Wash. Rev. Code » Title 48 · Chapter 48.44
Revised Code of Washington

Wash. Rev. Code § 48.44.020 (2026)

✓ current as of May 2026
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(1) Any health care service contractor may enter into contracts with or for the benefit of persons or groups of persons which require prepayment for health care services by or for such persons in consideration of such health care service contractor providing one or more health care services to such persons and such activity shall not be subject to the laws relating to insurance if the health care services are rendered by the health care service contractor or by a participating provider.
(2) The commissioner may on examination, subject to the right of the health care service contractor to demand and receive a hearing under chapters 48.04 and 34.05 RCW, disapprove any individual or group contract form for any of the following grounds:
(a) If it contains or incorporates by reference any inconsistent, ambiguous or misleading clauses, or exceptions and conditions which unreasonably or deceptively affect the risk purported to be assumed in the general coverage of the contract; or
(b) If it has any title, heading, or other indication of its provisions which is misleading; or
(c) If purchase of health care services thereunder is being solicited by deceptive advertising; or
(d) If it contains unreasonable restrictions on the treatment of patients; or
(e) If it violates any provision of this chapter; or
(f) If it fails to conform to minimum provisions or standards required by regulation made by the commissioner pursuant to chapter 34.05 RCW; or
(g) If any contract for health care services with any state agency, division, subdivision, board, or commission or with any political subdivision, municipal corporation, or quasi-municipal corporation fails to comply with state law.
(3) In addition to the grounds listed in subsection (2) of this section, the commissioner may disapprove any contract if the benefits provided therein are unreasonable in relation to the amount charged for the contract. Rates, or any modification of rates effective on or after July 1, 2008, for individual health benefit plans may not be used until sixty days after they are filed with the commissioner. If the commissioner does not disapprove a rate filing within sixty days after the health care service contractor has filed the documents required in RCW 48.44.017(2) and any rules adopted pursuant thereto, the filing shall be deemed approved.
(4)(a) Every contract between a health care service contractor and a participating provider of health care services shall be in writing and shall state that in the event the health care service contractor fails to pay for health care services as provided in the contract, the enrolled participant shall not be liable to the provider for sums owed by the health care service contractor. Every such contract shall provide that this requirement shall survive termination of the contract.
(b) No participating provider, insurance producer, trustee, or assignee may maintain any action against an enrolled participant to collect sums owed by the health care service contractor.
[ 2008 c 303 s 2; 2008 c 217 s 51; 2000 c 79 s 28; 1990 c 120 s 5; 1986 c 223 s 2; 1985 c 283 s 1; 1983 c 286 s 4; 1973 1st ex.s. c 65 s 1; 1969 c 115 s 1; 1961 c 197 s 2; 1947 c 268 s 2; Rem. Supp. 1947 s 6131-11.]

Notes:

