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Washington - Compensation & Benefit Legislation

WASHINGTON - AASHOWME

Demonstrates www.BenefitsReview.com™ site. Illustrates insurance carriers' coverages within the State.

 

WASHINGTON - ADOPTED CHILD HEALTH CARE MANDATE

OBRA 1993 (Federal) requires group health plans to honor medical and child support orders. Also, plans must treat adopted children like biological children covered by the plan, and plans are precluded from applying pre-existing condition exclusions to an adopted child where no such exclusion applies to a newborn biological child. Health plans that covered the cost of pediatric vaccines as of May 1, 1993, and fail to continue that level of coverage, will be subject to an excise tax penalty applicable to plans that fail to meet the health care continuation coverage requirements under OBRA 1993.

 

Mandatory coverage of birth of adopted children is included in state's newborn health care mandate.

 

Preventive care for children: No.

 

(Washington Rev. Code Sections 48-21.150, 48-21.155, 48-21.244, 48-21.280)

 

WASHINGTON - ALCOHOLISM & DRUG ABUSE

Mandatory coverage.

 

Minimum yearly inpatient coverage: No statutory requirements.

 

Minimum yearly outpatient coverage: No statutory requirements.

 

Minimum lifetime coverage: No statutory requirements.

 

(Washington Rev. Code Section 48.21.180)

 

WASHINGTON - CAFETERIA PLAN TAX LAWS

State income tax, unemployment insurance tax on salary reduction: Washington has no personal income tax. State Unemployment Insurance law has no specific provisions on cafeteria plans, but employer contributions toward health and accident benefits and group-term life insurance are not taxable, even if provided under a cafeteria plan. Employee salary reductions for the purchase of group-term life insurance are taxable.

 

WASHINGTON - CONTINUATION OF COVERAGE CONVERSIONS

Events Triggering Continuation of Coverage:

 

WASHINGTON - COORDINATION OF BENEFITS

Requires use of the birthday rule if coordinating benefits. Based on 1986 National Association of Insurance Commissioner Rules model. (Washington Admin. Code Sections 284-1-010)

 

WASHINGTON - COST-OF-LIVING

ERI's Relocation Assessor™ is a recommended source for U.S./Canadian cost-of-living data and U.S. Automobile Cost Survey.

 

WASHINGTON - DRUG TESTING AND EMPLOYEE ASSISTANCE BENEFITS

Who is Covered by Statute: All employers. Employer does not include any governmental entity.

 

Applicant Testing: Applicants may be required to submit to drug test after offer of employment is extended.

 

Employee Testing: Employee testing is allowed on a random basis, based on reasonable suspicions, or after workplace accident.

 

How Test Results are Used: Employer may terminate employee for refusing to submit to a drug or alcohol test, failure to comply with last chance agreement, and upon second verified positive drug or alcohol test result.

 

Enforcement of Statutes: State has no statutory requirements.

 

Employee Remedies: State has no statutory requirements.

 

Employer Penalties: State has no statutory requirements.

 

Who Pays for Testing: Employer shall pay the cost of all drug and alcohol tests, initial and confirmation, that the employer requires of the employee. Employee or applicant shall pay the costs of additional tests not required by the employer.

 

Employee Assistance Benefits: EAP is required by statute. The EAP shall provide the employer with a system for dealing with employees whose job performance is declining due to unresolved problems, including alcohol and other drug-related problems, marital problems, and legal and financial problems.

 

Other Requirements: State has no statutory requirements.

 

Washington Rev. Code Sections 49.82.010 thru 49.82.901.)

 

WASHINGTON - GROUP HEALTH CODE ADDITIONS (MANDATED)

Adopted Children: Disability and health care policies providing hospital and medical coverage to dependent children must cover adoptive children placed with the insured on the same basis as other dependents. (S5419, 1995) (Washington Rev. Code Ann. Sections 48.20.500, 48.21.280, 48.44.420.)

