RCW 48.212.005
Intent.
(Effective May 1, 2026.)
The intent of this chapter is to promote the public interest, support the availability of supplemental long-term care coverage, establish standards for supplemental long-term care coverage, facilitate public understanding and comparison of supplemental long-term care contract benefits, protect persons insured under supplemental long-term care insurance policies and certificates, protect applicants for supplemental long-term care policies from unfair or deceptive sales or enrollment practices, and provide for flexibility and innovation in the development of supplemental long-term care insurance coverage.
[
2025 c 380 s 17
.]
NOTES:
Effective date
—
2025 c 380 ss 17-39, 47, and 48:
"Sections 17 through 39, 47, and 48 of this act take effect May 1, 2026." [
2025 c 380 s 49
.]
RCW 48.212.010
Application.
(Effective May 1, 2026.)
(1) This chapter applies to all supplemental long-term care insurance policies, contracts, or riders delivered or issued for delivery in this state on or after May 1, 2026. This chapter does not supersede the obligations of entities subject to this chapter to comply with other applicable laws to the extent that they do not conflict with this chapter, except that laws and regulations designed and intended to apply to medicare supplement insurance policies shall not be applied to supplemental long-term care insurance.
(2) Coverage advertised, marketed, or offered as supplemental long-term care insurance must comply with this chapter. Any coverage, policy, or rider advertised, marketed, or offered as supplemental long-term care or nursing home insurance shall comply with this chapter.
(3) This chapter is not intended to prohibit approval of supplemental long-term care funded through life insurance policies, contracts, or riders, provided the policy meets the definition of supplemental long-term care insurance and provides all required benefits of this chapter.
[
2025 c 380 s 18
.]
NOTES:
Effective date
—
2025 c 380 ss 17-39, 47, and 48:
See note following RCW 48.212.005
.
RCW 48.212.020
Definitions.
(Effective May 1, 2026.)
The definitions in this section apply throughout this chapter unless the context clearly requires otherwise.
(1) "Applicant" means: (a) In the case of an individual supplemental long-term care insurance policy, the person who seeks to contract for benefits; and (b) in the case of a group supplemental long-term care insurance policy, the proposed certificate holder.
(2) "Certificate" includes any certificate issued under a group supplemental long-term care insurance policy that has been delivered or issued for delivery in this state.
(3) "Commissioner" means the insurance commissioner of Washington state.
(4) "Issuer" includes insurance companies, fraternal benefit societies, health care service contractors, health maintenance organizations, or other entity delivering or issuing for delivery any supplemental long-term care insurance policy, contract, or rider.
(5) "Group supplemental long-term care insurance" means a supplemental long-term care insurance policy or contract that is delivered or issued for delivery in this state and is issued to:
(a) One or more employers; one or more labor organizations; or a trust or the trustees of a fund established by one or more employers or labor organizations for current or former employees, current or former members of the labor organizations, or a combination of current and former employees or members, or a combination of such employers, labor organizations, trusts, or trustees; or
(b) A professional, trade, or occupational association for its members or former or retired members, if the association:
(i) Is composed of persons who are or were all actively engaged in the same profession, trade, or occupation; and
(ii) Has been maintained in good faith for purposes other than obtaining insurance; or
(c)(i) An association, trust, or the trustees of a fund established, created, or maintained for the benefit of members of one or more associations. Before advertising, marketing, or offering supplemental long-term care coverage in this state, the association or associations, or the insurer of the association or associations, must file evidence with the commissioner that the association or associations have at the time of such filing at least 100 persons who are members and that the association or associations have been organized and maintained in good faith for purposes other than that of obtaining insurance; have been in active existence for at least one year; and have a constitution and bylaws that provide that:
(A) The association or associations hold regular meetings at least annually to further the purposes of the members;
(B) Except for credit unions, the association or associations collect dues or solicit contributions from members; and
(C) The members have voting privileges and representation on the governing board and committees of the association.
