Washington · Regulations
Chapter 284-43 — HEALTH CARRIERS AND HEALTH PLANS
139 sections
139 sections
- WAC 284-43-0110WAC 284-43-0110. Purpose
- WAC 284-43-0120WAC 284-43-0120. Applicability and scope
- WAC 284-43-0140WAC 284-43-0140. Compliance with state and federal laws
- WAC 284-43-0160WAC 284-43-0160. Definitions
- WAC 284-43-0200WAC 284-43-0200. Deadline for filing individual health plans, small group health plans, and stand-alone dental plans
- WAC 284-43-0210WAC 284-43-0210. Transitional reinsurance program
- WAC 284-43-0230WAC 284-43-0230. Risk adjustment program
- WAC 284-43-0250WAC 284-43-0250. Grandfathered health plan status
- WAC 284-43-0270WAC 284-43-0270. Market conduct requirements related to grandfathered status
- WAC 284-43-0290WAC 284-43-0290. Small group coverage market transition requirements
- WAC 284-43-0350WAC 284-43-0350. Individual coverage market transition requirements
- WAC 284-43-0400WAC 284-43-0400. Purpose and scope
- WAC 284-43-0410WAC 284-43-0410. Definitions
- WAC 284-43-0420WAC 284-43-0420. Sensitive health care services
- WAC 284-43-0430WAC 284-43-0430. Requests regarding confidentiality and to limit disclosure
- WAC 284-43-1020WAC 284-43-1020. Special enrollment requirements for small group plans
- WAC 284-43-1040WAC 284-43-1040. Special enrollment periods for small group qualified health plans
- WAC 284-43-1060WAC 284-43-1060. Duration and effective dates of small group special enrollment periods
- WAC 284-43-1080WAC 284-43-1080. Individual market open enrollment requirements
- WAC 284-43-1100WAC 284-43-1100. Individual market special enrollment requirements
- WAC 284-43-1120WAC 284-43-1120. Individual market special enrollment period requirements for qualified health plans
- WAC 284-43-1140WAC 284-43-1140. Duration, notice requirements and effective dates of coverage for individual market special enrollment periods
- WAC 284-43-2000WAC 284-43-2000. Health care services utilization review — Generally
- WAC 284-43-2020WAC 284-43-2020. Drug utilization review — Generally
- WAC 284-43-2021WAC 284-43-2021. Prescription drug utilization management exception and substitution process
- WAC 284-43-2022WAC 284-43-2022. Time frame for exception and substitution request determinations
- WAC 284-43-2050WAC 284-43-2050. Prior authorization processes
- WAC 284-43-2060WAC 284-43-2060. Extenuating circumstances in prior authorization
- WAC 284-43-2070WAC 284-43-2070. Forms for authorization of inpatient or residential substance use disorder treatment
- WAC 284-43-3000WAC 284-43-3000. Scope and intent
- WAC 284-43-3010WAC 284-43-3010. Definitions
- WAC 284-43-3030WAC 284-43-3030. Review of adverse benefit determinations — Generally
- WAC 284-43-3050WAC 284-43-3050. Explanation of right to review
- WAC 284-43-3070WAC 284-43-3070. Notice and explanation of adverse benefit determination — General requirements
- WAC 284-43-3090WAC 284-43-3090. Electronic disclosure and communication by carriers
- WAC 284-43-3110WAC 284-43-3110. Internal review of adverse benefit determinations
- WAC 284-43-3130WAC 284-43-3130. Exhaustion of internal review remedies
- WAC 284-43-3150WAC 284-43-3150. Notice of internal review determination
- WAC 284-43-3170WAC 284-43-3170. Expedited review
- WAC 284-43-3190WAC 284-43-3190. Concurrent expedited review of adverse benefit determinations
- WAC 284-43-4000WAC 284-43-4000. Application of subchapter F
- WAC 284-43-4020WAC 284-43-4020. Grievance and complaint procedures—Generally
- WAC 284-43-4040WAC 284-43-4040. Procedures for review and appeal of adverse determinations
- WAC 284-43-4500WAC 284-43-4500. Definition
- WAC 284-43-4520WAC 284-43-4520. Grievance process — Generally
- WAC 284-43-5000WAC 284-43-5000. Preexisting condition limitations
- WAC 284-43-5020WAC 284-43-5020. Recognizing the exercise of conscience by purchasers of basic health plan services and ensuring access for all enrollees to such services
- WAC 284-43-5060WAC 284-43-5060. General prescription drug benefit requirements