 

Alcoholism and Drug Abuse: Group disability policies covering hospital or medical care must cover treatment for chemical dependency under rules adopted by the Insurance Commission. (Washington Rev. Code Ann. Section 48.21.160 - .197, 44.240 - .245.) The regulations require benefits to be provided on the same basis as for other illnesses and equal to at least $5,000 (exclusive of deductibles, co-payments, and co-insurance) in any two year period or the benefit limit for other illnesses and a lifetime maximum of $10,000 (exclusive of deductibles, co-payments, and co-insurance.) (Washington Rev. Code Ann. Section 284.53.010.)

 

Basic Policies: Basic health care for uninsured state residents will be expanded to cover more low income individuals. (Washington Rev. Code Section 70.47.1.)

 

Breast Reconstruction: Disability policies covering hospital and medical expenses must cover breast reconstruction resulting from mastectomy. (Washington Rev. Code Ann. Sections 48.20.395, 48.21.230, 48.44.330.)

 

Coverage Continuation and Conversion:Group disability policies must provide conversion rights to terminated employees for themselves and their dependents and to spouses and dependents and to spouses and dependents ineligible due to death of insured or dissolution of marriage. (Washington Rev. Code Ann. Sections 48.21.210, 48.21.260, 48.44.370.) Insurers must offer group policyholders coverage providing continuation rights for persons becoming ineligible for coverage. (Washington Rev. Code Ann. Sections 48.21.250, 48.44.360.)

 

Domestic Violence: An insurer may not deny or refuse an applicant for insurance, refuse to insure, refuse to renew, cancel, restrict, or otherwise terminate an insurance policy, or change a different rate for the same coverage, on the basis that the applicant or insured person is, has been, or may be a victim of domestic abuse. Insurers may, however, consider loss history, medical condition, or any other factor not prohibited by law. (Washington Rev. Code Ann. Section 48.18 added by SB 6565, effective June 1998).

 

Emergency Services: Health carriers must cover emergency services if a prudent layperson acting reasonably would have believed an emergency medical condition existed. (Washington Rev. Code Ann. Ch. 48.43 added by HB 2018, effective January 1998).

 

Handicapped Dependents: Coverage for dependent children cannot be terminated while a person is incapable of employment due to mental retardation or physical handicap and chiefly dependent on the insured. (Washington Rev. Code Ann. Sections 48.20.420, 48.21.150, 48.44.200.)

 

Health Care Savings Accounts: Health care savings accounts may be offered as options to all employers and residents as incentives to reduce health services utilization, administration, and paperwork, and to promote consumer involvement in health spending. (Washington Rev. Code Ann. Section 70.47.2).

 

Health Insurance Pools: Health insurance pools may offer 1 or more managed care plans. Pools pay only the usual, customary and reasonable charges for medically necessary services. Minimum benefits which must be offered by the plans under health insurance pools include:

 

(Washington Rev. Code Ann. Section 48.41.110)

 

Pre-existing condition exclusions may apply for no more than 3 months. No exclusion may be applied to maternity coverage. (Washington Rev. Code Ann. Section 48.41.110)

 

Hospice and Home Health Care: Insurers must offer policyholders coverage for 130 home health care visits per year and six months of hospice care. (Washington Rev. Code Ann. Sections 48.21.220, 48.21A.090, 48.44.320.)

 

Mammography Screening: Disability policies covering hospital and medical expenses must cover mammography screening or diagnostic services. (Washington Rev. Code Ann. Sections 48.20.393, 48.21.225, 48.44.325.)

 

Mastectomy: No insurer may cancel or deny coverage or restrict rates or benefits of a person who received a mastectomy of lumpectomy more than five years previously. (Washington Rev. Code Ann. Sections 48.20.397, 48.21.235, 48.44. 335.)

