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Wash. Rev. Code § 48.43.510

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Carrier required to disclose health plan information — Marketing and advertising restrictions — Rules

Before offering to sell a health plan, carriers must offer to provide individuals or group representatives with information regarding the plan benefits, coverage limits, plan premiums, the grievance process, the plan’s point-of-service option, and the means of accessing the list of the plan’s primary care and specialty providers.

Carriers must provide, upon the request of any individual, information regarding the medical coverage agreement, consultation with non-primary care providers, prior authorizations, reimbursement and payment arrangements, provider compensation programs, annual payment amounts, grievances, accreditation, and HEDIS data.

Carriers must “provide all enrollees and prospective enrollees a list of available disclosure items.”

Carriers that market their plan as including health prevention or promotion activities must: (1) provide “all clinical preventive health services provided by the basic health plan;” (2) monitor the plan performance on measures of health care and distribute the results annually to plan enrollees; and (3) provide enrollees, upon request, with their plan for managing enrollee rates of cancer, heart disease, stroke, and other prevalent diseases.

Current as of June 2015