furnished 3
by the insurance commissioner; 4
(d) Other documents, stipulations, or information as the 5
insurance commissioner may reasonably require to evidence compliance 6
with the provisions of this chapter; 7
(8) ((Which subjects)) Subjects itself and any affiliate thereof, 8
as that term is defined in RCW 48.31B.005, to periodic examinations 9
conducted under chapter 48.03 RCW as may be deemed necessary by the 10
insurance commissioner; 11
(9) ((Which files)) Files with the insurance commissioner for the 12
commissioner's advance approval a copy of any policy or contract form 13
to be offered or issued to residents of this state. The grounds for 14
disapproval of the policy or contract form are set forth in RCW 15
48.18.110; and 16
(10) ((Which:))(a) Files with the insurance commissioner 17
annually, within ((sixty)) 60 days of the end of its fiscal year a 18
report of its current financial condition, management, and affairs, 19
on a form and in a manner prescribed by the commissioner, as well as 20
such other financial material as may be requested, including the 21
annual statement or other such financial materials as may be 22
requested relating to any affiliate, as that term is defined in RCW 23
48.31B.005; 24
(b) Attaches to the report of its current financial condition the 25
statement of a qualified actuary setting forth the actuary's opinion 26
relating to annuity reserves and other actuarial items for the fiscal 27
year covered by the report. "Qualified actuary" as used in this 28
subsection means a member in good standing of the American academy of 29
actuaries or a person who has otherwise demonstrated actuarial 30
competence to the satisfaction of the insurance regulatory official 31
of the domiciliary state; and 32
(c) ((On or before March 1st of each year )) Within 60 days of the 33
end of the fiscal year , pays an annual filing fee of ((twenty-five 34
dollars)) $25 plus ((five dollars )) $5 for each charitable gift 35
annuity contract written for residents of this state during ((its)) 36
the preceding fiscal year ((ending on or before December 31st of the 37
previous calendar year)). 38
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Sec. 8. RCW 48.38.012 and 1998 c 284 s 7 are each amended to 1
read as follows: 2
After June 30, 1998, an insurer or institution which does not 3
have the minimum ((unrestricted)) net assets without donor 4
restrictions required by RCW 48.38.010(6) may not issue any new 5
charitable gift annuities until the insurer or institution has and 6
maintains the minimum ((unrestricted)) net assets without donor 7
restrictions required by RCW 48.38.010(6). 8
Sec. 9. RCW 48.43.0128 and 2021 c 280 s 3 are each amended to 9
read as follows: 10
(1) A health carrier offering a nongrandfathered health plan or a 11
plan deemed by the commissioner to have a short-term limited purpose 12
or duration, or to be a student-only plan that is guaranteed 13
renewable while the covered person is enrolled as a regular, full-14
time undergraduate student at an accredited higher education 15
institution may not: 16
(a) In its benefit design or implementation of its benefit 17
design, discriminate against individuals because of their age, 18
expected length of life, present or predicted disability, degree of 19
medical dependency, quality of life, or other health conditions; and20
(b) With respect to the health plan or plan deemed by the 21
commissioner to have a short-term limited purpose or duration, or to 22
be a student-only plan that is guaranteed renewable while the covered 23
person is enrolled as a regular, full-time undergraduate student at 24
an accredited higher education institution, discriminate on the basis 25
of race, color, national origin, disability, age, sex, gender 26
identity, or sexual orientation. 27
(2) Nothing in this section may be construed to prevent a carrier 28
from appropriately utilizing reasonable medical management 29
techniques. 30
(3) For health plans issued or renewed on or after January 1, 31
2022: 32
(a) A health carrier may not deny or limit coverage for gender-33
affirming treatment when that treatment is prescribed to an 34
individual because of, related to, or consistent with a person's 35
gender expression or identity, as defined in RCW 49.60.040, is 36
medically necessary, and is prescribed in accordance with accepted 37
standards of care. 38
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(b) A health carrier may not apply categorical cosmetic or 1
blanket exclusions to gender-affirming treatment. When prescribed as 2
