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Private Insurance Data Requirements in Washington

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         Washington’s laws governing private health insurers is not very extensive.  Primarily, the law requires health insurers that desire to conduct business in Washington to comply with certain requirements regarding oversight by the Washington state health care authority and attorneys’ fees.1  The state also has a Basic Health Plan Administrator, whose function it is to monitor the quality of care provided to beneficiaries, oversee mandatory utilization reporting requirements, and verify insurer compliance with relevant requirements.2  The law also requires carriers to disclose to group and individual beneficiaries, information regarding plan benefits, premiums, grievance procedures, and ways of accessing provider lists.3  The law also requires the Department of Health to certify independent review organizations to review an insurer’s decision to deny payment for health care services.4

 

Footnotes

  • 1. Wash. Rev. Code §74.09A.030
  • 2. Wash. Rev. Code §70.47.060
  • 3. Wash. Rev. Code §48.43.510
  • 4. Wash. Rev. Code §43.70.235

 

Private Insurance Data Requirements in Washington

Subtopic Statute/Regulation Description
Disclosure of information held by health plan, including notice requirements Wash. Rev. Code § 48.43.021 Personally identifiable health information — Restrictions on release Carriers, the Washington State Health Insurance Pool, and their agents may...
Wash. Rev. Code § 48.43.510 Carrier required to disclose health plan information — Marketing and advertising restrictions — Rules Before offering to sell a health...
Wash. Rev. Code § 48.43.535 Independent review of health care disputes--System for using certified independent review organizations—Rules An individual may obtain an...
Wash. Rev. Code § 51.14.120 Copy of claim file — Notice of protest or appeal — Medical report Washington requires all self-insured employers to provide their injured...
Wash. Rev. Code § 74.09A.030 Duties of health insurers — Providing information — Payments — Claims — Costs and fees Health insurers that desire to conduct...
Health plan required reporting Wash. Rev. Code § 48.43.510 Carrier required to disclose health plan information — Marketing and advertising restrictions — Rules Before offering to sell a health...
Wash. Rev. Code § 70.47.060 Powers and duties of administrator — Schedule of services — Premiums, copayments, subsidies — Enrollment The Washington basic...
Grievance procedures Wash. Rev. Code § 48.43.535 Independent review of health care disputes--System for using certified independent review organizations—Rules An individual may obtain an...
Privacy notices required to be given to consumers (Cross reference to Privacy & Confidentiality) Wash. Rev. Code § 70.24.325 Counseling and testing — Insurance requirements Insurance issuers that request current or prospective enrollees to provide the results of an...
Click on the individual state law in the table above to see our summary of the individual law.


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by Dr. Radut.