The bill amends RCW 48.43.047 to ensure that nongrandfathered health plans issued on or after the effective date of the section provide coverage for specific preventive services without cost-sharing. The preventive services must align with the recommendations or guidelines that existed as of January 8, 2024, which include evidence-based items rated A or B by the United States Preventive Services Task Force, immunizations recommended by the Advisory Committee on Immunization Practices, and additional preventive care for women as outlined by the Health Resources and Services Administration. The bill also stipulates that health plans must cover these services for plan years beginning one year after the issuance of the relevant recommendations or guidelines.

Furthermore, the bill establishes that health plans cannot impose cost-sharing for preventive services when provided by in-network providers, and if no in-network provider is available, the plan must cover the service from an out-of-network provider without cost-sharing. The insurance commissioner is tasked with enforcing these provisions in accordance with federal rules and may adopt necessary rules to implement the section, ensuring compliance with future preventive service recommendations. The bill also includes provisions for health carriers to annually assess the coverage of preventive services and make necessary adjustments based on updated guidelines.

Statutes affected:
Original Bill: 48.43.047
Substitute Bill: 48.43.047
Engrossed Substitute: 48.43.047
Bill as Passed Legislature: 48.43.047
Session Law: 48.43.047