S-4122.1  _______________________________________________

                         SENATE BILL 6346

          _______________________________________________

State of Washington      54th Legislature     1996 Regular Session

By Senators Kohl, Quigley, Wood, Franklin and Thibaudeau

Read first time 01/11/96.  Referred to Committee on Health & Long‑Term Care.

Establishing health plan disclosure requirements.

    AN ACT Relating to health plan disclosure requirements; and amending RCW 48.43.045.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:

    Sec. 1.  RCW 48.43.045 and 1995 c 265 s 8 are each amended to read as follows:

    Every health plan delivered, issued for delivery, or renewed by a health carrier on and after January 1, 1996, shall:

    (1) Permit every category of health care provider to provide health services or care for conditions included in the basic health plan services to the extent that:

    (a) The provision of such health services or care is within the health care providers' permitted scope of practice; and

    (b) The providers agree to abide by standards related to:

    (i) Provision, utilization review, and cost containment of health services;

    (ii) Management and administrative procedures; and

    (iii) Provision of cost-effective and clinically efficacious health services.

    (2) Annually report the names and addresses of all officers, directors, or trustees of the health carrier during the preceding year, and the amount of wages, expense reimbursements, or other payments to such individuals.

(3) Provide enrollees and upon request potential enrollees with written disclosure of coverage and benefits, including coverage principles and any exclusions or restrictions on coverage, and make available upon request information on evaluation and treatment policies and other specific conditions.  Such information must be current, easily understandable, and easily available prior to enrollment and upon request thereafter.

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