reglab/statecodes huggingface dataset:
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.80 - Health Care False Claim Act. › 48.80.030 - Making false claims, concealing information—Penalty—Exclusions.

RCW 48.80.030
Making false claims, concealing information—Penalty—Exclusions.
(1) A person shall not make or present or cause to be made or presented to a health care payer a claim for a health care payment knowing the claim to be false.
(2) No person shall knowingly present to a health care payer a claim for a health care payment that falsely represents that the goods or services were medically necessary in accordance with professionally accepted standards. Each claim that violates this subsection shall constitute a separate offense.
(3) No person shall knowingly make a false statement or false representation of a material fact to a health care payer for use in determining rights to a health care payment. Each claim that violates this subsection shall constitute a separate violation.
(4) No person shall conceal the occurrence of any event affecting his or her initial or continued right under a contract, certificate, or policy of insurance to have a payment made by a health care payer for a specified health care service. A person shall not conceal or fail to disclose any information with intent to obtain a health care payment to which the person or any other person is not entitled, or to obtain a health care payment in an amount greater than that which the person or any other person is entitled.
(5) No provider shall willfully collect or attempt to collect an amount from an insured knowing that to be in violation of an agreement or contract with a health care payor to which the provider is a party.
(6) A person who violates this section is guilty of a class C felony punishable under chapter 9A.20 RCW.
(7) This section does not apply to statements made on an application for coverage under a contract or certificate of health care coverage issued by an insurer, health care service contractor, health maintenance organization, or other legal entity which is self-insured and providing health care benefits to its employees.
[ 1990 c 119 § 11; 1986 c 243 § 3.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.80 - Health Care False Claim Act. › 48.80.040 - Use of circumstantial evidence.

RCW 48.80.040
Use of circumstantial evidence.
In a prosecution under this chapter, circumstantial evidence may be presented to demonstrate that a false statement or claim was knowingly made. Such evidence may include but shall not be limited to the following circumstances:
(1) Where a claim for a health care payment is submitted with the person's actual, facsimile, stamped, typewritten, or similar signature on the form required for the making of a claim for health care payment; and
(2) Where a claim for a health care payment is submitted by means of computer billing tapes or other electronic means if the person has advised the health care payer in writing that claims for health care payment will be submitted by use of computer billing tapes or other electronic means.
[ 1986 c 243 § 4.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.80 - Health Care False Claim Act. › 48.80.050 - Civil action not limited.

RCW 48.80.050
Civil action not limited.
This chapter shall not be construed to prohibit or limit a prosecution of or civil action against a person for the violation of any other law of this state.
[ 1986 c 243 § 5.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.80 - Health Care False Claim Act. › 48.80.060 - Conviction of provider, notification to regulatory agency.

RCW 48.80.060
Conviction of provider, notification to regulatory agency.
Upon the conviction under this chapter of any provider, the prosecutor shall provide written notification to the appropriate regulatory or disciplinary agency of such conviction.
[ 1986 c 243 § 6.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.83 - Long-Term Care Insurance Coverage—Standards. › 48.83.005 - Intent.

RCW 48.83.005
Intent.
The intent of this chapter is to promote the public interest, support the availability of long-term care coverage, establish standards for long-term care coverage, facilitate public understanding and comparison of long-term care contract benefits, protect persons insured under long-term care insurance policies and certificates, protect applicants for long-term care policies from unfair or deceptive sales or enrollment practices, and provide for flexibility and innovation in the development of long-term care insurance coverage.
[ 2008 c 145 § 1.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.83 - Long-Term Care Insurance Coverage—Standards. › 48.83.010 - Application.

RCW 48.83.010
Application.
This chapter applies to all long-term care insurance policies, contracts, or riders delivered or issued for delivery in this state on or after January 1, 2009. 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 long-term care insurance.
(1) Coverage advertised, marketed, or offered as long-term care insurance shall comply with the provisions of this chapter. Any coverage, policy, or rider advertised, marketed, or offered as long-term care or nursing home insurance shall comply with the provisions of this chapter.
(2) Individual and group long-term care contracts issued prior to January 1, 2009, remain governed by chapter 48.84 RCW and rules adopted thereunder.
(3) This chapter is not intended to prohibit approval of long-term care funded through life insurance.
[ 2008 c 145 § 2.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.83 - Long-Term Care Insurance Coverage—Standards. › 48.83.030 - Out-of-state policy—Restriction.