(ii) Thirty days after filing the evidence in accordance with this section, the association or associations will be deemed to have satisfied the organizational requirements, unless the commissioner makes a finding that the association or associations do not satisfy those organizational requirements; or
(d) A group other than as described in (a), (b), or (c) of this subsection subject to a finding by the commissioner that:
(i) The issuance of the group policy is not contrary to the best interest of the public;
(ii) The issuance of the group policy would result in economies of acquisition or administration; and
(iii) The benefits are reasonable in relation to the premiums charged.
(6) "Policy" includes a document such as an insurance policy, contract, subscriber agreement, rider, or endorsement delivered or issued for delivery in this state by an insurer, fraternal benefit society, health care service contractor, health maintenance organization, or any similar entity authorized by the insurance commissioner to transact the business of supplemental long-term care insurance.
(7) "Qualified supplemental long-term care insurance contract" or "federally tax-qualified supplemental long-term care insurance contract" means:
(a) An individual or group insurance contract that meets the requirements of section 7702B(b) of the internal revenue code of 1986, as amended; or
(b) The portion of a life insurance contract that provides supplemental long-term care insurance coverage by rider or as part of the contract and that satisfies the requirements of sections 7702B(b) and (e) of the internal revenue code of 1986, as amended.
(8) "Supplemental long-term care insurance" means an insurance policy, contract, or rider that is advertised, marketed, offered, or designed to provide coverage for at least 12 consecutive months for a covered person after benefits provided under chapter
50B.04
RCW have been exhausted. Supplemental long-term care insurance may be on an expense incurred, indemnity, prepaid, or other basis, for one or more necessary or medically necessary diagnostic, preventive, therapeutic, rehabilitative, maintenance, or personal care services, provided in a setting other than an acute care unit of a hospital. Supplemental long-term care insurance includes any policy, contract, or rider that provides for payment of benefits based upon cognitive impairment or the loss of functional capacity that supplements benefits provided in chapter
50B.04
RCW.
(a) Supplemental long-term care insurance includes group and individual life insurance policies or riders that provide directly or supplement long-term care insurance and that supplements benefits provided in chapter
50B.04
RCW. However, supplemental long-term care insurance does not include life insurance policies that: (i) Accelerate the death benefit specifically for one or more of the qualifying events of terminal illness, medical conditions requiring extraordinary medical intervention, or permanent institutional confinement; (ii) provide the option of a lump sum payment for those benefits; and (iii) do not condition the benefits or the eligibility for the benefits upon the receipt of long-term care.
(b) Supplemental long-term care insurance also includes qualified supplemental long-term care insurance contracts.
(c) Supplemental long-term care insurance does not include any insurance policy, contract, or rider that is offered primarily to provide coverage for basic medicare supplement, basic hospital expense, basic medical-surgical expense, hospital confinement indemnity, major medical expense, disability income, related income, asset protection, accident only, specified disease, specified accident, or limited benefit health. These may not be marketed to consumers as providing coverage that is supplemental to the long-term care benefits provided in chapter
50B.04
RCW.
[
2025 c 380 s 19
.]
NOTES:
Effective date
—
2025 c 380 ss 17-39, 47, and 48:
See note following RCW 48.212.005
.
RCW 48.212.030
Documents filed with commissioner
—
Requirements.
(Effective May 1, 2026.)
(1) A supplemental long-term care insurance policy, contract, rider, or certificate form or application form shall not be issued, delivered, or used unless it has been filed with and approved by the commissioner.
(2) Rates, or modification of rates, for supplemental long-term care policies or certificates shall not be used until filed with and approved by the commissioner.
(3) A form or rate shall not knowingly be issued, delivered, or used if the commissioner's approval does not then exist.
[
2025 c 380 s 20
.]
NOTES:
Effective date
—
2025 c 380 ss 17-39, 47, and 48:
See note following RCW 48.212.005
.