 

Maternity: Effective January 1, 1998, health care insurers (HMOs included) which provide coverage for maternity services must permit attending providers, in consultation with mothers, to make decisions on the length of inpatient stays based on accepted medical practices. Follow up care specifications for a mother and her newborn child must be decided by an attending provider in consultation with a mother at the time of hospital discharge. If a mother an a newborn child have separate hospital admissions, the coverage for a child must be not less than the coverage for the mother for no less than three weeks. Health care insurers which cover maternity care must not deselect, terminate the services of, require additional documentation from, require additional utilization review of, reduce payments to, or otherwise provide financial disincentives to an attending provider for maternity care. Insurers providing coverage for maternity benefits must make written disclosure of required benefits to covered individuals in the next scheduled mailing, in the mailing which includes the yearly summary of benefits, or by January 1, 1999. (S6120, 1996) (Washington Rev. Code Ann. Section 48.43.)

 

Mental Health: Insurers must offer group disability policyholders coverage for mental health treatment at usual and customary rates. (Washington Rev. Code Ann. Sections 48.21.240, 48.44.340.)

 

Neurodevelopmental Therapies. Employer sponsored group policies for comprehensive health insurance must cover such therapies for covered persons aged six or under. (Washington Rev. Code Ann. Sections 48.21.310, 48.44.450.)

 

Newborns: Policies providing family coverage must provide benefits for newborns from the moment of birth for injury or sickness, including treatment of medically diagnosed congenital anomalies. (Washington Rev. Code Ann. Sections 48.20.430, 48.21.15.5, 48.44.212.)

 

Obstetrician/Gynecologist Access: All health insurance carriers must permit women to directly access women’s health care practitioners (obstetricians and gynecologists) without prior referral from another practitioner. Direct access may be limited to those providers who have signed participating provider agreements with the carrier. No carrier may impose cost sharing, such as co-payments or deductibles, for directly accessed women’s health care services that are not required for access to other primary care providers. (Washington Administrative Code Section 284-43-100).

 

Phenylketonuria: Disability policies covering hospital or medical expenses must cover the cost of formula used for treatment. (Washington Rev. Code Ann. Sections 48.20.520, 48.21.300, 48.44.440.)

 

Policies for Small Employers: Small employers are businesses which actively employed no more than 50 workers, the majority of which worked in this state, who had normal work weeks of 30 or more hours on at least 50 percent of the working days during the preceding calendar quarter. (H1590, 1997) (Washington Rev. Code Ann. Section 48.43.005.) An insurer offering any health benefit plan to a small employer must offer a plan providing benefits identical to or better than the schedule of covered services that are required to be delivered to an individual enrolled in the basic health plan. Less comprehensive coverage may be offered to a small employer only if the differences are fully disclosed in a brochure approved by the State Insurance Commissioner. Premium rates for small employer policies must be community rated, adjusted only geographic area, family size, age, and wellness activities. Minimum participation requirements vary by employer size. (Washington Rev. Code Ann. Sections 48.21.045, 48.44.15, 48.44.023, 48.46.17, 48.46.066.)

 

Portability: Health carriers must waive any pre-existing condition exclusion or limitation for persons or groups who had similar coverage under a different health plan at any time during the three month period immediately preceding the date of application of the new health plan, if such person was continuously covered during the preceding three month period. If covered for less than three months, then the waiting period should be credited proportionately. (Washington Rev. Code Ann. Section 70.47.5.)

 

Pre-existing Conditions: Carriers may not reject a Washington state resident for health plan coverage based on pre-existing conditions and may not deny, exclude, or otherwise limit coverage for a pre-existing condition, except for imposing a three month waiting period for conditions for which medical advice or treatment was given in the three months preceding the date of coverage. (Washington Rev. Code Ann. Section 70.47.65.)

 

Prenatal Testing: Insurers must offer group disability policyholders with coverage for pregnancy, childbirth, and related conditional optional coverage for prenatal diagnosis of congenital disorders. (Washington Rev. Code Ann. Sections 48.21.244, 48.44.344.)

 

Providers: Chiropractors, Optometrists, Registered Nurses, Chiropodists, Psychologists, and Dentists: Costs for services must be covered by disability policies if the provider is licensed, the service is within the provider's scope of services, and the service is covered by the policy. (Washington Rev. Code Ann. Sections 48.20.390, 48.20.410 - .416, 48.21.130, 48.21.140 - 146, 48.44.290, 48.44.310.) Effective January 1, 1996, health policies issued or renewed must permit every category of health care provider to provide health services or care for conditions included in the basic health plan services to the extent that the provision of the service or care is within the providers' permitted scope of practice, and the providers agree to abide by the standards related to the provision, utilization review, and cost containment of health services; management and administrative procedures; and provision of cost-effective and clinically effective health services. (Washington Rev. Code Ann. Section 48.43.8.)