RCW 48.83.030
Out-of-state policy—Restriction.
A group 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 48.83.020(6)(d), unless this state or another state having statutory and regulatory long-term care insurance requirements substantially similar to those adopted in this state has made a determination that such requirements have been met.
[ 2008 c 145 § 4.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.83 - Long-Term Care Insurance Coverage—Standards. › 48.83.040 - Preexisting conditions.

RCW 48.83.040
Preexisting conditions.
(1) A 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 long-term care insurance under RCW 48.83.020(6) (a), (b), or (c).
(2) A 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 48.83.020(6)(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 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.
[ 2008 c 145 § 5.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.83 - Long-Term Care Insurance Coverage—Standards. › 48.83.050 - Prohibited policy terms and practices—Field-issued, defined.

RCW 48.83.050
Prohibited policy terms and practices—Field-issued, defined.
No long-term care insurance policy may:
(1) 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;
(2) 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;
(3) 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;
(4) Condition eligibility for any benefits on a prior hospitalization requirement;
(5) Condition eligibility for benefits provided in an institutional care setting on the receipt of a higher level of institutional care;
(6) Condition eligibility for any benefits other than waiver of premium, postconfinement, postacute care, or recuperative benefits on a prior institutionalization requirement;
(7) Include a postconfinement, postacute care, or recuperative benefit unless:
(a) Such requirement is clearly labeled in a separate paragraph of the policy or certificate entitled "Limitations or Conditions on Eligibility for Benefits"; and
(b) Such limitations or conditions specify any required number of days of preconfinement or postconfinement;
(8) Condition eligibility for noninstitutional benefits on the prior receipt of institutional care;
(9) A 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.
[ 2008 c 145 § 6.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.83 - Long-Term Care Insurance Coverage—Standards. › 48.83.060 - Right to return policy or certificate—Refund.

RCW 48.83.060
Right to return policy or certificate—Refund.
(1) Long-term care insurance applicants may return a policy or certificate for any reason within thirty days after its delivery and to have the premium refunded.
(2) All long-term care insurance policies and certificates shall 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 thirty days after its delivery and to have the premium refunded.
(3) Refunds or denials of applications must be made within thirty days of the return or denial.
(4) This section shall not apply to certificates issued pursuant to a policy issued to a group defined in RCW 48.83.020(6)(a).
[ 2008 c 145 § 7.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.83 - Long-Term Care Insurance Coverage—Standards. › 48.83.070 - Required documents for prospective and approved applicants—Contents—When due.

RCW 48.83.070
Required documents for prospective and approved applicants—Contents—When due.
(1) An outline of coverage must be delivered to a prospective applicant for 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.
(b) When an insurance producer makes a solicitation in person, he or she 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.
(d) If a policy is issued to a group as defined in RCW 48.83.020(6)(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 long-term care insurance contract or certificate, the issuer must deliver the contract or certificate of insurance to the applicant within thirty days after the date of approval. A policy summary must be delivered with an individual life insurance policy that provides 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 shall include:
(i) An explanation of how the 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 long-term care;
(iv) A statement that any long-term care inflation protection option required by RCW 48.83.110 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.
[ 2008 c 145 § 8.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.83 - Long-Term Care Insurance Coverage—Standards. › 48.83.080 - Benefit funded through life insurance policy—Acceleration of a death benefit.

RCW 48.83.080
Benefit funded through life insurance policy—Acceleration of a death benefit.
If a 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 long-term care benefits paid out during the month;
(2) An explanation of any changes in the policy resulting from paying the long-term care benefits, such as a change in the death benefit or cash values; and
(3) The amount of long-term care benefits that remain to be paid.
[ 2008 c 145 § 9.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.83 - Long-Term Care Insurance Coverage—Standards. › 48.83.090 - Denial of claims—Written explanation.

RCW 48.83.090
Denial of claims—Written explanation.
All long-term care denials must be made within thirty days after receipt of a written request made by a policyholder or certificate holder, or his or her representative. All denials of long-term care claims by the issuer must provide a written explanation of the reasons for the denial and make available to the policyholder or certificate holder all information directly related to the denial.
[ 2013 c 8 § 1; 2008 c 145 § 10.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.83 - Long-Term Care Insurance Coverage—Standards. › 48.83.100 - Rescission of policy or certificate.