RCW 48.212.040
Group policy issued in another state
—
Restrictions.
(Effective May 1, 2026.)
A group supplemental long-term care insurance policy may not be offered to a resident of this state under a group policy issued in another state to a group described in RCW 48.212.020
(5)(d), unless this state or another state having statutory and regulatory supplemental long-term care insurance requirements substantially similar to those adopted in this state has made a determination that such requirements have been met.
[
2025 c 380 s 21
.]
NOTES:
Effective date
—
2025 c 380 ss 17-39, 47, and 48:
See note following RCW 48.212.005
.
RCW 48.212.050
Preexisting conditions.
(Effective May 1, 2026.)
(1) A supplemental long-term care insurance policy or certificate may not define "preexisting condition" more restrictively than as a condition for which medical advice or treatment was recommended by or received from a provider of health care services, within six months preceding the effective date of coverage of an insured person, unless the policy or certificate applies to group supplemental long-term care insurance under RCW 48.212.020
(5) (a), (b), or (c).
(2) A supplemental long-term care insurance policy or certificate may not exclude coverage for a loss or confinement that is the result of a preexisting condition unless the loss or confinement begins within six months following the effective date of coverage of an insured person, unless the policy or certificate applies to a group as defined in RCW 48.212.020
(5)(a).
(3) The commissioner may extend the limitation periods for specific age group categories in specific policy forms upon finding that the extension is in the best interest of the public.
(4) An issuer may use an application form designed to elicit the complete health history of an applicant and underwrite in accordance with that issuer's established underwriting standards, based on the answers on that application. Unless otherwise provided in the policy or certificate and regardless of whether it is disclosed on the application, a preexisting condition need not be covered until the waiting period expires.
(5) A supplemental long-term care insurance policy or certificate may not exclude or use waivers or riders to exclude, limit, or reduce coverage or benefits for specifically named or described preexisting diseases or physical conditions beyond the waiting period.
[
2025 c 380 s 22
.]
NOTES:
Effective date
—
2025 c 380 ss 17-39, 47, and 48:
See note following RCW 48.212.005
.
RCW 48.212.060
Prohibited policy terms and practices.
(Effective May 1, 2026.)
(1) No supplemental long-term care insurance policy may:
(a) Be canceled, nonrenewed, or otherwise terminated on the grounds of the age or the deterioration of the mental or physical health of the insured individual or certificate holder;
(b) Contain a provision establishing a new waiting period in the event existing coverage is converted to or replaced by a new or other form within the same company, except with respect to an increase in benefits voluntarily selected by the insured individual or group policyholder;
(c) Provide coverage for skilled nursing care only or provide significantly more coverage for skilled care in a facility than coverage for lower levels of care;
(d) Condition eligibility for any benefits on a prior hospitalization requirement;
(e) Condition eligibility for benefits provided in an institutional care setting on the receipt of a higher level of institutional care;
(f) Condition eligibility for any benefits other than waiver of premium, postconfinement, postacute care, or recuperative benefits on a prior institutionalization requirement;
(g) Include a postconfinement, postacute care, or recuperative benefit unless:
(i) Such requirement is clearly labeled in a separate paragraph of the policy or certificate entitled "Limitations or Conditions on Eligibility for Benefits"; and
(ii) Such limitations or conditions specify any required number of days of preconfinement or postconfinement;
(h) Condition eligibility for noninstitutional benefits on the prior receipt of institutional care;
(i)(i) Provide for a deductible that is greater than the maximum dollar equivalent provided in RCW 50B.04.060
(3)(b), including inflation adjustments provided in RCW 50B.04.010
(3), without the limitation provided in RCW 50B.04.050
(2). The issuer may provide for a deductible that is less than the maximum dollar equivalent provided in RCW 50B.04.060
(3)(b), especially for a policyholder born before 1968;
(ii) The issuer must accept notice from the department of social and health services that the policyholder has exhausted the benefits provided under chapter
50B.04
RCW as evidence of satisfying the deductible. However, for a policyholder born before 1968, the department must provide the amount of benefits paid under chapter
50B.04
RCW as evidence of payment toward the deductible;
(j) Include an elimination period of greater than 12 months. Any period of time the policyholder is considered an eligible beneficiary as defined in RCW 50B.04.010
must count toward any elimination period in a supplemental long-term care insurance policy. If the policy includes a deductible and an elimination period, the policy may provide that the elimination period is satisfied after the later of when the deductible or the elimination period has been met; and
(k) Require a policyholder to undergo a functional assessment to satisfy a benefit trigger to determine that the elimination period has begun or ended. However, the issuer may require the policyholder to undergo a functional assessment and apply a benefit trigger for purposes of approving a claim and authorizing benefits.