medically necessary gender-affirming treatment, a health carrier may 3
not exclude as cosmetic services facial feminization surgeries and 4
other facial gender-affirming treatment, such as tracheal shaves, 5
hair electrolysis, and other care such as mastectomies, breast 6
reductions, breast implants, or any combination of gender-affirming 7
procedures, including revisions to prior treatment.8
(c) A health carrier may not issue an adverse benefit 9
determination denying or limiting access to gender-affirming 10
services, unless a health care provider with experience prescribing 11
or delivering gender-affirming treatment has reviewed and confirmed 12
the appropriateness of the adverse benefit determination.13
(d) Health carriers must comply with all network access rules and 14
requirements established by the commissioner. 15
(4) For the purposes of this section, "gender-affirming 16
treatment" means a service or product that a health care provider, as 17
defined in RCW 70.02.010, prescribes to an individual to treat any 18
condition related to the individual's gender identity and is 19
prescribed in accordance with generally accepted standards of care. 20
Gender-affirming treatment must be covered in a manner compliant with 21
the federal mental health parity and addiction equity act of 2008 and 22
the federal affordable care act. Gender-affirming treatment can be 23
prescribed to two spirit, transgender, nonbinary, intersex, and other 24
gender diverse individuals. 25
(5) Nothing in this section may be construed to mandate coverage 26
of a service that is not medically necessary. 27
(6) By December 1, 2022, the commissioner, in consultation with 28
the health care authority and the department of health, must issue a 29
report on geographic access to gender-affirming treatment across the 30
state. The report must include the number of gender-affirming 31
providers offering care in each county, the carriers and medicaid 32
managed care organizations those providers have active contracts 33
with, and the types of services provided by each provider in each 34
region. The commissioner must update the report ((biannually)) 35
biennially and post the report on its website. 36
(7) The commissioner shall adopt any rules necessary to implement 37
subsections (3), (4), and (5) of this section. 38
(8) Unless preempted by federal law, the commissioner shall adopt 39
any rules necessary to implement subsections (1) and (2) of this 40
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section, consistent with federal rules and guidance in effect on 1
January 1, 2017, implementing the patient protection and affordable 2
care act. 3
Sec. 10. RCW 48.43.115 and 2020 c 80 s 37 are each amended to 4
read as follows: 5
(1) The legislature recognizes the role of health care providers 6
as the appropriate authority to determine and establish the delivery 7
of quality health care services to maternity patients and their newly 8
born children. It is the intent of the legislature to recognize 9
patient preference and the clinical sovereignty of providers as they 10
make determinations regarding services provided and the length of 11
time individual patients may need to remain in a health care facility 12
after giving birth. It is not the intent of the legislature to 13
diminish a carrier's ability to utilize managed care strategies but 14
to ensure the clinical judgment of the provider is not undermined by 15
restrictive carrier contracts or utilization review criteria that 16
fail to recognize individual postpartum needs. 17
(2) Unless otherwise specifically provided, the following 18
definitions apply throughout this section: 19
(a) "Attending provider" means a provider who: Has clinical 20
hospital privileges consistent with RCW 70.43.020; is included in a 21
provider network of the carrier that is providing coverage; and is a 22
physician licensed under chapter 18.57 or 18.71 RCW, a certified 23
nurse midwife licensed under chapter 18.79 RCW, a midwife licensed 24
under chapter 18.50 RCW, a physician's assistant licensed under 25
chapter 18.71A RCW, or an advanced practice registered nurse 26
((practitioner)) licensed under chapter 18.79 RCW.27
(b) "Health carrier" or "carrier" means disability insurers 28
regulated under chapter 48.20 or 48.21 RCW, health care services 29
contractors regulated under chapter 48.44 RCW, health maintenance 30
organizations regulated under chapter 48.46 RCW, plans operating 31
under the health care authority under chapter 41.05 RCW, the state 32