RCW 48.83.100
Rescission of policy or certificate.
(1) An issuer may rescind a long-term care insurance policy or certificate or deny an otherwise valid 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 that 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 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 long-term care that are governed by RCW 48.23.050 the state's life insurance incontestability clause. In all other situations, this section shall apply to life insurance policies that accelerate benefits for long-term care.
[ 2008 c 145 § 11.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.83 - Long-Term Care Insurance Coverage—Standards. › 48.83.110 - Inflation protection features—Rules.

RCW 48.83.110
Inflation protection features—Rules.
(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.
[ 2008 c 145 § 12.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.83 - Long-Term Care Insurance Coverage—Standards. › 48.83.120 - Nonforfeiture benefit option—Offer required—Rules.

RCW 48.83.120
Nonforfeiture benefit option—Offer required—Rules.
(1) Except as provided by this section, a 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 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 long-term care insurance as defined in RCW 48.83.020(6)(d) other than to a continuing care retirement community or other similar entity, the offering shall 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 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.
[ 2008 c 145 § 13.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.83 - Long-Term Care Insurance Coverage—Standards. › 48.83.140 - Determining whether coverage is appropriate—Suitability standards—Information protected—Rules.

RCW 48.83.140
Determining whether coverage is appropriate—Suitability standards—Information protected—Rules.
Issuers and their agents, if any, must determine whether issuing long-term care insurance coverage to a particular person is appropriate, except in the case of a life insurance policy that accelerates benefits for long-term care.
(1) An issuer must:
(a) Develop and use suitability standards to determine whether the purchase or replacement of long-term care coverage is appropriate for the needs of the applicant or insured;
(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.
(2) 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 long-term care and the advantages and disadvantages of 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.
(3) 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.
(4)(a) The commissioner shall adopt, by rule, forms of consumer-friendly personal worksheets that issuers and their agents must use for applications for 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.
[ 2008 c 145 § 15.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.83 - Long-Term Care Insurance Coverage—Standards. › 48.83.150 - Prohibited practices.

RCW 48.83.150
Prohibited practices.
A person engaged in the issuance or solicitation of long-term care coverage shall 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.
[ 2008 c 145 § 16.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.83 - Long-Term Care Insurance Coverage—Standards. › 48.83.160 - Violations—Fine.

RCW 48.83.160
Violations—Fine.
An issuer or an insurance producer who violates a law or rule relating to the regulation of long-term care insurance or its marketing shall be subject to a fine of up to three times the amount of the commission paid for each policy involved in the violation or up to ten thousand dollars, whichever is greater.
[ 2008 c 145 § 17.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.83 - Long-Term Care Insurance Coverage—Standards. › 48.83.170 - Rules, generally.

RCW 48.83.170
Rules, generally.
(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 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 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 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 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 effectuate any provision of this chapter in accordance with the requirements of chapter 34.05 RCW.
[ 2013 c 8 § 2; 2008 c 145 § 18.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.83 - Long-Term Care Insurance Coverage—Standards. › 48.83.901 - Effective date—2008 c 145.

RCW 48.83.901
Effective date—2008 c 145.
This act takes effect January 1, 2009.
[ 2008 c 145 § 24.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.84 - Long-Term Care Insurance Act. › 48.84.010 - General provisions, intent.

RCW 48.84.010
General provisions, intent.
This chapter may be known and cited as the "long-term care insurance act" and is intended to govern the content and sale of long-term care insurance and long-term care benefit contracts issued before January 1, 2009, as defined in this chapter. This chapter shall be liberally construed to promote the public interest in protecting purchasers of long-term care insurance from unfair or deceptive sales, marketing, and advertising practices. The provisions of this chapter shall apply in addition to other requirements of Title 48 RCW.
[ 2008 c 145 § 19; 1986 c 170 § 1.]
NOTES:
Effective date—2008 c 145: See RCW 48.83.901.
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.84 - Long-Term Care Insurance Act. › 48.84.020 - Definitions.

