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Private Insurance Data Requirements in Washington

         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
Private Insurance Data Requirements Wash. rev. code § 43.70.235 Health care disputes--Certifying independent review organizations--Application--Restrictions--Maximum fee schedule for conducting reviews—Rules...
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 § 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 § 70.47.060 Powers and duties of administrator — Schedule of services — Premiums, copayments, subsidies — Enrollment The Washington basic...
Wash. Rev. Code § 74.09A.030 Duties of health insurers — Providing information — Payments — Claims — Costs and fees Health insurers that desire to conduct...