Washington State

House of Representatives

Office of Program Research



Health Care & Wellness Committee

HB 1099

This analysis was prepared by non-partisan legislative staff for the use of legislative members in their deliberations. This analysis is not a part of the legislation nor does it constitute a statement of legislative intent.

Brief Description: Providing notice about network adequacy to consumers.

Sponsors: Representatives Jinkins, Cody, Tharinger, Robinson and Reeves.

Brief Summary of Bill

  • Requires health carriers to post certain information on network adequacy on their web sites.

Hearing Date: 1/23/19

Staff: Jim Morishima (786-7191).


Health carriers are required by federal and state law to maintain provider networks that provide enrollees reasonable access to covered services. Under rules adopted by the Insurance Commissioner, health carriers must meet a variety of geographic and timeliness requirements related to network adequacy.

Geographic Network Maps.

Health carriers must submit a separate map to the Insurance Commissioner for each of the following provider types:

Timeliness Requirements.

Health carriers are subject to various timeliness requirements for urgent and non-urgent appointments. For example, an enrollee must have access within 48 hours to urgent appointments that do not require prior authorization. For urgent appointments that require prior authorization, an enrollee must have access within 96 hours. For non-urgent primary care appointments, an enrollee must have access within 10 business days. For non-urgent specialty care appointments, an enrollee must have access within 15 days.

Summary of Bill:

Beginning with the 2020 plan year, a health carrier must post information on its web site regarding the carrier's compliance with network adequacy requirements adopted by the Insurance Commissioner for each health plan. The information must include:

The health carrier must post the information prominently and in an easily understandable format. The Insurance Commissioner must specify a model format for the information and a health carrier is deemed in compliance with formatting requirements if it uses the model format.

The health carrier must update the information at least quarterly. To help consumers make purchasing decisions, the carrier must continue to post the information for at least two years after the end of the applicable plan year.

The Insurance Commissioner may audit the information a health carrier posts.

Appropriation: None.

Fiscal Note: Requested January 21, 2019.

Effective Date: The bill takes effect 90 days after adjournment of the session in which the bill is passed.