RCW 48.84.020
Definitions.
Unless the context requires otherwise, the definitions in this section apply throughout this chapter.
(1) "Long-term care insurance" or "long-term care benefit contract" means any insurance policy or benefit contract primarily advertised, marketed, offered, or designed to provide coverage or services for either institutional or community-based convalescent, custodial, chronic, or terminally ill care. Such terms do not include and this chapter shall not apply to policies or contracts governed by chapter 48.66 RCW and continuing care retirement communities.
(2) "Loss ratio" means the incurred claims plus or minus the increase or decrease in reserves as a percentage of the earned premiums, or the projected incurred claims plus or minus the increase or decrease in projected reserves as a percentage of projected earned premiums, as defined by the commissioner.
(3) "Preexisting condition" means a covered person's medical condition that caused that person to have received medical advice or treatment during the specified time period before the effective date of coverage.
(4) "Medicare" means Title XVIII of the United States social security act, or its successor program.
(5) "Medicaid" means Title XIX of the United States social security act, or its successor program.
(6) "Nursing home" means a nursing home as defined in RCW 18.51.010.
[ 1986 c 170 § 2.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.84 - Long-Term Care Insurance Act. › 48.84.030 - Rules—Benefits-premiums ratio, coverage limitations.

RCW 48.84.030
Rules—Benefits-premiums ratio, coverage limitations.
(1) The commissioner shall adopt rules requiring reasonable benefits in relation to the premium or price charged for long-term care policies and contracts which rules may include but are not limited to the establishment of minimum loss ratios.
(2) In addition, the commissioner may adopt rules establishing standards for long-term care coverage benefit limitations, exclusions, exceptions, and reductions and for policy or contract renewability.
[ 1986 c 170 § 3.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.84 - Long-Term Care Insurance Act. › 48.84.040 - Policies and contracts—Prohibited provisions.

RCW 48.84.040
Policies and contracts—Prohibited provisions.
No long-term care insurance policy or benefit contract may:
(1) Use riders, waivers, endorsements, or any similar method to limit or reduce coverage or benefits;
(2) Indemnify against losses resulting from sickness on a different basis than losses resulting from accidents;
(3) Be canceled, nonrenewed, or segregated at the time of rerating solely on the grounds of the age or the deterioration of the mental or physical health of the covered person;
(4) Exclude or limit coverage for preexisting conditions for a period of more than one year prior to the effective date of the policy or contract or more than six months after the effective date of the policy or contract;
(5) Differentiate benefit amounts on the basis of the type or level of nursing home care provided;
(6) Contain a provision establishing any new waiting period in the event an existing policy or contract is converted to a new or other form within the same company.
[ 1986 c 170 § 4.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.84 - Long-Term Care Insurance Act. › 48.84.050 - Disclosure rules—Required provisions in policy or contract.

RCW 48.84.050
Disclosure rules—Required provisions in policy or contract.
(1) The commissioner shall adopt rules requiring disclosure to consumers of the level, type, and amount of benefits provided and the limitations, exclusions, and exceptions contained in a long-term care insurance policy or contract. In adopting such rules the commissioner shall require an understandable disclosure to consumers of any cost for services that the consumer will be responsible for in utilizing benefits covered under the policy or contract.
(2) Each long-term care insurance policy or contract shall include a provision, prominently displayed on the first page of the policy or contract, stating in substance that the person to whom the policy or contract is sold shall be permitted to return the policy or contract within thirty days of its delivery. In the case of policies or contracts solicited and sold by mail, the person may return the policy or contract within sixty days. Once the policy or contract has been returned, the person may have the premium refunded if, after examination of the policy or contract, the person is not satisfied with it for any reason. An additional ten percent penalty shall be added to any premium refund due which is not paid within thirty days of return of the policy or contract to the insurer or insurance producer. If a person, pursuant to such notice, returns the policy or contract to the insurer at its branch or home office, or to the insurance producer from whom the policy or contract was purchased, the policy or contract shall be void from its inception, and the parties shall be in the same position as if no policy or contract had been issued.
(3) No later than January 1, 2010, or when the insurer has used all of its existing paper long-term care insurance policy forms which were in its possession on July 1, 2009, whichever is earlier, the notice required by subsection (2) of this section shall use the term insurance producer in place of agent.
[ 2008 c 217 § 67; 1986 c 170 § 5.]
NOTES:
Severability—Effective date—2008 c 217: See notes following RCW 48.03.020.
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.84 - Long-Term Care Insurance Act. › 48.84.060 - Prohibited practices.

