Source: https://app.leg.wa.gov/RCW/default.aspx?cite=48.125&full=true
Timestamp: 2019-12-10 02:29:23
Document Index: 684631914

Matched Legal Cases: ['§ 1', '§ 2', '§ 8', '§ 9', '§ 10', '§ 10', '§ 11', '§ 12', '§ 13', '§ 14', '§ 15', '§ 17', '§ 18', '§ 6', '§ 29']

Chapter 48.125 RCW: SELF-FUNDED MULTIPLE EMPLOYER WELFARE ARRANGEMENTS
RCWs > Title 48 > Chapter 48.125
Chapter 48.125 RCW
48.125.003 Short title.
48.125.005 Purposes.
48.125.010 Definitions.
48.125.020 Certificate of authority required.
48.125.030 Certificate of authority—Requirements for issuance.
48.125.040 Certificate of authority—Continued compliance with certain conditions—Commissioner's discretion.
48.125.050 Certificate of authority—Application—Form—Documentation.
48.125.060 Surplus required—Amount—Enforcement.
48.125.070 Contribution rates.
48.125.080 Certificate of authority—Granting or denying application.
48.125.090 Reporting requirements.
48.125.100 Failure to comply with chapter—Sanctions.
48.125.110 Certificate of authority—Failure to obtain.
48.125.120 Policy must contain specific notice.
48.125.130 Additional compliance requirements.
48.125.140 Examination of operations—Commissioner's powers—Definition of affiliate.
48.125.150 Chapter not applicable.
48.125.160 Taxable amounts—Participant contributions.
48.125.200 Prostate cancer screening.
48.125.901 Effective date—2004 c 260.
RCW 48.125.003
This chapter may be cited as the "self-funded multiple employer welfare arrangement regulation act."
[ 2004 c 260 § 1.]
RCW 48.125.005
(1) Provide for the authorization and registration of self-funded multiple employer welfare arrangements;
(2) Regulate self-funded multiple employer welfare arrangements in order to ensure the financial integrity of the arrangements;
(3) Provide reporting requirements for self-funded multiple employer welfare arrangements; and
(4) Provide for sanctions against self-funded multiple employer welfare arrangements organized, operated, providing benefits, or maintained in this state that do not comply with this chapter.
[ 2004 c 260 § 2.]
RCW 48.125.060
Surplus required—Amount—Enforcement.
Self-funded multiple employer welfare arrangements must maintain continuously a surplus equal to at least ten percent of the next twelve months projected incurred claims or two million dollars, whichever is greater. The commissioner may proceed against self-funded multiple employer welfare arrangements that fail to maintain the level of surplus required by this section in any manner that the commissioner is authorized to proceed against a health care service contractor that failed to maintain minimum net worth.
[ 2004 c 260 § 8.]
RCW 48.125.070
A self-funded multiple employer welfare arrangement must establish and maintain contribution rates for participation under the arrangement that satisfy either of the following requirements:
(1) Contribution rates must equal or exceed the sum of projected incurred claims for the year, plus all projected costs of operation of the arrangement for the year, plus an amount equal to any deficiency in the surplus of the arrangement for the prior year, minus an amount equal to the surplus of the arrangement in excess of the minimum required level of surplus; or
(2) Contribution rates must equal or exceed a funding level established by a report prepared by a qualified actuary.
[ 2004 c 260 § 9.]
RCW 48.125.080
Certificate of authority—Granting or denying application.
(1) The commissioner shall grant or deny an application for a certificate of authority within one hundred eighty days of the date that a completed application, together with the items designated in RCW 48.125.050, is submitted to the commissioner.
(2) The commissioner shall grant the application of an arrangement that satisfies the applicable requirements of RCW 48.125.030 through 48.125.070.
(3) The commissioner shall deny the application of an arrangement that does not satisfy the applicable requirements of RCW 48.125.030 through 48.125.070. Denial of an application for a certificate of authority is subject to appeal under chapter 34.05 RCW.
(4) A certificate of authority granted to an arrangement is effective unless revoked by the commissioner under RCW 48.125.100.
[ 2004 c 260 § 10.]
RCW 48.125.090
(1) A self-funded multiple employer welfare arrangement must comply with the reporting requirements of this section.