(2) A supplemental long-term care insurance policy or certificate may be field-issued if the compensation to the field issuer is not based on the number of policies or certificates issued. For purposes of this section, "field-issued" means a policy or certificate issued by a producer or a third-party administrator of the policy pursuant to the underwriting authority by an issuer and using the issuer's underwriting guidelines.
[
2025 c 380 s 23
.]
NOTES:
Effective date
—
2025 c 380 ss 17-39, 47, and 48:
See note following RCW 48.212.005
.
RCW 48.212.070
Returns of policies or certificates.
(Effective May 1, 2026.)
(1) Supplemental long-term care insurance applicants may return a policy or certificate for any reason within 30 days after its delivery and to have the premium refunded.
(2) All supplemental long-term care insurance policies and certificates must have a notice prominently printed on or attached to the first page of the policy stating that the applicant may return the policy or certificate within 30 days after its delivery and to have the premium refunded.
(3) Refunds or denials of applications must be made within 30 days of the return or denial.
(4) This section does not apply to certificates issued pursuant to a policy issued to a group defined in RCW 48.212.020
(5)(a).
[
2025 c 380 s 24
.]
NOTES:
Effective date
—
2025 c 380 ss 17-39, 47, and 48:
See note following RCW 48.212.005
.
RCW 48.212.080
Outline of coverage
—
Contract delivery
—
Policy summary.
(Effective May 1, 2026.)
(1) An outline of coverage must be delivered to a prospective applicant for supplemental long-term care insurance at the time of initial solicitation through means that prominently direct the attention of the recipient to the document and its purpose.
(a) The commissioner must prescribe a standard format, including style, arrangement, overall appearance, and the content of an outline of coverage. The outline of coverage must also include a disclosure:
(i) Of how the supplemental long-term care insurance interacts with benefits provided in chapter
50B.04
RCW and any potential gaps in coverage or discontinuities of care between benefits provided under chapter
50B.04
RCW and the policy;
(ii) That the premiums may increase over time and an explanation of the conditions that may result in an increase in premiums;
(iii) If the policyholder's circumstances change or premiums increase and the policyholder is unable or unwilling to pay the increased premiums, the options available to the consumer, including a reduction in benefits and nonforfeiture of premiums;
(iv) That premiums continue after retirement;
(v) When premium payments are no longer required under the policy, known as a waiver of premiums; and
(vi) That the purchase of the policy does not qualify the policyholder to apply to be exempt from premium assessments under RCW 50B.04.085
.
(b) When an insurance producer makes a solicitation in person, the insurance producer must deliver an outline of coverage before presenting an application or enrollment form.
(c) In a direct response solicitation, the outline of coverage must be presented with an application or enrollment form. The disclosures required under (a) of this subsection are required in any marketing materials.
(d) If a policy is issued to a group as defined in RCW 48.212.020
(5)(a), an outline of coverage is not required to be delivered, if the information that the commissioner requires to be included in the outline of coverage is in other materials relating to enrollment. Upon request, any such materials must be made available to the commissioner.
