This section modifies existing section 49.60.178. Here is the modified chapter for context.
It is an unfair practice for any person whether acting for himself, herself, or another in connection with an insurance transaction or transaction with a health maintenance organization to cancel or fail or refuse to issue or renew insurance or a health maintenance agreement to any person because of sex, marital status, sexual orientation, race, creed, color, national origin, citizenship or immigration status, or the presence of any sensory, mental, or physical disability or the use of a trained dog guide or service animal by a person with disabilities: PROVIDED, That a practice which is not unlawful under RCW 48.30.300, 48.44.220, or 48.46.370 does not constitute an unfair practice for the purposes of this section. For the purposes of this section, "insurance transaction" is defined in RCW 48.01.060, health maintenance agreement is defined in RCW 48.46.020, and "health maintenance organization" is defined in RCW 48.46.020.
For a health carrier offering a health plan issued or renewed on or after January 1, 2022:
It is an unfair practice to issue an adverse benefit determination for gender affirming treatment when that care is prescribed to an individual because of, related to, or consistent with a protected gender identity characteristic under RCW 49.60.040 and is medically necessary.
It is unfair practice to apply categorical cosmetic or blanket exclusions to gender affirming treatment.
Facial feminization surgeries and facial gender affirming treatment, such as tracheal shaves, hair electrolysis, and other care such as mastectomies, breast reductions, and breast implants, or any combination of gender affirming procedures, when prescribed as gender affirming treatment and are medically necessary, shall not be excluded as cosmetic.
Health carriers must ensure that health care providers who have experience prescribing or delivering gender affirming treatment conduct the utilization reviews pursuant to RCW 48.43.005(45) for any claim for gender affirming treatment.
If the health carrier does not have an adequate network for gender affirming treatment, the health carrier shall ensure the delivery of timely and geographically accessible medically necessary gender affirming treatment at no greater expense than if the health carrier had an in-network, geographically accessible provider available. This includes, but is not limited to, providing case management services to secure out-of-network gender affirming treatment options that are available to the enrollee in a timely manner within their geographic region. The enrollee shall pay no more than the same cost sharing that the enrollee would pay for the same covered services received from an in-network provider.
Subsections (1) and (2) of this section apply to health plans under chapter 74.09 RCW and all employee benefit plans pursuant to RCW 41.05.075.
The fact that such unfair practice may also be a violation of chapter 48.30, 48.44, or 48.46 RCW does not constitute a defense to an action brought under this section.
The insurance commissioner, under RCW 48.30.300, and the human rights commission, under chapter 49.60 RCW, shall have concurrent jurisdiction under this section and shall enter into a working agreement as to procedure to be followed in complaints under this section.
The insurance commissioner may adopt rules necessary for the implementation of this section.
This section modifies existing section 41.05.017. Here is the modified chapter for context.
Each health plan that provides medical insurance offered under this chapter, including plans created by insuring entities, plans not subject to the provisions of Title 48 RCW, and plans created under RCW 41.05.140, are subject to the provisions of RCW 48.43.500, 70.02.045, 48.43.505 through 48.43.535, 48.43.537, 48.43.545, 48.43.550, 70.02.110, 70.02.900, 48.43.190, 48.43.083, 48.30.300, and chapter 48.49 RCW.