RCW 48.84.060
Prohibited practices.
No insurance producer or other representative of an insurer, contractor, or other organization selling or offering long-term care insurance policies or benefit contracts may: (1) Complete the medical history portion of any form or application for the purchase of such policy or contract; (2) knowingly sell a long-term care policy or contract to any person who is receiving medicaid; or (3) use or engage in any unfair or deceptive act or practice in the advertising, sale, or marketing of long-term care policies or contracts.
[ 2008 c 217 § 68; 1986 c 170 § 6.]
NOTES:
Severability—Effective date—2008 c 217: See notes following RCW 48.03.020.
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.84 - Long-Term Care Insurance Act. › 48.84.070 - Separation of data regarding certain policies.

RCW 48.84.070
Separation of data regarding certain policies.
Commencing with reports for accounting periods beginning on or after January 1, 1988, all insurers, fraternal benefit societies, health care services contractors, and health maintenance organizations shall, for reporting and recordkeeping purposes, separate data concerning long-term care insurance policies and contracts from data concerning other insurance policies and contracts.
[ 1986 c 170 § 7.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.84 - Long-Term Care Insurance Act. › 48.84.910 - Effective date, application—1986 c 170.

RCW 48.84.910
Effective date, application—1986 c 170.
RCW 48.84.060 shall take effect on November 1, 1986, and the commissioner shall adopt all rules necessary to implement RCW 48.84.060 by its effective date including rules prohibiting particular unfair or deceptive acts and practices in the advertising, sale, and marketing of long-term care policies and contracts. The commissioner shall adopt all rules necessary to implement the remaining sections of this chapter by July 1, 1987, and the remaining sections of this chapter shall apply to policies and contracts issued on or after January 1, 1988.
[ 1986 c 170 § 10.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.85 - Washington Long-Term Care Partnership. › 48.85.010 - Washington long-term care partnership program—Generally.

RCW 48.85.010
Washington long-term care partnership program—Generally.
The department of social and health services shall, in conjunction with the office of the insurance commissioner, coordinate a long-term care insurance program entitled the Washington long-term care partnership, whereby private insurance and medicaid funds shall be used to finance long-term care. For individuals purchasing a long-term care insurance policy or contract governed by chapter 48.84 or 48.83 RCW and meeting the criteria prescribed in this chapter, and any other terms as specified by the office of the insurance commissioner and the department of social and health services, this program shall allow for the exclusion of some or all of the individual's assets in determination of medicaid eligibility as approved by the centers for medicare and medicaid services.
[ 2012 c 211 § 9; 2008 c 145 § 21; 1995 1st sp.s. c 18 § 76; 1993 c 492 § 458.]
NOTES:
Effective date—2008 c 145: See RCW 48.83.901.
Conflict with federal requirements—Severability—Effective date—1995 1st sp.s. c 18: See notes following RCW 74.39A.030.
Findings—Intent—1993 c 492: See notes following RCW 43.20.050.
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.85 - Washington Long-Term Care Partnership. › 48.85.020 - Protection of assets—Federal approval—Rules.

RCW 48.85.020
Protection of assets—Federal approval—Rules.
The department of social and health services shall seek approval from the centers for medicare and medicaid services to allow the protection of an individual's assets as provided in this chapter. The department shall adopt all rules necessary to implement the Washington long-term care partnership program, which rules shall permit the exclusion of all or some of an individual's assets in a manner specified by the department in a determination of medicaid eligibility to the extent that private long-term care insurance provides payment or benefits for services.
[ 2012 c 211 § 10; 1995 1st sp.s. c 18 § 77; 1993 c 492 § 459.]
NOTES:
Conflict with federal requirements—Severability—Effective date—1995 1st sp.s. c 18: See notes following RCW 74.39A.030.
Findings—Intent—1993 c 492: See notes following RCW 43.20.050.
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.85 - Washington Long-Term Care Partnership. › 48.85.030 - Insurance policy criteria—Rules.

