§ 48.49.090 — Carrier—Requirement to update website and provider directory—Requirement to provide enrollee with certain information.

Washington § 48.49.090

• Jurisdiction: Washington
• Title 48: INSURANCE
• Ch. 48.49: BALANCE BILLING PROTECTION ACT

Text

(1) A carrier must update its website and provider directory no later than thirty days after the addition or termination of a facility or provider.

(2) A carrier must provide an enrollee with:

(a) A clear description of the health plan's out-of-network health benefits;

(b) The notice of consumer rights developed under RCW 48.49.060 ;

(c) Notification that if the enrollee receives services from an out-of-network provider, facility, behavioral health emergency services provider, or ground ambulance services organization, under circumstances other than those described in RCW 48.49.020 and 48.49.200 , the enrollee will have the financial responsibility applicable to services provided outside the health plan's network in excess of applicable cost-sharing amounts and that the enrollee may be responsible for any costs in excess of those allowed by the health plan;

(d) Information on how to use the carrier's member transparency tools under RCW 48.43.007 ;

(e) Upon request, information regarding whether a health care provider is in-network or out-of-network, and whether there are in-network providers available to provide emergency medicine, anesthesiology, pathology, radiology, neonatology, surgery, hospitalist, intensivist, and diagnostic services, including radiology and laboratory services at specified in-network hospitals or ambulatory surgical facilities; and

(f) Upon request, an estimated range of the out-of-pocket costs for an out-of-network benefit.

Effective date — 2022 c 263: See note following RCW 43.371.100 .

Legislative History

[2024 c 218 s 5;2022 c 263 s 15;2019 c 427 s 13.]