(2) If an issuer approves an application for a supplemental long-term care insurance contract or certificate, the issuer must deliver the contract or certificate of insurance to the applicant within 30 days after the date of approval. A policy summary must be delivered with an individual life insurance policy that provides supplemental long-term care benefits within the policy or by rider. In a direct response solicitation, the issuer must deliver the policy summary, upon request, before delivery of the policy, if the applicant requests a summary.
(a) The policy summary must include:
(i) An explanation of how the supplemental long-term care benefit interacts with other components of the policy, including deductions from any applicable death benefits;
(ii) An illustration of the amount of benefits, the length of benefits, and the guaranteed lifetime benefits if any, for each covered person;
(iii) Any exclusions, reductions, and limitations on benefits of supplemental long-term care;
(iv) A statement that any supplemental long-term care inflation protection option required by RCW 48.212.140
is not available under this policy; and
(v) If applicable to the policy type, the summary must also include:
(A) A disclosure of the effects of exercising other rights under the policy;
(B) A disclosure of guarantees related to long-term care costs of insurance charges; and
(C) Current and projected maximum lifetime benefits.
(b) The provisions of the policy summary may be incorporated into a basic illustration required under chapter
48.23A
RCW, or into the policy summary which is required under rules adopted by the commissioner.
[
2025 c 380 s 25
.]
NOTES:
Effective date
—
2025 c 380 ss 17-39, 47, and 48:
See note following RCW 48.212.005
.
RCW 48.212.090
Required options for policyholders.
(Effective May 1, 2026.)
A supplemental long-term care insurance policy, contract, or rider must:
(1) Allow the policyholder options for reduction of benefits or nonforfeiture of premiums as provided in RCW 48.212.150
if the premiums increase or the policyholder's circumstances change and the policyholder is unable or unwilling to pay the increased premiums;
(2) Allow for continuity of coverage of care settings and providers, including family providers, that the policyholder was receiving as benefits under the program provided in chapter
50B.04
RCW unless there is substantial clinical or other information showing that the current care setting or provider cannot meet the care and safety needs of the policyholder. If the issuer makes a determination that the care setting or providers are not suited to meeting the care and safety needs of the policyholder, the issuer may require a change of care setting or provider under the policy, effective 90 days after the transition from the benefits provided under chapter
50B.04
RCW. The policyholder may appeal the determination through an independent third-party review as tracked by the commissioner. The issuer may audit for fraudulent claims where the care being claimed is not being provided; and
(3) Cover family providers, provided they are suited to meet the care and safety needs of the policyholder.
[
2025 c 380 s 26
.]
NOTES:
Effective date
—
2025 c 380 ss 17-39, 47, and 48:
See note following RCW 48.212.005
.
RCW 48.212.100
Consent to share information
—
Limitations on sharing.
(Effective May 1, 2026.)
(1) When a policyholder purchases a supplemental long-term care insurance policy, the issuer must request written consent from the policyholder to share information with the department of social and health services. If the policyholder provides written consent, the issuer must inform the department of social and health services that the policyholder has purchased a supplemental long-term care insurance policy and share any information with the department for the purposes of any potential care coordination.
(2) Only basic demographic information that would allow a person to be identified in the program provided in chapter
50B.04
RCW may be shared if the individual consents to sharing information. No health care information as defined in RCW 70.02.010
or data on claims may be shared.
[
2025 c 380 s 27
.]
NOTES:
Effective date
—
2025 c 380 ss 17-39, 47, and 48:
See note following RCW 48.212.005
.
RCW 48.212.110
Supplemental long-term care benefits funded by specific life insurance policies
—
Reporting.
(Effective May 1, 2026.)
If a supplemental long-term care benefit funded through a life insurance policy by the acceleration of the death benefit is in benefit payment status, a monthly report must be provided to the policyholder. The report must include:
(1) A record of all supplemental long-term care benefits paid out during the month;
(2) An explanation of any changes in the policy resulting from paying the supplemental long-term care benefits, such as a change in the death benefit or cash values; and
(3) The amount of supplemental long-term care benefits that remain to be paid.