- WAC 284-43-5080WAC 284-43-5080. Prescription drug benefit design
- WAC 284-43-5100WAC 284-43-5100. Formulary changes
- WAC 284-43-5110WAC 284-43-5110. Cost-sharing for prescription drugs
- WAC 284-43-5130WAC 284-43-5130. Health plan disclosure requirements
- WAC 284-43-5150WAC 284-43-5150. Unfair practice relating to health coverage
- WAC 284-43-5151WAC 284-43-5151. Unfair practice relating to gender affirming treatment and services
- WAC 284-43-5170WAC 284-43-5170. Prescription drug benefit disclosures
- WAC 284-43-5200WAC 284-43-5200. Anticancer medication
- WAC 284-43-5400WAC 284-43-5400. Purpose and scope
- WAC 284-43-5410WAC 284-43-5410. Definitions
- WAC 284-43-5420WAC 284-43-5420. Clinical trials
- WAC 284-43-5440WAC 284-43-5440. Medical necessity determination
- WAC 284-43-5602WAC 284-43-5602. Essential health benefits package benchmark reference plan
- WAC 284-43-5604WAC 284-43-5604. Essential health benefits package benchmark plan
- WAC 284-43-5622WAC 284-43-5622. Plan design
- WAC 284-43-5624WAC 284-43-5624. Plan design
- WAC 284-43-5642WAC 284-43-5642. Essential health benefit categories
- WAC 284-43-5644WAC 284-43-5644. Essential health benefit categories
- WAC 284-43-5702WAC 284-43-5702. Essential health benefit category — Pediatric oral services
- WAC 284-43-5704WAC 284-43-5704. Essential health benefit category — Pediatric oral services
- WAC 284-43-5720WAC 284-43-5720. Purpose and scope — Pediatric dental benefits for health benefit plans sold outside of the health benefit exchange
- WAC 284-43-5740WAC 284-43-5740. Definitions
- WAC 284-43-5760WAC 284-43-5760. Pediatric dental benefits design — Methods of satisfying requirements
- WAC 284-43-5782WAC 284-43-5782. Pediatric vision services
- WAC 284-43-5784WAC 284-43-5784. Pediatric vision services
- WAC 284-43-5800WAC 284-43-5800. Plan cost-sharing and benefit substitutions and limitations
- WAC 284-43-5820WAC 284-43-5820. Representations regarding coverage
- WAC 284-43-5900WAC 284-43-5900. Effective date
- WAC 284-43-5910WAC 284-43-5910. Prohibition on organ transplant waiting periods
- WAC 284-43-5920WAC 284-43-5920. Health plan rescission
- WAC 284-43-5930WAC 284-43-5930. Qualified health plan marketing and benefit design
- WAC 284-43-5935WAC 284-43-5935. Definitions
- WAC 284-43-5937WAC 284-43-5937. Hearing instrument coverage
- WAC 284-43-5939WAC 284-43-5939. Hearing instrument coverage
- WAC 284-43-5940WAC 284-43-5940. Nondiscrimination in health plans, short-term limited duration medical plans and student-only health plans
- WAC 284-43-5950WAC 284-43-5950. Access for individuals with limited-English proficiency and individuals with disabilities
- WAC 284-43-5960WAC 284-43-5960. Meaningful access for individuals with limited-English proficiency
- WAC 284-43-5965WAC 284-43-5965. Effective communication for people with disabilities
- WAC 284-43-5970WAC 284-43-5970. Equal program access on the basis of sex
- WAC 284-43-5975WAC 284-43-5975. Designation of responsible employee and adoption of grievance procedures
- WAC 284-43-5980WAC 284-43-5980. Notice requirement
- WAC 284-43-6000WAC 284-43-6000. Authority and purpose
- WAC 284-43-6010WAC 284-43-6010. Applicability and scope
- WAC 284-43-6020WAC 284-43-6020. Definitions
- WAC 284-43-6040WAC 284-43-6040. Demonstration that benefits provided are not reasonable in relation to the amount charged for a contract per RCW 48.44.020 and 48.46.060
- WAC 284-43-6100WAC 284-43-6100. Contents of individual and small group filings
- WAC 284-43-6500WAC 284-43-6500. Applicability and scope
- WAC 284-43-6520WAC 284-43-6520. Definitions
- WAC 284-43-6540WAC 284-43-6540. Summary for group contract filings other than small group contract filings
- WAC 284-43-6560WAC 284-43-6560. When a carrier is required to file
- WAC 284-43-6580WAC 284-43-6580. General contents of all filings
- WAC 284-43-6590WAC 284-43-6590. Requirements for mitigating inequity in the health insurance market