 

Temporomandibular Joint Disorders: Insurers must offer group policyholders coverage for such disorders. (Washington Rev. Code Ann. Sections 48.21.320, 49.44.460.)

          

WASHINGTON - GROUP HEALTH FOR SMALL EMPLOYERS

For insurance plans offered to small employers:

 

An insurer offering any health benefit plan to a small employer must offer a plan providing benefits identical to or better than the schedule of covered services that are required to be delivered to an individual enrolled in the basic health plan. Less comprehensive coverage may be offered to a small employer only if the differences are fully disclosed in a brochure approved by the state insurance commissioner. A small employer is defined as one which, on a at least 50% of the working days preceding calendar quarter had no more than 50 eligible employees, each working at least 30 hours per week, the majority of whom were employed in Washington. After a policy is issued, the size of the small employer is re-determined annually. Premium rates for small employer policies must be community rated, adjusted only by geographic area, family size, age, and wellness activities. Minimum participation requirements vary by employer size. (Washington Rev. Code Ann. Sections 48.21.045, 48.43.005, 48.44.023, 48.46.17, 48.46.066).

 

Optional Benefits: Insurers must offer policyholders coverage for 130 home health are visits per year and 6 months of hospice care. (Washington Rev. Code Ann. Sections 48.21.220, 48.21A.090, 48.44.320).

 

Insurers must offer group disability policyholders coverage for mental health treatment at usual and customary rates. (Washington Rev. Code Ann. Sections 48.21.240, 48.44.340).

 

Insurers must offer group disability policyholders coverage for pregnancy, childbirth, and related conditions, and optional coverage for prenatal diagnosis of congenital disorders. (Washington Rev. Code Ann. Sections 48.21.244, 48.44.460).

 

Insurers must offer group policyholders coverage for temporomandibular joint disorders. (Sections 48.21.320, 48.44.460).

 

The state legislature has created guidelines to be used in determining whether a proposed mandatory benefit should be implemented. (Washington Rev. Code Ann. T.48, added by HB 1191, effective 1997).

 

WASHINGTON - GROUP LIFE CODE ADDITIONS

Employer required to pay part of premium: Yes.

 

Percent of employees who must elect coverage (if employees pay part of premium): 75%.

 

Percent of employees who must be covered if employer pays all of premium: 100%.

 

Minimum number of employees in group plan: 10.

 

Employer prohibited as beneficiary: Yes.

 

Grace period (days): 31.

 

Mandatory conversion: Yes.

 

Other provisions: None.

 

(Washington Rev. Code Sections 48.24.020, 48.24.110, 48.24.180, 48.24.190)

 

WASHINGTON - HOLIDAYS

January 1, Washington's Birthday (or 3rd Monday in February), Memorial Day (or last Monday in May), July 4, Labor Day (or 1st Monday in September), Veterans Day, and December 25 are state holidays in all 50 states and in the District of Columbia. Other holidays under State law include: Martin Luther King's birthday (or 3rd Monday in January), Thanksgiving, Sunday. Other: If any holiday (except Sunday) falls on Sunday, following Monday is a holiday. (Washington Rev. Code Section 1.16.050)

 

WASHINGTON - IMMIGRATION (PREVAILING WAGE POLICY)

See U.S. Federal General Administrative Letter 1-2000

 

WASHINGTON - JURY DUTY & WITNESS TIME OFF

Employer Restriction For Discharging Employee For Taking Leave For Jury Service: Yes.

 

Remedies and Penalties: Violator is guilty of a misdemeanor. Employee may bring civil action for damages, reinstatement, and reasonable attorney fees.

 

Other Requirements: None reported. (Washington Rev. Code Ann. Section 2.36.165.)