health insurance pool operating under chapter 48.41 RCW, and insuring 33
entities regulated under this chapter. 34
(3)(a) Every health carrier that provides coverage for maternity 35
services must permit the attending provider, in consultation with the 36
mother, to make decisions on the length of inpatient stay, rather 37
than making such decisions through contracts or agreements between 38
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providers, hospitals, and insurers. These decisions must be based on 1
accepted medical practice. 2
(b) Covered eligible services may not be denied for inpatient, 3
postdelivery care to a mother and her newly born child after a 4
vaginal delivery or a cesarean section delivery for such care as 5
ordered by the attending provider in consultation with the mother.6
(c) At the time of discharge, determination of the type and 7
location of follow-up care must be made by the attending provider in 8
consultation with the mother rather than by contract or agreement 9
between the hospital and the insurer. These decisions must be based 10
on accepted medical practice. 11
(d) Covered eligible services may not be denied for follow-up 12
care, including in-person care, as ordered by the attending provider 13
in consultation with the mother. Coverage for providers of follow-up 14
services must include, but need not be limited to, attending 15
providers as defined in this section, home health agencies licensed 16
under chapter 70.127 RCW, and registered nurses licensed under 17
chapter 18.79 RCW. 18
(e) This section does not require attending providers to 19
authorize care they believe to be medically unnecessary.20
(((f) Coverage for the newly born child must be no less than the 21
coverage of the child's mother for no less than three weeks, even if 22
there are separate hospital admissions.))23
(4) A carrier that provides coverage for maternity services may 24
not deselect, terminate the services of, require additional 25
documentation from, require additional utilization review of, reduce 26
payments to, or otherwise provide financial disincentives to any 27
attending provider or health care facility solely as a result of the 28
attending provider or health care facility ordering care consistent 29
with this section. This section does not prevent any insurer from 30
reimbursing an attending provider or health care facility on a 31
capitated, case rate, or other financial incentive basis.32
(5) Every carrier that provides coverage for maternity services 33
must provide notice to policyholders regarding the coverage required 34
under this section. The notice must be in writing and must be 35
transmitted at the earliest of the next mailing to the policyholder, 36
the yearly summary of benefits sent to the policyholder, or January 1 37
of the year following June 6, 1996. 38
(6) This section does not establish a standard of medical care.39
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(7) This section applies to coverage for maternity services under 1
a contract issued or renewed by a health carrier after June 6, 1996, 2
and applies to plans operating under the health care authority under 3
chapter 41.05 RCW beginning January 1, 1998. 4
Sec. 11. RCW 48.43.135 and 2023 c 245 s 1 are each amended to 5
read as follows: 6
(1) For nongrandfathered group health plans other than small 7
group health plans issued or renewed on or after January 1, 2024, and 8
for health plans issued or renewed on or after January 1, 2026, a 9
health carrier shall include coverage for hearing instruments, 10
including bone conduction hearing devices. This section does not 11
include coverage of over-the-counter hearing instruments.12
(2) Coverage shall also include the initial assessment, fitting, 13
adjustment, auditory training, and ear molds as necessary to maintain 14
optimal fit. Coverage of the services in this subsection shall 15
include services for enrollees who intend to obtain or have already 16
obtained any hearing instrument, including an over-the-counter 17
hearing instrument. 18
(3) ((A))(a) Until the date specified in (b) of this subsection, 19
a health carrier shall provide coverage for hearing instruments as 20
provided in subsection (1) of this section at no less than $3,000 per 21
ear with hearing loss every 36 months. 22
(b) For health plans issued or renewed on or after January 1, 23
2026, a health carrier shall provide coverage for hearing instruments 24
as provided in subsection (1) of this section every 36 months per ear 25
with hearing loss and may not establish any lifetime or annual limit 26
