Emergency Order No. 26-02: One-time prescription refills, 60-day premium grace period, and cancellation prohibition
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Applies to Washington-regulated fully insured health carriers in affected ZIP codes; orders one-time early prescription refills, a minimum 60-day premium grace period with claims paid for the first 30 days, and prohibits cancellations for nonpayment except at the insured's direction; excludes Medicaid, Medicare, PEBB/SEBB, and ERISA-governed plans.
Regulated Entities must allow a one-time refill of covered prescription medications prior to the expiration of waiting periods to maintain adequate supply.
Regulated Entities must allow a grace period for payment of premiums of no less than 60 days, with claims paid for services during the first 30 days of the grace period.
Regulated Entities shall not cancel a health plan for nonpayment of premium unless specifically directed to do so by the insured.
Emergency Coverage Directives
Emergency coverage directives
Requirements for Regulated Entities during the emergency:
ALL of the following
ALL of the following
- Allow enrollees to obtain a one-time early refill of covered prescription medications prior to the expiration of standard refill waiting periods so enrollees can maintain an adequate supply of necessary medication.
- Carriers may consider patient safety risks when approving early refills for certain drug classes (for example, opioids, benzodiazepines, and stimulants).
ALL of the following
- Provide a premium grace period of no less than sixty (60) days for individual and group health plans, except qualified health plans purchased with advanced premium tax credits through the Health Benefit Exchange.
- Pay all claims for services rendered to enrollees during the first thirty (30) days of the grace period that are covered under the terms of the health plan and applicable law, including applicable emergency orders.
- Regulated Entities may delay adjudicating claims for services rendered during days 31–60 of the grace period.
- Any communications to enrollees or plan sponsors during the grace period must clearly state the enrollee's or plan sponsor's obligation to repay premiums and that providers may bill enrollees for unpaid claims after the first thirty days, and must clearly describe the Regulated Entity's obligations during the grace period in light of the emergency.
ALL of the following
- Do not cancel a health plan for nonpayment of premium unless the insured specifically directs the carrier to cancel the plan.
ALL of the following
- This Order applies to fully insured health plans regulated by the Washington Insurance Commissioner in all ZIP codes and adjacent ZIP codes where wildfires have burned homes/structures and/or official evacuation orders are issued; it is effective immediately and remains in effect through September 30, 2026, subject to extension.
- This Order does not apply to Medicaid, Medicare, Public Employees Benefits Board (PEBB) or School Employees Benefits Board (SEBB) plans, or to plans governed by ERISA (self-funded and Taft-Hartley plans).
Coding and Key Policy Values
| No codes listed |
Provider Actions and Billing Rules
One-time early prescription refill
Allow enrollees to obtain a one-time refill of covered prescription medications prior to the expiration of the waiting period between refills so enrollees can maintain an adequate supply of necessary medication. Carriers may consider patient safety risks for certain drug classes (e.g., opioids, benzodiazepines, stimulants) when approving early refills.
- One-time early refill permitted per enrollee.
- Carriers may consider safety risks for specific drug classes when approving.
Claims payment during grace period
Provide a premium grace period of no less than 60 days; pay all claims for services rendered during the first 30 days of the grace period that are covered under the health plan and current law. Regulated Entities may delay adjudicating claims for services rendered during days 31–60 of the grace period, and communications to enrollees or plan sponsors must explain repayment obligations and potential provider billing after the first 30 days.
- Minimum grace period: 60 days.
- Claims guaranteed paid: first 30 days of the grace period.
- Claims for days 31–60 may be delayed in adjudication; communications must state enrollee repayment obligations and potential provider billing.
Cancellation prohibition
Do not cancel a health plan for nonpayment of premium unless the insured specifically directs the Regulated Entity to do so.
- Cancellation prohibition applies to regulated entities during the declared emergency.
Scope and Exclusions
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