(2) Every arrangement holding a certificate of authority from the commissioner must file its financial statements as required by this title and by the commissioner in accordance with the accounting practices and procedures manuals as adopted by the national association of insurance commissioners, unless otherwise provided by law.
(3) Every arrangement must comply with the provisions of chapters 48.12 and 48.13 RCW.
(4) Every domestic arrangement holding a certificate of authority shall annually, on or before the first day of March, file with the commissioner a true statement of its financial condition, transactions, and affairs as of the thirty-first day of December of the preceding year. The statement forms must be those forms approved by the national association of insurance commissioners for health insurance. The statement must be verified by the oaths of at least two officers of the arrangement. Additional information may be required by this title or by the request of the commissioner.
(5) Every arrangement must report their annual and other statements in the same manner required of other insurers by rule of the commissioner.
(6) The arrangement must file with the commissioner a copy of the arrangement's internal revenue service form 5500 together with all attachments to the form, at the time required for filing the form.
[ 2006 c 25 § 10; 2004 c 260 § 11.]
RCW 48.125.100
Failure to comply with chapter—Sanctions.
(1) The commissioner may impose sanctions against a self-funded multiple employer welfare arrangement that fails to comply with this chapter. The maximum fine may not exceed ten thousand dollars for each violation.
(2) The commissioner may issue a notice of intent to revoke the certificate of authority of a self-funded multiple employer welfare arrangement that fails to comply with RCW 48.125.060, 48.125.070, or 48.125.090. If, within sixty days of receiving notice under this subsection, the arrangement fails to file with the commissioner a plan to bring the arrangement into compliance with RCW 48.125.060, 48.125.070, or 48.125.090, the commissioner may revoke the arrangement's certificate of authority. A revocation of a certificate of authority is subject to appeal under chapter 34.05 RCW.
(3) An arrangement that fails to maintain the level of surplus required by RCW 48.125.060 is subject to the sanctions authorized in RCW 48.44.160 through 48.44.166.
[ 2004 c 260 § 12.]
RCW 48.125.110
Certificate of authority—Failure to obtain.
A self-funded multiple employer welfare arrangement organized, operated, providing benefits, or maintained in this state without a certificate of authority is in violation of this title.
[ 2004 c 260 § 13.]
RCW 48.125.120
Policy must contain specific notice.
Each policy issued by a self-funded multiple employer welfare arrangement must contain, in ten-point type on the front page and the declaration page, the following notice:
This policy is issued by a self-funded multiple employer welfare arrangement. A self-funded multiple employer welfare arrangement may not be subject to all of the insurance laws and regulations of your state. State insurance insolvency guaranty funds are not available for a self-funded multiple employer welfare arrangement."
[ 2004 c 260 § 14.]
RCW 48.125.130
A self-funded multiple employer welfare arrangement is subject to RCW 48.43.300 through 48.43.370, the rehabilitation provisions under chapter 48.31 RCW, and chapter 48.99 RCW.
[ 2004 c 260 § 15.]
RCW 48.125.150
Chapter not applicable.
(1) Single employer entities;
(2) Taft-Hartley plans; or
(3) Self-funded multiple employer welfare arrangements that do not provide coverage for health care services.
[ 2004 c 260 § 17.]
RCW 48.125.160
Taxable amounts—Participant contributions.
Participant contributions used to determine the taxable amounts in this state under RCW 48.14.0201 shall be determined in the same manner as premiums taxable in this state are determined under RCW 48.14.090.
[ 2004 c 260 § 18.]
RCW 48.125.200
(1) Each self-funded multiple employer welfare arrangement established, operated, providing benefits, or maintained in this state after December 31, 2006, that provides coverage for hospital or medical expenses shall provide coverage for prostate cancer screening, provided that the screening is delivered upon the recommendation of the patient's physician, advanced registered nurse practitioner, or physician assistant.
(2) This section shall not be construed to prevent the application of standard policy provisions applicable to other benefits, such as deductible or copayment provisions. This section does not limit the authority of a self-funded multiple employer welfare arrangement to negotiate rates and contract with specific providers for the delivery of prostate cancer screening services.
[ 2006 c 367 § 6.]
RCW 48.125.901
Effective date—2004 c 260.
This act is necessary for the immediate preservation of the public peace, health, or safety, or support of the state government and its existing public institutions, and takes effect immediately [March 31, 2004].
[ 2004 c 260 § 29.]