RCW 48.85.030
Insurance policy criteria—Rules.
(1) The insurance commissioner shall adopt rules defining the criteria that qualified long-term care partnership insurance policies must meet to satisfy the requirements of this chapter. The rules shall incorporate any requirements set forth by chapter 48.83 RCW and the deficit reduction act of 2005 for qualified long-term care partnership insurance policies purchased for the purposes of this chapter.
(2) Insurers offering long-term care policies for the purposes of this chapter shall demonstrate to the satisfaction of the insurance commissioner that they:
(a) Have procedures to provide notice to each purchaser of the long-term care consumer education program;
(b) Have procedures that provide for the keeping of individual policy records and procedures for the explanation of coverage and benefits identifying those payments or services available under the policy that meet the purposes of this chapter;
(c) Agree to provide the insurance commissioner any required annual report containing information derived from the long-term care partnership long-term care insurance uniform data set as specified by the office of the insurance commissioner.
[ 2011 c 47 § 12; 1995 1st sp.s. c 18 § 78; 1993 c 492 § 460.]
NOTES:
Conflict with federal requirements—Severability—Effective date—1995 1st sp.s. c 18: See notes following RCW 74.39A.030.
Findings—Intent—1993 c 492: See notes following RCW 43.20.050.
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.85 - Washington Long-Term Care Partnership. › 48.85.040 - Consumer education program.

RCW 48.85.040
Consumer education program.
The insurance commissioner shall, with the cooperation of the department of social and health services and members of the long-term care insurance industry, develop a consumer education program designed to educate consumers as to the need for long-term care, methods for financing long-term care, the availability of long-term care insurance, and the availability and eligibility requirements of the asset protection program provided under this chapter.
[ 1995 1st sp.s. c 18 § 79; 1993 c 492 § 461.]
NOTES:
Conflict with federal requirements—Severability—Effective date—1995 1st sp.s. c 18: See notes following RCW 74.39A.030.
Findings—Intent—1993 c 492: See notes following RCW 43.20.050.
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.85 - Washington Long-Term Care Partnership. › 48.85.900 - Short title—Savings—Reservation of legislative power—Effective dates—1993 c 492.

RCW 48.85.900
Short title—Savings—Reservation of legislative power—Effective dates—1993 c 492.
See RCW 43.72.910 through 43.72.915.
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.87 - Midwives and Birthing Centers—Joint Underwriting Association. › 48.87.010 - Intent.

RCW 48.87.010
Intent.
Certified nurse midwives and licensed midwives experience a major problem in both the availability and affordability of malpractice insurance. In particular midwives practicing outside hospital settings are unable to obtain malpractice insurance at any price in this state at this time. Licensed midwives have been unable to obtain hospital privileges due in part to the requirement of almost all Washington hospitals that professional staff members have liability insurance.
The services performed by midwives are in demand by many women for childbirth and prenatal care. Women often choose to have a home or birth center birth instead of a hospital birth. Women are entitled to the provider of their choice at such a critical life event. Studies document the safety of midwife-attended births and the safety of home births for low-risk women.
At a time when safety, cost-effectiveness, and individual choice are of paramount concern to the citizens of Washington state, midwifery care in a variety of settings must be available to the public. This is essential to the goals of increased access to maternity care and increased cost-effectiveness of care, as well as addressing problems of provider shortage. One of the primary impediments to the availability of maternity services performed by midwives is the lack of available and affordable malpractice liability insurance coverage.
This chapter is intended to increase the availability of cost-effective, high quality maternity care by making malpractice insurance available for midwives. This chapter is implemented by requiring all insurers authorized to write commercial or professional liability insurance to be members of a joint underwriting association created to provide malpractice insurance for midwives.
[ 1993 c 112 § 1.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.87 - Midwives and Birthing Centers—Joint Underwriting Association. › 48.87.020 - Definitions.

RCW 48.87.020
Definitions.
Unless the context clearly requires otherwise, the definitions in this section apply throughout this chapter.
(1) "Association" means the joint underwriting association established under this chapter.
(2) "Midwifery and birth center malpractice insurance" means insurance coverage against the legal liability of the insured and against loss damage or expense incident to a claim arising out of the death or injury of a person as a result of negligence or malpractice in rendering professional service by a licensee.
(3) "Licensee" means a person or facility licensed to provide midwifery services under chapter 18.50, 18.79, or 18.46 RCW.
[ 2002 c 300 § 1; 1993 c 112 § 2.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.87 - Midwives and Birthing Centers—Joint Underwriting Association. › 48.87.030 - Plan for establishing association—Commissioner's duty—Market assistance plan.

RCW 48.87.030
Plan for establishing association—Commissioner's duty—Market assistance plan.
The insurance commissioner shall approve by December 31, 1993, a reasonable plan for the establishment of a nonprofit, joint underwriting association for midwifery and birth center malpractice insurance subject to the conditions and limitations contained in this chapter. Such plan shall include a market assistance plan to be used prior to activating a joint underwriting association.
[ 1993 c 112 § 3.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.87 - Midwives and Birthing Centers—Joint Underwriting Association. › 48.87.040 - Composition of association.