[
2025 c 380 s 28
.]
NOTES:
Effective date
—
2025 c 380 ss 17-39, 47, and 48:
See note following RCW 48.212.005
.
RCW 48.212.120
Deadline to pay or decline to pay claims.
(Effective May 1, 2026.)
Within 30 business days after receipt of all the requested additional information, an insurer must pay a claim for benefits under a supplemental long-term care insurance policy or certificate if it is a clean claim, or send a written notice that the insurer is declining to pay all or part of the claim and the specific reason or reasons for denial.
[
2025 c 380 s 29
.]
NOTES:
Effective date
—
2025 c 380 ss 17-39, 47, and 48:
See note following RCW 48.212.005
.
RCW 48.212.130
Recission of policy or certificate.
(Effective May 1, 2026.)
(1) An issuer may rescind a supplemental long-term care insurance policy or certificate or deny an otherwise valid supplemental long-term care insurance claim if:
(a) A policy or certificate has been in force for less than six months and upon a showing of misrepresentation that is material to the acceptance for coverage; or
(b) A policy or certificate has been in force for at least six months but less than two years, upon a showing of misrepresentation that is both material to the acceptance for coverage and that pertains to the condition for which benefits are sought.
(2) After a policy or certificate has been in force for two years it is not contestable upon the grounds of misrepresentation alone. Such a policy or certificate may be contested only upon a showing that the insured knowingly and intentionally misrepresented relevant facts relating to the insured's health.
(3) An issuer's payments for benefits under a supplemental long-term care insurance policy or certificate may not be recovered by the issuer if the policy or certificate is rescinded.
(4) This section does not apply to the remaining death benefit of a life insurance policy that accelerates benefits for supplemental long-term care that are governed by RCW 48.23.050
the state's life insurance incontestability clause. In all other situations, this section applies to life insurance policies that accelerate benefits for supplemental long-term care.
[
2025 c 380 s 30
.]
NOTES:
Effective date
—
2025 c 380 ss 17-39, 47, and 48:
See note following RCW 48.212.005
.
RCW 48.212.140
Inflation protection features
—
Rules.
(Effective May 1, 2026.)
(1) The commissioner must establish minimum standards for inflation protection features.
(2) An issuer must comply with the rules adopted by the commissioner that establish minimum standards for inflation protection features.
[
2025 c 380 s 31
.]
NOTES:
Effective date
—
2025 c 380 ss 17-39, 47, and 48:
See note following RCW 48.212.005
.
RCW 48.212.150
Nonforfeiture benefit option
—
Offer required
—
Rules.
(Effective May 1, 2026.)
(1) Except as provided by this section, a supplemental long-term care insurance policy may not be delivered or issued for delivery in this state unless the policyholder or certificate holder has been offered the option of purchasing a policy or certificate that includes a nonforfeiture benefit. The offer of a nonforfeiture benefit may be in the form of a rider that is attached to the policy. If a policyholder or certificate holder declines the nonforfeiture benefit, the issuer must provide a contingent benefit upon lapse that is available for a specified period of time following a substantial increase in premium rates.
(2) If a group supplemental long-term care insurance policy is issued, the offer required in subsection (1) of this section must be made to the group policyholder. However, if the policy is issued as group supplemental long-term care insurance as defined in RCW 48.212.020
(5)(d) other than to a continuing care retirement community or other similar entity, the offering must be made to each proposed certificate holder.
(3) The commissioner must adopt rules specifying the type or types of nonforfeiture benefits to be offered as part of supplemental long-term care insurance policies and certificates, the standards for nonforfeiture benefits, and the rules regarding contingent benefit upon lapse, including a determination of the specified period of time during which a contingent benefit upon lapse will be available and the substantial premium rate increase that triggers a contingent benefit upon lapse.
[
2025 c 380 s 32
.]
