Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-66 - Washington medicare supplement insurance regulation › Section 284-66-080 - Outline of coverage required

Current through Register Vol. 24-14, July 15, 2024
(1)
			 Issuers must provide an outline of coverage to all applicants at the time an
			 application is presented to the prospective applicant and, except for direct
			 response policies and certificates, must obtain an acknowledgment of receipt of
			 the outline from the applicant.
(2)
			 The "outline of coverage," is set forth on the commissioner's web site, and
			 incorporated by reference herein in this rule. The issuer's form of outline of
			 coverage must be completed in substantially the form set forth on the
			 commissioner's web site, and filed with the commissioner before being used in
			 this state.
(3) If an outline of
			 coverage is provided at the time of application and the medicare supplement
			 policy or certificate is issued on a basis that would require revision of the
			 outline, a substitute outline of coverage properly describing the policy or
			 certificate must accompany the policy or certificate when it is delivered and
			 contain the following statement, in no less than twelve point type, immediately
			 above the company name: "NOTICE: Read this outline of coverage carefully. It is
			 not identical to the outline of coverage provided upon application and the
			 coverage originally applied for has not been issued."
(4) The outline of coverage provided to
			 applicants set forth in this section consists of four parts: A cover page,
			 premium information, disclosure pages, and charts displaying the features of
			 each benefit plan offered by the issuer. The outline of coverage must be in the
			 language and format prescribed in WAC 284-66-092 in no less than twelve point
			 type. All plans A- N must be shown on the cover page, and the plan(s) that are
			 offered by the issuer must be prominently identified. Premium information for
			 plans that are offered must be shown on the cover page or immediately following
			 the cover page and must be prominently displayed. The premium and mode must be
			 stated for all plans that are offered to the prospective applicant. All
			 possible premiums for the prospective applicant must be illustrated.
(5) Where inappropriate terms are used, such
			 as "insurance," "policy," or "insurance company," a fraternal benefit society,
			 health care service contractor, or health maintenance organization must
			 substitute appropriate terminology.
Statutory Authority:
				  RCW
				  48.66.030(3)(a),
				  48.66.041, and
				  48.66.165. 09-24-052 (Matter No. R
				  2009-08), §
										284-66-080, filed 11/24/09,
				  effective 1/19/10. Statutory Authority:
				  RCW
				   48.02.060 and
				  48.66.165. 05-17-019 (Matter No. R
				  2004-08), §
										284-66-080, filed 8/4/05,
				  effective 9/4/05. Statutory Authority:
				  RCW
				   48.02.060,
				  48.20.450,
				  48.20.460,
				  48.20.470,
				  48.30.010,
				  48.44.020,
				  48.44.050,
				  48.44.070,
				  48.46.030,
				  48.46.130 and
				  48.46.200. 92-06-021 (Order R
				  92-1), §
										284-66-080, filed 2/25/92,
				  effective 3/27/92. Statutory Authority:
				  RCW
				   48.02.060,
				  48.20.450,
				  48.20.460,
				  48.20.470,
				  48.30.010,
				  48.44.020,
				  48.44.050,
				  48.44.070,
				  48.46.030,
				  48.46.130,
				  48.46.200,
				  48.66.041,
				  48.66.050,
				  48.66.100,
				  48.66.110,
				  48.66.120,
				  48.66.130,
				  48.66.150 and
				  48.66.160. 90-07-059 (Order R
				  90-4), §
										284-66-080, filed 3/20/90,
				  effective 4/20/90.