48.49.090 Carrier—Requirement to update web site and provider directory—Requirement to provide enrollee with certain information.

WA Rev Code § 48.49.090 (2019) (N/A)

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RCW 48.49.090 Carrier—Requirement to update web site and provider directory—Requirement to provide enrollee with certain information. (Effective January 1, 2020.)

(1) A carrier must update its web site 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; and

(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 or facility, under circumstances other than those described in RCW 48.49.020, 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 surgical or ancillary 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.

[ 2019 c 427 § 13.]

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48.49.080 Health care provider—Requirement to provide certain information on web site or upon consumer request—Requirement to submit network status information to carriers.

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48.49.100 Pattern of unresolved violations—Enforcement action by department of health or appropriate disciplining authority.