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The definitions in this section apply throughout this chapter unless the context clearly requires otherwise.
A vision benefit manager may not:
Provide different reimbursement amounts for covered vision services or covered vision materials among tiers of contracting providers of the same licensed profession in the same health plan;
Reimburse a provider licensed under chapter 18.53 RCW, acting within the provider's scope of practice, less than it reimburses ophthalmologists licensed under chapter 18.57 or 18.71 RCW for the same covered vision services or covered vision materials;
Require a contracting provider to purchase vision services or vision materials from suppliers, including optical laboratories, in which the vision benefit manager has a financial interest;
Require a contracting provider to provide vision services or vision materials at a fee limited or set by the vision benefit manager, unless the vision materials or services are covered vision services or covered vision materials;
Require a provider of covered vision services or covered vision materials, as a condition of becoming a participating provider for a specific health plan, to:
Join a network of providers maintained by the vision benefit manager in lieu of contracting directly with the health carrier;
Participate with any other health plan, including another health plan managed by, or affiliated with, the vision benefit manager; or
Participate with any discount plan regulated under chapter 48.155 RCW;
Require an enrollee's cost sharing, including copayments, for covered vision services or vision materials to exceed 50 percent of the amount the provider is reimbursed for those services or materials, unless a higher amount is necessary to preserve the enrollee's ability to claim tax exempt contributions from the enrollee's health savings account under internal revenue service laws and regulations; or
Impose different credentialing standards for providers licensed under chapter 18.53 RCW than it imposes for ophthalmologists licensed under chapter 18.57 or 18.71 RCW.
For purposes of this section, "health plan" includes:
A health plan as defined in chapter 48.43 RCW;
A health plan issued by an employee benefits program; and
Vision-only coverage issued by a limited health care service contractor under chapter 48.44 RCW or a health carrier as defined in chapter 48.43 RCW.
This section applies to contracts entered into or renewed on or after the effective date of this section.
A health carrier offering vision coverage or a limited health care service contractor offering vision-only coverage may not:
Provide different reimbursement amounts for covered vision services or covered vision materials among tiers of contracting providers of the same licensed profession in the same health plan;
Reimburse a provider licensed under chapter 18.53 RCW, acting within the provider's scope of practice, less than it reimburses ophthalmologists licensed under chapter 18.57 or 18.71 RCW for the same covered vision services or covered vision materials;
Require a contracting provider to purchase vision services or vision materials from suppliers, including optical laboratories, in which the health carrier, limited health care service contractor, or affiliated vision benefit manager has a financial interest;
Require a contracting provider to provide vision services or materials at a fee limited or set by the health carrier, limited health care service contractor, or affiliated vision benefit manager, unless the vision services or vision materials are covered vision services or covered vision materials;
Require a provider of covered vision services or covered vision materials, as a condition of becoming a participating provider for a specific health plan, to:
Join a network of providers maintained by a vision benefit manager in lieu of contracting directly with the health carrier;
Participate with any other health plan, including another health plan managed by, or affiliated with, an affiliated vision benefit manager; or
Participate with any discount plan regulated under chapter 48.155 RCW;
Require an enrollee's cost sharing, including copayments, for covered vision services or vision materials to exceed 50 percent of the amount the provider is reimbursed for those services or materials, unless a higher amount is necessary to preserve the enrollee's ability to claim tax exempt contributions from the enrollee's health savings account under internal revenue service laws and regulations; or
Impose different credentialing standards for providers licensed under chapter 18.53 RCW than it imposes for ophthalmologists licensed under chapter 18.57 or 18.71 RCW.
For purposes of this section:
"Health plan" means:
A health plan as defined in RCW 48.43.005; and
Vision-only coverage issued by a limited health care service contractor under chapter 48.44 RCW or a health carrier.
"Limited health care service contractor" has the same meaning as in RCW 48.44.035.
"Vision benefit manager" has the same meaning as in RCW 48.200.020.
"Vision materials" means ophthalmic devices including, but not limited to, devices containing lenses, artificial intraocular lenses, ophthalmic frames and other lens mounting apparatuses, prisms, lens treatments and coatings, contact lenses, or prosthetic devices to correct, relieve, or treat defects or abnormal conditions of the human eye or its adnexa.
This section applies to contracts entered into or renewed on or after the effective date of this section.
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, 48.43.0128, 48.43.780, 48.43.435, 48.43.815, 48.200.020 through 48.200.280, 48.200.300 through 48.200.320, 48.43.440, section 3 of this act, and chapter 48.49 RCW.
The insurance commissioner may adopt any rules necessary to implement this act.
Sections 1 through 4 of this act take effect January 1, 2026.