(1) A nongrandfathered health plan issued on or after April 1, 2026, must, at a minimum, provide coverage for the following preventive services:
(a) Evidence-based items or services that have a rating of A or B in the recommendations of the United States preventive services task force in effect on June 30, 2025, and items and services included in rules adopted by the insurance commissioner under this section with respect to the enrollee;
(b) With respect to infants, children, and adolescents, evidence-informed preventive care and screenings provided for in comprehensive guidelines supported by the health resources and services administration in effect on June 30, 2025, and preventive care and screenings included in rules adopted by the insurance commissioner under this section;
(c) With respect to women, additional preventive care and screenings that are not listed with a rating of A or B by the United States preventive services task force but that are provided for in comprehensive guidelines supported by the health resources and services administration in effect on June 30, 2025, and preventive care and screenings included in rules adopted by the insurance commissioner under this section; and
(d) Immunizations that have in effect a recommendation from the department of health under RCW
43.70.527.
(2) A nongrandfathered health plan must provide coverage for:
(a) The preventive services required to be covered under subsection (1)(a) through (c) of this section consistent with federal rules and guidance related to coverage of such preventive services in effect on June 30, 2025, and rules adopted by the insurance commissioner under this section; and
(b) Immunizations required to be covered under subsection (1)(d) of this section consistent with department of health guidance issued under RCW
43.70.527.
(3) A nongrandfathered health plan must provide coverage for the preventive services required to be covered under subsections (1) and (2) of this section for plan years that begin on or after the date that is one year after the date the recommendation or guideline is issued.
(4)(a) Except as provided in (b) of this subsection, the health plan may not impose cost-sharing requirements for the preventive services required to be covered under subsections (1) and (2) of this section when the services are provided by an in-network provider. If a plan does not have in its network a provider who can provide an item or service described in subsections (1) and (2) of this section, the plan must cover the item or service when performed by an out-of-network provider and may not impose cost sharing with respect to the item or service.
(b) For a health plan offered as a qualifying health plan for a health savings account, the carrier may apply cost sharing to coverage of the services required to be covered under subsections (1) and (2) of this section only at the minimum level necessary to preserve the enrollee's ability to claim tax exempt contributions and withdrawals from the enrollee's health savings account under internal revenue service laws and regulations.
(5) A carrier may use reasonable medical management techniques to determine the frequency, method, treatment, or setting for an item or service described in subsections (1) and (2) of this section to the extent not specified in the relevant recommendation or guideline, federal rules and guidance related to the coverage of preventive services in effect on June 30, 2025, department of health guidance issued under RCW
43.70.527, and any rules adopted by the insurance commissioner.
(6) The insurance commissioner may adopt rules necessary to implement the requirements of this section, including rules modifying coverage requirements for preventive services under subsection (1)(a) through (c) of this section based on the addition of preventive services or other changes to the recommendations and guidelines referenced in subsection (1)(a) through (c) of this section that are made after June 30, 2025. Any rules adopted by the insurance commissioner must be as or more favorable to enrollees with respect to coverage of preventive services than the recommendations and guidelines in effect on June 30, 2025. In adopting any rules under this subsection, the insurance commissioner must:
(a) Consult with the health care authority and department of health; and
(b) Consider the recommendations of the department of health issued under RCW
43.70.527 and recommendations issued by the United States preventive services task force, the health resources and services administration, and experts and expert organizations that the commissioner in their discretion deems relevant and based on reasonable scientific evidence and judgment.