Reviser's note: This section was amended by 2008 c 217 s 51 and by 2008 c 303 s 2, each without reference to the other. Both amendments are incorporated in the publication of this section under RCW 1.12.025(2). For rule of construction, see RCW 1.12.025(1).
Severability—Effective date—2008 c 217: See notes following RCW 48.03.020.
Effective date—Severability—2000 c 79: See notes following RCW 48.04.010.
Severability—1983 c 286: See note following RCW 48.44.309.
Notes of Decisions
Cited in 17 cases (1 in the last 5 years), 1970–2023 · leading case: Leingang v. Pierce Co. Med. Bureau, Inc., 930 P.2d 288 (Wash. 1997).
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Leingang v. Pierce Co. Med. Bureau, Inc., 930 P.2d 288 (Wash. 1997). · cites it 2× “In Brown , we explained that while there was some question about the extent to which insurance law applies to health care service contracts, compare RCW 48.44.020(1) with RCW 48.44.309, for the purposes of that case, the court agreed with the parties that "general rules…”
Leingang v. Pierce Cnty. Med. Bureau, Inc., 131 Wash. 2d 133 (Wash. 1997). · cites it 2× “In Brown , we explained that while there was some question about the extent to which insurance law applies to health care service contracts, compare RCW 48.44.020(1) with RCW 48.44.309, for the purposes of that case, the court agreed with the parties that "general rules…”
Brown v. Snohomish Cnty. Physicians Corp., 845 P.2d 334 (Wash. 1993). · cites it 3× “The court noted that RCW 48.44.020 authorizes the Insurance Commissioner to disapprove any health care contract form which "contains or incorporates by reference any inconsistent, ambiguous or misleading clauses, or exceptions and conditions which unreasonably or deceptively…”
Pleasant v. Regence BlueShield, 325 P.3d 237 (Wash. Ct. App. 2014). “See RCW 48.44.020; WAC 284-43-920. A “mechanical embolectomy” is a procedure intended “to restore blood flow in the neurovasculature by removing thrombus in patients experiencing ischemic stroke.”
Myers v. Kitsap Physicians Serv., 474 P.2d 109 (Wash. 1970). · cites it 2× “It is apparent that the commissioner has not determined that this contract is unreasonable or otherwise contrary to public policy.”
McCarthy Fin., Inc. v. Premera, 347 P.3d 872 (Wash. 2015). “” RCW 48.44.020(3), (2), .110. The OIC considers numerous factors when determining whether a health insurance premium is reasonable, including “[h]ow much profit the company expects to make[,] .”
Ketcham v. King Cnty. Med. Serv. Corp., 502 P.2d 1197 (Wash. 1972). · cites it 2× “RCW 48.44.020 specifically provides in part: (2) The commissioner [Insurance Commissioner] may require the submission of contract forms for his examination and may on examination, subject to the right of the health care service contractor to demand and receive a hearing under…”
P.E.L. v. Premera Blue Cross, 540 P.3d 105 (Wash. 2023). “See WAC XXX-XX-XXXX; RCW 48.44.020(2); RCW 48.43.535-.537; CP at 1940.”
Washington Osteopathic Med. Ass'n v. King Cnty. Med. Serv. Corp., 478 P.2d 228 (Wash. 1970). “115, § 1, RCW 48.44.020(2). Numerous other regulatory requirements and prohibitions were also added by this chapter.”
McCarthy Fin., Inc. v. Premera, 328 P.3d 940 (Wash. Ct. App. 2014). · cites it 2× “RCW 48.44.020(2), .110 (‘No person shall knowingly make, publish, or disseminate any false, deceptive, or misleading representation or advertising in the conduct of the business of a health care service contractor, or relative to the business of a health care service contractor…”
Kruger Clinic Orthopaedics, L.L.C. v. Regence BlueShield, 123 Wash. App. 355 (Wash. Ct. App. 2004). “Moreover, RCW 48.44.020 provides: (1) Any health care service contractor may enter into contracts with or for the benefit of persons or groups of persons which require prepayment for health care services by or for such persons in consideration of such health care service…”
Snohomish Cnty. Physicians Corp. v. Jungaro, 794 P.2d 76 (Wash. Ct. App. 1990). “" Here, the Insurance Commissioner has reviewed and approved SCPC's contract, including the exclusion provision. Thus, it is apparent that the Commissioner has determined that SCPC's contract, including the exclusion provision at issue here, is not unreasonable or otherwise…”
Show all 17 citing cases →
— Wash. Rev. Code § 48.44.020(1) — 3 cases
Leingang v. Pierce Co. Med. Bureau, Inc., 930 P.2d 288 (Wash. 1997). “In Brown , we explained that while there was some question about the extent to which insurance law applies to health care service contracts, compare RCW 48.44.020(1) with RCW 48.44.309, for the purposes of that case, the court agreed with the parties that "general rules…”
Leingang v. Pierce Cnty. Med. Bureau, Inc., 131 Wash. 2d 133 (Wash. 1997). “In Brown , we explained that while there was some question about the extent to which insurance law applies to health care service contracts, compare RCW 48.44.020(1) with RCW 48.44.309, for the purposes of that case, the court agreed with the parties that "general rules…”
Brown v. Snohomish Cnty. Physicians Corp., 845 P.2d 334 (Wash. 1993). “The court noted that RCW 48.44.020 authorizes the Insurance Commissioner to disapprove any health care contract form which "contains or incorporates by reference any inconsistent, ambiguous or misleading clauses, or exceptions and conditions which unreasonably or deceptively…”
— Wash. Rev. Code § 48.44.020(2) — 4 cases
P.E.L. v. Premera Blue Cross, 540 P.3d 105 (Wash. 2023). “See WAC XXX-XX-XXXX; RCW 48.44.020(2); RCW 48.43.535-.537; CP at 1940.”
Washington Osteopathic Med. Ass'n v. King Cnty. Med. Serv. Corp., 478 P.2d 228 (Wash. 1970). “115, § 1, RCW 48.44.020(2). Numerous other regulatory requirements and prohibitions were also added by this chapter.”
McCarthy Fin., Inc. v. Premera, 328 P.3d 940 (Wash. Ct. App. 2014). “RCW 48.44.020(2), .110 (‘No person shall knowingly make, publish, or disseminate any false, deceptive, or misleading representation or advertising in the conduct of the business of a health care service contractor, or relative to the business of a health care service contractor…”
Mccarthy Fin., Inc. v. Premera (Wash. Ct. App. 2014).
— Wash. Rev. Code § 48.44.020(2)(a) — 1 case
Brown v. Snohomish Cnty. Physicians Corp., 845 P.2d 334 (Wash. 1993). “The court noted that RCW 48.44.020 authorizes the Insurance Commissioner to disapprove any health care contract form which "contains or incorporates by reference any inconsistent, ambiguous or misleading clauses, or exceptions and conditions which unreasonably or deceptively…”
— Wash. Rev. Code § 48.44.020(3) — 4 cases
McCarthy Fin., Inc. v. Premera, 347 P.3d 872 (Wash. 2015). “” RCW 48.44.020(3), (2), .110. The OIC considers numerous factors when determining whether a health insurance premium is reasonable, including “[h]ow much profit the company expects to make[,] .”
McCarthy Fin., Inc. v. Premera, 328 P.3d 940 (Wash. Ct. App. 2014). “RCW 48.44.020(2), .110 (‘No person shall knowingly make, publish, or disseminate any false, deceptive, or misleading representation or advertising in the conduct of the business of a health care service contractor, or relative to the business of a health care service contractor…”
Mccarthy Fin., Inc. v. Premera (Wash. Ct. App. 2014).
McCarthy Fin., Inc. v. Premera (Wash. 2015).
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