 

Employer Restriction For Discharging Employee For Taking Leave to be a Witness: State reports no statutory requirements.

 

Remedies and Penalties: State reports no statutory requirements.

 

Other Requirements: State reports no statutory requirements.

 

WASHINGTON - LEAVES OF ABSENCE

Employers Subject to Leave Laws: All state agencies; private employer with more than 100 employees.

 

Criteria for Eligibility: Must be employed for at least 35 hours per week for prior 12 months.

 

Maximum length of leave: 12 weeks in a 24 month period.

 

Paid Leave: State does not require paid leave.

 

Acceptable Reasons for Leave: Birth/adoption of a child; care for child under 18 with terminal illness.

 

Employment Guarantees After Leave: Entitled to reinstatement in the position held prior to leave or equivalent position, unless employer's business conditions changes significantly.

 

Use of Vacation or other Time-off Benefits: Employee may use sick leave for own illness and may use accrued vacation and sick benefits to extend the leave.

 

Certification Required: Employer may require certification of terminal illness or of premature birth or mother's illness.

 

Effect of Leave on Other Benefits: All benefits continue while on leave, but employee may be required to pay for medical and dental benefits.

 

Effect of Seniority Accrual During Leave: Seniority benefits do not accrue while on leave.

 

Minimum Requirements for Notification to Employer: 30 days notice, if possible, for birth/adoption of a child is required; 14 days notice for child care is required.

 

Conditions for Denial of a Request For Leave: Leave may be denied or limited for up to 10% of the work force or for key personnel. If both spouses work for the same employer, total leave time for the couple may be limited to 12 weeks in a 24 hour period.

 

(Washington Rev. Code Sections 49-78.010 - 49.78.100, 49-78.110, 49 - 78.140, 49-78.180 - 49-78.200.)

 

See U.S. Federal Family and Medical Leave Act

 

WASHINGTON - LONG TERM DISABILITY CODE ADDITIONS

State does not require employer to provide long term disability benefits; although many employers do in order to remain competitive in hiring/retention of employees.

 

See LEAVES OF ABSENCE (above), WORKERS' COMPENSATION (below) and U.S. Federal Americans With Disabilities Act

 

WASHINGTON - MANDATED PROVIDERS

Optometrists, chiropractors, dentists, psychologists, podiatrists, nurse practitioners and midwives Mandatory coverage for nursing services, denturists, and chiropodists. (Washington Rev. Code Sections 48.20.130, 48.21.140, 48.21.141, 48.21.142, 48.21.144, 48.21.146, 48.21.148)

 

WASHINGTON - MENTAL HEALTH CARE

Employer option.

 

Minimum yearly inpatient coverage: No statutory requirements.

 

Minimum yearly outpatient coverage: No statutory requirements.

 

Minimum lifetime coverage: No statutory requirements.

 

(Washington Rev. Code Section 48.21.240)

 

WASHINGTON - MINIMUM WAGE

$6.72 per hour (effective January 1, 2001).

 

Exemptions: Certain agriculture workers, domestics, outside sales, and students. Apprentices and handicapped workers in special environments may be exempt by special certificate. (Washington Rev. Code Sections 49.46.010, 49.46.020, 49.46.060).

 

See U.S. Minimum Wage

 

WASHINGTON - NEW HIRE REPORTING

Who is required to report: All employers.

 

Who must be reported: Employees and rehires.

 

Exempt from reporting: Employees hired less than 1 month, employees working less than 350 hours in a 6 month period, or employees earning less than $300 a month.

 

Form(s) to file: Employer Reporting Program Report Form DSHS 18-468, W-4 for, or other mutually agreeable method.

 

Filing deadline: Within 20 days of employment.

 

Employer information to be included: Name, address, and employment security reference number or unified business number.

 

Employee information to be included: Name, address, SSN, and date of birth.

 

Penalty for failure to report: $25 per employee not reported, $500 if failure to report is the result of conspiracy.

 

(Washington Rev. Code Ann. Section 26.23.040)

 

WASHINGTON - NEWBORN CARE MANDATE

Mandated coverage.