on the dollar amount of coverage for services described in subsection 27
(1) or (2) of this section for any individual, whether provided in-28
network or out-of-network.29
(c) A health carrier may require prior authorization or adopt 30
other appropriate utilization controls in approving coverage for 31
medically necessary hearing instruments.32
(4) The services and hearing instruments covered under this 33
section are not subject to the enrollee's deductible unless the 34
health plan is offered as a qualifying health plan for a health 35
savings account. For such a qualifying health plan, the carrier may 36
apply a deductible to coverage of the services covered under this 37
section only at the minimum level necessary to preserve the 38
enrollee's ability to claim tax exempt contributions and withdrawals 39
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from the enrollee's health savings account under internal revenue 1
service laws and regulations. 2
(5) Coverage for a minor under 18 years of age shall be available 3
under this section only after the minor has received medical 4
clearance within the preceding six months from: 5
(a) An otolaryngologist for an initial evaluation of hearing 6
loss; or 7
(b) A licensed physician, which indicates there has not been a 8
substantial change in clinical status since the initial evaluation by 9
an otolaryngologist. 10
(6) For the purposes of this section: 11
(a) "Hearing instrument" has the same meaning as defined in RCW 12
18.35.010. 13
(b) "Over-the-counter hearing instrument" has the same meaning as 14
"over-the-counter hearing aid" in 21 C.F.R. Sec. 800.30 as of 15
December 28, 2022. 16
Sec. 12. RCW 48.43.743 and 2015 c 9 s 2 are each amended to read 17
as follows: 18
(1) Each health carrier offering a dental only plan in Washington 19
shall submit to the commissioner on or before April 1st of each year 20
as part of the additional data statement , or as a supplemental data 21
statement ((the following information)), Washington specific data for 22
the preceding year that is derived from the carrier's annual 23
statement, including the exhibit of premiums, enrollments, and 24
utilization for the company at an aggregate level and the additional 25
data to the annual statement: 26
(a) The total number of dental members; 27
(b) The total amount of dental revenue; 28
(c) The total amount of dental payments; 29
(d) The dental loss ratio that is computed by dividing the total 30
amount of dental payments by the total amount of dental revenues;31
(e) The average amount of premiums per member per month; and32
(f) The percentage change in the average premium per member per 33
month, measured from the previous year. 34
(2) A carrier shall electronically submit the information 35
described in subsection (1) of this section in a format and according 36
to instructions prescribed by the commissioner. 37
(3) The commissioner shall make the information reported under 38
this section available to the public ((in a format that allows 39
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comparison among carriers through a searchable )) on the 1
commissioner's public website on the internet. 2
(4) For the purposes of licensed disability insurers and health 3
care service contractors, the commissioner shall work collaboratively 4
with insurers to develop an additional or supplemental data statement 5
that utilizes to the maximum extent possible information from the 6
annual statement forms that are currently filed by these entities.7
(5) For purposes of this section, "health carrier," in addition 8
to the definition in RCW 48.43.005, also includes health care service 9
contractors, limited health care service contractors, and disability 10
insurers offering dental only coverage. 11
(6) Nothing in this section is intended to establish a minimum 12
dental loss ratio. 13
Sec. 13. RCW 48.135.030 and 2006 c 284 s 4 are each amended to 14
read as follows: 15
The annual cost of operating the fraud program is funded from the 16
insurance commissioner's ((regulatory)) fraud account under RCW 17
48.02.190 subject to appropriation by the legislature.18
Sec. 14. RCW 48.140.040 and 2006 c 8 s 204 are each amended to 19
read as follows: 20
((The commissioner must prepare aggregate statistical summaries 21
of closed claims based on data submitted under RCW 48.140.020.22
(1) At a minimum, the commissioner must summarize data by 23
calendar year and calendar/incident year. The commissioner may also 24
