The Washington Office of Insurance Commissioner (OIC) adopted R 2025-12 Consolidated Healthcare Rulemaking, effective January 19, 2026. The rule addresses several topics, including extending essential health benefits plan coverage requirements, adding a definition of medically necessary for unfair practices in gender-affirming care treatment, and other administrative or textual ease-of-reading changes.
Most notably, R 2025-12 provides expected implementation details to hearing instrument coverage requirements. Washington Substitute Senate Bill 5262 (2025) mandates health plans issued or renewed on or after January 1, 2026, to cover certain hearing instruments — detailed in our prior edition of NFP's Compliance Corner: Washington Governor Signs Various Healthcare Bills into Law.
Consistent with those changes, R2025-12 states health carriers must provide in-network coverage for instruments every 36 months (based on time specific to the enrollee’s current carrier) per ear with hearing loss and may not establish any lifetime or annual limit on the dollar amount of coverage for services for any individual, whether provided in-network or out-of-network. The rule also requires health carriers to provide coverage of an initial assessment, annual hearing exams, fitting, adjustment, auditory training, and ear molds as necessary to ensure optimal fit. Coverage of over-the-counter hearing instruments is not required.
R2025-12 likewise clarifies that these hearing services are not subject to a deductible, but a carrier may apply a deductible to coverage of the services 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.
For the full text of the rule, please see R 2025-12 Consolidated Healthcare Rulemaking.