 

Preventive care for children: No.

 

(Washington Rev. Code Sections 48-21.150, 48-21.155, 48-21.244, 48-21.280)

 

WASHINGTON - PARENTAL LEAVE

See U.S. Federal Family and Medical Leave Act

 

WASHINGTON - PAYROLL RECORDS

Each employer must keep a record of names of all persons employed. Director may inspect these records upon request. (Washington Revised Code Section 49.12.050).

 

Employers subject to the minimum wage or overtime provisions must keep records of persons employed and of wages, hours, and other practices and conditions of employment (Washington Revised Code Section 49.46.040).

 

Employer must make a record of the name, address, and occupation of each employee; rate of pay; amount paid each pay period; hours worked each day and each week by each employee; and such other information as the director prescribes. Records must be open for inspection and copying by the director or a representative at any reasonable time. (Washington Revised Code Section 49.46.070).

 

Wage and hour records as required under Section 49.46.070 must be retained for 3 years (Washington Revised Code Section 49.30.020).

 

Employer must furnish employee (including agricultural workers) for each pay period an itemized statement of basis of pay, rate of pay, gross wages and deductions (Washington Revised Code Section 49.30.020).

 

WASHINGTON - PRE-EXISTING CONDITIONS

State reports no statutory requirements.

 

See U.S. Federal Health Insurance Portability & Accountability Act

 

WASHINGTON - PROTECTED CLASSIFICATIONS

Age: Yes, older than 40.

Race:  Yes.

Color:  Yes.

National Origin: Yes.

Ancestry:  Yes.

Religion: Yes.

Sex: Yes.               

Pregnancy:  No specific law. State has expressed policy against discrimination.

Sexual Harassment:   No specific law. State has expressed policy against discrimination.

 

(Wash. Rev. Code Sections 49.12.200, 49.44.090, 49.60.010-49.60.040, 49.60.180, 49.60.205.)

 

WASHINGTON - SALARY SURVEY

ERI's Relocation Assessor™ is a recommended source for U.S./Canadian wages & salaries (covering 3,000 positions).

 

WASHINGTON - SHORT TERM DISABILITY CODE ADDITIONS

State does not require employer or employee participation in short term disability plans.

 

WASHINGTON - TERMINATION & SEVERANCE PAY

Date pay is due if employee is discharged: Payday.

 

Date due if employee resigns: Payday.

 

Wages: Yes.

 

Vacation Pay: No.

 

Holiday: No.

 

Sick leave: No.

 

Severance: No.

 

(Washington Rev. Code Section 49.48.010)

 

WASHINGTON - UNEMPLOYMENT TAX

Employer Contributions:

 

 

Voluntary Contribution Provision: Yes.

 

(Washington Rev. Code Ann. Sections 50.12.070, 50.12.080, 50.12.140, 50.16.070, 50.29.025.)

 

WASHINGTON - VACATION PAY

State reports no statutory requirements.

 

WASHINGTON - VOTING TIME OFF

Reasonable time, up to 2 hours while the polls are open, if employee does not already have 2 consecutive hours. Provision does not apply if employee has time to secure absentee ballot after employee learns work schedule for election day. (Washington Rev. Code Ann. Sections 29.85.060, 29.85.070, 49.28.120.)

 

WASHINGTON - WORKERS' COMPENSATION

Private Employers: Mandatory as to all employments. Elective as to partners, sole proprietors, joint ventures, and corporate officers who are shareholders/directors.

 

Public Employers: Mandatory coverage to all public employments.

 

Exceptions: Domestic servants, voluntary law enforcement officers; Indian tribal members employed on reservation; home repair and gardening workers; railroad workers; unpaid workers in elemosynary institutions; children under 18 on family farm; jockeys, employments not in usual course of employer's business; and interstate truckers.

 

Special Coverage Provisions: Covers apprentices registered with Apprenticeship Council. Excludes purchaser of contract musical or entertainment performance.

 

(U.S. Chamber of Commerce, 1994 Analysis of Workers' Compensation Laws.)