decide to display data in other ways if the commissioner:25
(a) Protects information as required under RCW 48.140.060(2); and26
(b) Exempts from disclosure data described in RCW 42.56.400(11).27
(2) The summaries must be available by April 30th of each year, 28
unless the commissioner notifies legislative committees by March 15th 29
that data are not available and informs the committees when the 30
summaries will be completed.31
(3))) Information included in an individual closed claim report 32
submitted by an insuring entity, self-insurer, provider, or facility 33
under this chapter is confidential and exempt from public disclosure, 34
and the commissioner must not make these data available to the 35
public. 36
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Sec. 15. RCW 48.140.050 and 2006 c 8 s 205 are each amended to 1
read as follows: 2
((Beginning in 2010, the )) The commissioner must prepare an 3
annual report that summarizes and analyzes the medical malpractice 4
closed claim ((reports for medical malpractice )) data filed under RCW 5
48.140.020 and 7.70.140 and the annual financial ((reports)) data 6
filed ((by authorized insurers )) with the national association of 7
insurance commissioners by insuring entities writing medical 8
malpractice insurance in this state. The commissioner must complete 9
the report by ((June 30th, unless the commissioner notifies 10
legislative committees by June 1st that data are not available and 11
informs the committees when the summaries will be completed )) 12
September 1st. 13
(1) The report must include: 14
(a) An analysis of reported closed claims from prior years for 15
which data are collected. The analysis must show: 16
(i) Trends in the frequency and severity of claim payments;17
(ii) A comparison of economic and noneconomic damages;18
(iii) A distribution of allocated loss adjustment expenses and 19
other legal expenses; 20
(iv) The types of medical malpractice for which claims have been 21
paid; and 22
(v) Any other information the commissioner finds relevant to 23
trends in medical malpractice closed claims if the commissioner:24
(A) Protects information as required under RCW 48.140.060(2); and25
(B) Exempts from disclosure data described in RCW 26
42.56.400(((11))) (10); 27
(b) An analysis of the medical malpractice insurance market in 28
Washington state, including: 29
(i) An analysis of the financial ((reports)) data of the 30
authorized insurers with a combined market share of at least 31
((ninety)) 90 percent of direct written medical malpractice premium 32
in Washington state for the prior calendar year; 33
(ii) A loss ratio analysis of medical malpractice insurance 34
written in Washington state; and 35
(iii) A profitability analysis of the authorized insurers with a 36
combined market share of at least ((ninety)) 90 percent of direct 37
written medical malpractice premium in Washington state for the prior 38
calendar year; 39
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(c) A comparison of loss ratios and the profitability of medical 1
malpractice insurance in Washington state to other states based on 2
financial ((reports)) data filed with the national association of 3
insurance commissioners and any other source of information the 4
commissioner deems relevant; and 5
(d) A summary of the rate filings for medical malpractice that 6
have been approved by the commissioner for the prior calendar year, 7
including an analysis of the trend of direct incurred losses as 8
compared to prior years. 9
(2) The commissioner must post reports required by this section 10
on the internet no later than ((thirty)) 30 days after they are due.11
(3) The commissioner may adopt rules that require insuring 12
entities and self-insurers required to report under RCW 48.140.020 13
and subsection (1)(a) of this section to report data related to:14
(a) The frequency and severity of closed claims for the reporting 15
period; and 16
(b) Any other closed claim information that helps the 17
commissioner monitor losses and claim development patterns in the 18
Washington state medical malpractice insurance market.19
Sec. 16. RCW 48.150.100 and 2007 c 267 s 12 are each amended to 20
read as follows: 21
(1) Direct practices must submit annual statements, beginning on 22
October 1, 2007, to the office of (([the])) the insurance 23
commissioner specifying the number of providers in each practice, 24
total number of patients being served, the average direct fee being 25
charged, providers' names, and the business address for each direct 26