NOTES:
Effective date
—
2025 c 380 ss 17-39, 47, and 48:
See note following RCW 48.212.005
.
RCW 48.212.160
Insurance producers
—
Requirements
—
Duties.
(Effective May 1, 2026.)
(1) A person may not sell, solicit, or negotiate supplemental long-term care insurance unless the person is appropriately licensed as an insurance producer and has successfully completed supplemental long-term care coverage education that meets the requirements of this section and:
(a) Has successfully completed long-term care coverage education that meets the requirements of RCW 48.83.130
; and
(b) Has completed an approved one-hour course on supplemental long-term care insurance that includes education on:
(i) The provisions of chapter
50B.04
RCW and any rules adopted to implement the long-term services and supports trust program;
(ii) The relationship between benefits offered under chapter
50B.04
RCW, qualified state long-term care insurance partnership programs, and other public and private coverage of long-term care services, including medicaid; and
(iii) This chapter.
(2) The insurance producer education required by this section may not include training that is issuer or company product-specific or that includes any sales or marketing information, materials, or training, other than those required by state or federal law.
(3) Issuers must obtain verification that an insurance producer receives training required by this section before that producer is permitted to sell, solicit, or otherwise negotiate the issuer's supplemental long-term care insurance products.
(4) Issuers must maintain records subject to the state's record retention requirements and make evidence of that verification available to the commissioner upon request.
(5)(a) Issuers must maintain records with respect to the training of its producers concerning the distribution of its long-term care partnership policies that will allow the commissioner to provide assurance to the state department of social and health services, medicaid division, that insurance producers engaged in the sale of supplemental long-term care insurance contracts have received the training required by this section and any rules adopted by the commissioner, and that producers have demonstrated an understanding of the partnership policies and their relationship to benefits offered under chapter
50B.04
RCW and public and private coverage of long-term care, including medicaid, in this state.
(b) These records must be maintained in accordance with the state's record retention requirements and be made available to the commissioner upon request.
[
2025 c 380 s 33
.]
NOTES:
Effective date
—
2025 c 380 ss 17-39, 47, and 48:
See note following RCW 48.212.005
.
RCW 48.212.170
Issuers
—
Determinations
—
Standards
—
Rules.
(Effective May 1, 2026.)
(1) Issuers and their agents, if any, must determine whether issuing supplemental long-term care insurance coverage to a particular person is appropriate, except in the case of a life insurance policy that accelerates benefits for supplemental long-term care.
(2) An issuer must:
(a) Develop and use suitability standards to determine whether the purchase or replacement of supplemental long-term care coverage is appropriate for the needs of the applicant or insured, using a best interest standard. The issuers and their agents must act in the best interests of the applicant or policyholder under the circumstances known at the time the recommendation is made, without putting the issuer or agent's financial interests ahead of the interests of the applicant or policyholder;
(b) Train its agents in the use of the issuer's suitability standards; and
(c) Maintain a copy of its suitability standards and make the standards available for inspection, upon request.
(3) The following must be considered when determining whether the applicant meets the issuer's suitability standards:
(a) The ability of the applicant to pay for the proposed coverage and any other relevant financial information related to the purchase of or payment for coverage;
(b) The applicant's goals and needs with respect to supplemental long-term care and the advantages and disadvantages of supplemental long-term care coverage to meet those goals or needs; and
(c) The values, benefits, and costs of the applicant's existing health or long-term care coverage, if any, when compared to the values, benefits, and costs of the recommended purchase or replacement.
(4) The sale or transfer of any suitability information provided to the issuer or agent by the applicant to any other person or business entity is prohibited.
(5)(a) The commissioner must adopt rules on forms of consumer-friendly personal worksheets that issuers and their agents must use for applications for supplemental long-term care coverage.
(b) The commissioner may require each issuer to file its current forms of suitability standards and personal worksheets with the commissioner.
[
2025 c 380 s 34
.]
