DISTRICTS ‑- SCHOOLS ‑- INSURANCE ‑- HEALTH ‑- CONTRACTS

DISTRICTS ‑- SCHOOLS ‑- INSURANCE ‑- HEALTH ‑- CONTRACTS

 (1) RCW 28A.58.420, as amended by § 2, chapter 269, Laws of 1971, 1st Ex. Sess., permits but does not require all school districts to make available to their employees an insurance program which would include medical or health care coverage entitling the beneficiaries to utilize the services of those practitioners who are licensed pursuant to chapters 18.22, 18.25, 18.53, 18.57 and 18.71 RCW.

(2) If an insurance contract procured by a school district for its employees under RCW 28A.58.420, as amended, does include medical coverage relating to services which can be rendered by more than one of the above enumerated classes of licensees, the contract must then entitle the beneficiaries to choose between the services of each of those categories of licensees which are authorized to treat the particular covered illness or injury in question.

(3) Where the board of directors of a school district is providing medical or health care insurance coverage for its employees under RCW 28A.58.420, as amended, it is not necessary that the contract for insurance or protection allow its beneficiaries to utilize the services of any practitioners in this state licensed pursuant to the enumerated RCW chapters; instead, it is permissible for the insurance contract to afford to those beneficiaries only the services of a designated list of named licensees practicing in a particular geographical area.

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                                                                 February 7, 1972

 Honorable John C.Merkel
Prosecuting Attorney
Kitsap County
614 Division Street
Port Orchard, Washington98366

                                                                                                                   Cite as:  AGO 1972 No. 5

 Dear Sir:

            This is written in response to your recent letter requesting  [[Orig. Op. Page 2]] our opinion on the meaning of a certain amendment to RCW 28A.58.420 which was added to this statute by § 2, chapter 269, Laws of 1971, 1st Ex. Sess.  We paraphrase the issues raised by your request as follows:

            (1) Does RCW 28A.58.420, as amended by § 2, chapter 269, Laws of 1971, 1st Ex. Sess., require all school districts to make available to their employees an insurance program which includes medical or health care coverage entitling the beneficiaries to utilize the services of those practitioners who are licensed pursuant to chapters 18.22, 18.25, 18.53, 18.57 and 18.71 RCW?

            (2) If an insurance contract procured by a school district for its employees does include medical coverage relating to conditions which can be treated by more than one of the above enumerated classes of licensees, must the coverage then entitle the beneficiaries to utilize the services of each of the categories of licensees which are authorized to treat the particular illness or injury in question?

            (3) Where the board of directors of a school district is providing medical or health care insurance coverage for its employees under RCW 28A.58.420, as amended, must the contract for insurance or protection allow its beneficiaries to utilize the services of any practitioners in this state licensed pursuant to the enumerated RCW chapters, or may the insurance contract instead afford to those beneficiaries only the services of a designated list of named licensees practicing in a particular geographical area?

            We answer question (1) in the negative; question (2) in the affirmative; and question (3) as set forth in our analysis.

                                                                     ANALYSIS

            RCW 28A.58.420, as amended by § 2, chapter 269, Laws of 1971, 1st Ex.Sess., provides as follows:

            "The board of directors of any of the state's school districts may make available liability, life, health, health care, accident, disability and salary protection or insurance or any one of, or a combination of the enumerated types of insurance, or any other type of insurance or protection,  [[Orig. Op. Page 3]] for the members of the boards of directors, the students, and employees of the school district, and their dependents.  Whenever funds shall be available for these purposes the board of directors of the school district may contribute ((toward)) all or a part of the cost of such ((life, health, accident, disability and salary)) protection or insurance ((, including hospitalization and medical aid)) for the employees of their respective school districts and their dependents in an amount not to exceed ((ten)) twenty dollars per month per employee covered.  The premiums on such liability insurance shall be borne by the school district.  The premiums due on such ((life, health, accident, or disability and salary)) protection or insurance shall be borne by the assenting school board member or student.  All contracts for insurance or protection written to take advantage of the provisions of this section shall provide that the beneficiaries of such contracts may utilize on an equal participation basis the services of those practitioners licensed pursuant to chapters 18.22, 18.25, 18.53, 18.57 and 18.71 RCW."

            Your questions all pertain to the amendatory sentence appearing at the end of this statute.

            Question (1):

            Although the subject amendatory sentence is couched in mandatory terms, the opening sentence of the statute remains permissive.  Therefore, we do not read RCW 28A.58.420, as amended, as requiring all school districts to include some form of medical coverage in the insurance program which they provide for their employees.  As we view it, each individual school district still remains free (1) to provide no insurance program for its employees at all; or (2) to provide an insurance program which includes any one or more of the types of insurance enumerated in the opening sentence of the statute ‑ i.e., liability insurance, life insurance, health insurance, health care coverage, accident insurance, disability or salary protection or any other type of insurance protection.