practice. The form and content for the annual statement must be 27
developed in a manner prescribed by the commissioner. The annual 28
statements and the data reported in them are confidential and exempt 29
from public disclosure, and from the requirements of chapter 42.56 30
RCW.31
(2) A health care provider may not act as, or hold himself or 32
herself out to be, a direct practice in this state, nor may a direct 33
agreement be entered into with a direct patient in this state, unless 34
the provider submits the annual statement in subsection (1) of this 35
section to the commissioner. 36
(3) The commissioner shall report annually to the legislature on 37
direct practices including, but not limited to, participation trends, 38
complaints received, voluntary data reported by the direct practices, 39
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and any necessary modifications to this chapter. The commissioner's 1
report and the data in it shall be in aggregate form that does not 2
permit the identification of individual direct practices. The initial 3
report shall be due December 1, 2009. 4
Sec. 17. RCW 48.160.020 and 2009 c 334 s 3 are each amended to 5
read as follows: 6
(1) This chapter applies only to guaranteed asset protection 7
waivers for financing of motor vehicles as defined in this chapter. 8
Any person or entity must register with the commissioner before 9
marketing, offering for sale or selling a guaranteed asset protection 10
waiver, and before acting as an obligor for a guaranteed asset 11
protection waiver, in this state. However, a retail seller of motor 12
vehicles that assigns more than ((eighty-five)) 85 percent of 13
guaranteed asset protection waiver agreements within ((thirty)) 30 14
days of such agreements' effective date, or an insurer authorized to 15
transact such insurance business in this state, are not required to 16
register pursuant to this section. Failure of any retail seller of 17
motor vehicles to assign ((one hundred )) 100 percent of guaranteed 18
asset protection waiver agreements within ((forty-five)) 45 days of 19
such agreements' effective date will result in that retail seller 20
being required to comply with the registration requirements of this 21
chapter. 22
(2) No person may market, offer for sale, or sell a guaranteed 23
asset protection waiver, or act as an obligor on a guaranteed asset 24
protection waiver in this state without a registration as provided in 25
this chapter, except as set forth in subsection (1) of this section.26
(3) The application for registration must include the following:27
(a) The applicant's name, address, and telephone number;28
(b) The identities of the applicant's executive officers or other 29
officers directly responsible for the waiver business;30
(c) An application fee of ((two hundred fifty dollars )) $250, 31
which shall be deposited into the ((guaranteed asset protection 32
waiver account)) general fund; 33
(d) A copy filed by the applicant with the commissioner of the 34
waivers the applicant intends to offer in this state;35
(e) A list of all unregistered marketers of guaranteed asset 36
protection waivers on which the applicant will be the obligor;37
(f) Such additional information as the commissioner may 38
reasonably require. 39
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(4) Once registered, the applicant shall keep the information 1
required for registration current by reporting changes within 2
((thirty)) 30 days after the end of the month in which the change 3
occurs. 4
NEW SECTION. Sec. 18. The following acts or parts of acts are 5
each repealed:6
(1) RCW 48.02.230 (Health insurance market stability program — 7
Confidentiality— Definitions— Reports— Commissioner's 8
responsibilities) and 2017 3rd sp.s. c 30 s 1; 9
(2) RCW 48.02.240 (Natural disaster and resiliency work group) 10
and 2019 c 388 s 2; 11
(3) RCW 48.19.500 (Motor vehicle insurance — Seat belts, etc) and 12
1989 c 11 s 20 & 1987 c 310 s 1; 13
(4) RCW 48.43.049 (Health carrier data — Information from annual 14
statement— Format prescribed by commissioner — Public availability) and 15
2006 c 104 s 2; 16
(5) RCW 48.43.650 (Fixed payment insurance products — 17
Commissioner's annual report) and 2007 c 296 s 6; 18
(6) RCW 48.140.070 (Model statistical reporting standards — Report 19
to legislature) and 2006 c 8 s 207; and 20
(7) RCW 48.160.005 (Guaranteed asset protection waiver account) 21
and 2009 c 334 s 10. 22
NEW SECTION. Sec. 19. Section 7 of this act takes effect 23
January 1, 2026.24
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