RCW 48.87.040
Composition of association.
The association shall be comprised of all insurers possessing a certificate of authority to write and engaged in writing medical malpractice insurance within this state and general casualty companies. Every insurer shall be a member of the association and shall remain a member as a condition of its authority to continue to transact business in this state. Only licensed midwives under chapter 18.50 RCW, certified nurse midwives licensed under chapter 18.79 RCW, or birth centers licensed under chapter 18.46 RCW may participate in the joint underwriting authority.
[ 2002 c 300 § 2; 1993 c 112 § 4.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.87 - Midwives and Birthing Centers—Joint Underwriting Association. › 48.87.050 - Midwifery and birth center malpractice insurance—Rating plan modified according to practice volume.

RCW 48.87.050
Midwifery and birth center malpractice insurance—Rating plan modified according to practice volume.
A licensee may apply to the association to purchase midwifery and birth center malpractice insurance and the association shall offer a policy with liability limits of one million dollars per claim and three million dollars per annual aggregate, or such other minimum level of mandated coverage as determined by the department of health. The insurance commissioner shall require the use of a rating plan for midwifery malpractice insurance that permits rates to be modified according to practice volume. Any rating plan for midwifery malpractice insurance used under this section must be based on sound actuarial principles. Coverage may not exclude midwives who engage in home birth or birth center deliveries.
[ 1994 c 90 § 1; 1993 c 112 § 5.]
NOTES:
Effective date—1994 c 90: "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 shall take effect immediately [March 23, 1994]." [ 1994 c 90 § 2.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.87 - Midwives and Birthing Centers—Joint Underwriting Association. › 48.87.060 - Administering a plan.

RCW 48.87.060
Administering a plan.
The commissioner may select an insurer to administer a plan established under this chapter. The insurer must be admitted to transact the business of insurance of the state of Washington.
[ 1993 c 112 § 6.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.87 - Midwives and Birthing Centers—Joint Underwriting Association. › 48.87.070 - Policies written on a claims made basis—Commissioner may not approve without insurer guarantees.

RCW 48.87.070
Policies written on a claims made basis—Commissioner may not approve without insurer guarantees.
The insurance commissioner may not approve a policy written on a claims made basis by an insurer doing business in this state unless the insurer guarantees to the commissioner the continued availability of suitable liability protection for midwives subsequent to the discontinuance of professional practice by the midwife or the sooner termination of the insurance policy by the insurer for so long as there is a reasonable probability of a claim for injury for which the health care provider might be liable.
[ 1993 c 112 § 7.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.87 - Midwives and Birthing Centers—Joint Underwriting Association. › 48.87.080 - Risk management program—Part of plan.

RCW 48.87.080
Risk management program—Part of plan.
A risk management program for insureds of the association must be established as a part of the plan. This program must include but not be limited to: Investigation and analysis of frequency, severity, and causes of adverse or untoward outcomes; development of measures to control these injuries; systematic reporting of incidents; investigation and analysis of patient complaints; and education of association members to improve quality of care and risk reduction.
[ 1993 c 112 § 8.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.87 - Midwives and Birthing Centers—Joint Underwriting Association. › 48.87.100 - Rule making.

RCW 48.87.100
Rule making.
The commissioner may adopt all rules necessary to ensure the efficient, equitable operation of the association, including but not limited to, rules requiring or limiting certain policy provisions.
[ 1993 c 112 § 10.]
2023 Revised Code of Washington › Title 48 - Insurance › Chapter 48.88 - Day Care Services—Joint Underwriting Association. › 48.88.010 - Intent.

RCW 48.88.010
Intent.
Day care service providers have experienced major problems in both the availability and affordability of liability insurance. Premiums for such insurance policies have recently grown as much as five hundred percent and the availability of such insurance in Washington markets has greatly diminished.
The availability of quality day care is essential to achieving such goals as increased workforce productivity, family self-sufficiency, and protection for children at risk due to poverty and abuse. The unavailability of adequate liability insurance threatens to decrease the availability of day care services.
This chapter is intended to remedy the problem of unavailable liability insurance for day care services by requiring all insurers authorized to write commercial or professional liability insurance to be members of a joint underwriting association created to provide liability insurance for day care services.
[ 1986 c 141 § 1.]