             [[Orig. Op. Page 4]]    Only if the insurance package thus provided includes one or more of those types of insurance covering illness, injuries or other physical infirmities (e.g., health insurance or health care coverage) which may, legally, be treated by one or more of the classes of licensees enumerated in the amendment does the mandatory requirement of "equal participation" apply.

            We reach this result on the basis, principally, of the following two rules of statutory construction:  (1) That in construing a statute effect must be given, if at all possible, to the entire enactment;1/ and (2) that absurd or unreasonable consequences are to be avoided where it is possible to do so.2/   The important point to be noted with respect to the subject statute is that it still speaks in terms of ". . . any one of, or a combination of the enumerated types of insurance . . ." ‑ so as to negate any inference that some form of medical insurance is required to be included in any insurance package provided by a school district under this legislation.  And, of course, to read the statute as requiring the services of a physician or osteopath, or one of the other professional licensees listed in the amendatory sentence,3/ to be included in a nonmedical insurance program would be highly incongruous.

            Question (2):

            This question assumes that a particular school district's insurance program does include a medical insurance feature to which the amendatory sentence applies and asks our opinion as to the meaning of the requirement that the contract in such a case must entitle the beneficiaries thereof to ". . . utilize on an equal participation basis the services of . . ." these practitioners.

            The meaning of this requirement, in our judgment, is simply  [[Orig. Op. Page 5]] this:  If the particular medical or health care insurance contract covers a particular disease or other physical or mental condition which can, legally, be treated by more than one of the enumerated categories of professional licensees, then the contract must be so written as to entitle its beneficiaries to choose which profession they shall be treated by.  For example, if the policy includes coverage for a back injury or condition which may be treated by either a chiropractor, an osteopath or a medical doctor, then the contract must cover the services of each of these three professions (even though their respective methods of treatment of the condition may differ) ‑ to the extent of allowing the beneficiary to choose which category of practitioner to go to for assistance.  Your second question is, therefore, answered in the affirmative.

            Question (3):

            Repeated for ease of reference, the critical language of the amendatory sentence is as follows:

            ". . . All contracts for insurance or protection written to take advantage of the provisions of this section shall provide that the beneficiaries of such contracts may utilize on an equal participation basis the services of those practitioners licensed pursuant to chapters 18.22, 18.25, 18.53, 18.57 and 18.71 RCW."

            The licenses granted pursuant to those RCW chapters cited in this statute all authorize the persons to whom they are issued to practice their professions on a state‑wide basis.  Therefore, you have asked whether the statute must be construed to entitle the beneficiaries of an insurance contract to which it pertains to utilize the services of any licensee in the state who is able to treat the particular covered condition.  Or, instead, you ask whether the contract may afford to those beneficiaries only the services of a designated list of named licensees who are practicing within a particular geographical area.

            In responding to this question, we are strongly influenced by an earlier portion of the amendatory statute in question; namely, the legislature's addition, in the first sentence of the amendment, of "health care" protection.  Since the  [[Orig. Op. Page 6]] legislature must be presumed to have been aware of its own prior legislation, accord, Ropo, Inc. v. Seattle, 67 Wn.2d 574, 409 P.2d 148 (1965), we would take this to be a reference to the medical protection offered in this state by "health care service contractors" under chapter 48.44 RCW.  Although these contractors may, legally, operate throughout the state as provided in RCW 48.44.015 they are, for the most part, local in nature.  For example the largest health care service contractor, Washington Physicians Service, basically operates through county-wide medical health bureaus such as King County Medical, Pierce County Medical, etc.  Moreover, the statutes relating to this form of health protection have long contemplated the general availability to the beneficiaries of a plan issued thereunder of only those doctors4/ who have contracted to be "participants" under the specific health care service contract by which these beneficiaries are covered.  See, RCW 48.44.010 (4), and related statutes in chapter 48.44 RCW, which was originally enacted by chapter 268, Laws of 1947.

            Accordingly, it will be seen that any interpretation of the concluding amendatory sentence to RCW 28A.58.420, supra, which would entitle the beneficiaries of a contract executed thereunder to utilize "on an equal participation basis" the services of any licensee in the state who is authorized to treat a covered condition would, practically speaking, have the effect of excluding from the statute most if not all of those same health care service contractors whose medical protection contracts were specifically added to the statute by the first sentence of this same 1971 amendment.  Yet is seems hardly plausible that the legislature would have added these contracts to the statute if it had also had in mind some type of geographic or other requirement as to participation which would largely work to disqualify most agencies providing such contracts from any utilization of the act.