NOTES:
Effective date
—
2025 c 380 ss 17-39, 47, and 48:
See note following RCW 48.212.005
.
RCW 48.212.180
Unfair or deceptive acts or practices prohibited.
(Effective May 1, 2026.)
A person engaged in the issuance or solicitation of supplemental long-term care coverage may not engage in unfair methods of competition or unfair or deceptive acts or practices, as such methods, acts, or practices are defined in chapter
48.30
RCW, or as defined by the commissioner.
[
2025 c 380 s 35
.]
NOTES:
Effective date
—
2025 c 380 ss 17-39, 47, and 48:
See note following RCW 48.212.005
.
RCW 48.212.190
Violations.
(Effective May 1, 2026.)
An issuer or an insurance producer who violates a law or rule relating to the regulation of supplemental long-term care insurance or its marketing is subject to a fine of up to three times the amount of the commission paid for each policy involved in the violation or $10,000, whichever is greater.
[
2025 c 380 s 36
.]
NOTES:
Effective date
—
2025 c 380 ss 17-39, 47, and 48:
See note following RCW 48.212.005
.
RCW 48.212.200
Rules.
(Effective May 1, 2026.)
(1) The commissioner must adopt rules that include standards for full and fair disclosure setting forth the manner, content, and required disclosures for the sale of supplemental long-term care insurance policies, terms of renewability, initial and subsequent conditions of eligibility, nonduplication of coverage provisions, coverage of dependents, preexisting conditions, termination of insurance, continuation or conversion, probationary periods, limitations, exceptions, reductions, elimination periods, requirements for replacement, recurrent conditions, and definitions of terms. The commissioner must adopt rules establishing loss ratio standards for supplemental long-term care insurance policies. The commissioner must adopt rules to promote premium adequacy and to protect policyholders in the event of proposed substantial rate increases, and to establish minimum standards for producer education, marketing practices, producer compensation, producer testing, penalties, and reporting practices for supplemental long-term care insurance.
(2) The commissioner must adopt rules establishing standards protecting patient privacy rights, rights to receive confidential health care services, and standards for an issuer's timely review of a claim denial upon request of a covered person.
(3) The commissioner must adopt by rule prompt payment requirements for supplemental long-term care insurance. The rules must include a definition of a "claim" and a definition of "clean claim." In adopting the rules, the commissioner must consider the prompt payment requirements in long-term care insurance model acts developed by the national association of insurance commissioners.
(4) The commissioner may adopt reasonable rules to carry out this chapter.
[
2025 c 380 s 37
.]
NOTES:
Effective date
—
2025 c 380 ss 17-39, 47, and 48:
See note following RCW 48.212.005
.
RCW 48.212.210
Consumer education guide and programs.
(Effective May 1, 2026.)
(1) The commissioner must:
(a) Develop a consumer education guide designed to educate consumers and help them make informed decisions as to the purchase of supplemental long-term care insurance policies provided under this chapter; and
(b) Expand programs to educate consumers as to the supplemental long-term care insurance policies provided under this chapter, with a focus on the middle-income market. If allowable under federal law, the commissioner must expand the statewide health insurance benefits advisor program to provide the consumer education.
(2) The guide and programs should:
(a) Provide additional information and counseling for consumers born before 1968. This information and counseling should educate these consumers as to potential out-of-pocket costs they may be subject to before supplemental long-term care insurance will begin paying claims and strategies for managing the gap between benefits payable under chapter
50B.04
RCW and coverage under supplemental long-term care insurance.
(b) Support consumers in assessing the tradeoffs between various elimination period options and premium rates.
(c) Educate consumers on budgeting any benefits available under chapter
50B.04
RCW carefully to reduce the likelihood and size of any potential gap between those benefits and the supplemental long-term care insurance.
[
2025 c 380 s 38
.]
NOTES:
Effective date
—
2025 c 380 ss 17-39, 47, and 48:
See note following RCW 48.212.005
.