reglab/statecodes huggingface dataset:
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-92 - Liability risk retention › PURCHASING GROUPS › Section 284-92-240 - Suspension and revocation of registration

Current through Register Vol. 24-14, July 15, 2024
The grounds for suspension or revocation mentioned in this
				  section are in addition to those mentioned elsewhere in this regulation or in
				  other applicable law or regulation. The registration of a purchasing group may
				  be suspended or revoked:
(1) If any
				basis exists on which, if the purchasing group were an insurer, or insurance
				producer, its certificate of authority or its license could be suspended or
				revoked.
(2) If any insurer issuing
				policies for the purchasing group is subject, or would be subject if it were an
				authorized insurer, to suspension or revocation of its certificate of authority
				under RCW
				 48.05.140.
(3) If any insurer issuing policies for or to
				the purchasing group has any order of supervision, receivership, conservation,
				or liquidation, or any order similar to such an order, entered against it in
				any state or country by a court or insurance commissioner (or equivalent
				supervisory official).
(4) If the
				purchasing group solicits or accepts, or permits the solicitation or
				acceptance, of insurance applications by a person not licensed in Washington as
				an insurance producer or surplus line broker; or does or permits any other act,
				by a person not licensed as an insurance producer or surplus line broker, if
				that act may be performed only by one so licensed.
(5) If the purchasing group fails to reply
				fully, accurately, and in writing to an inquiry of the commissioner.
Statutory Authority:
					 RCW
					 48.02.060(3)(a) and
					 48.17.010(5).
					 11-01-159 (Matter No. R 2010-09), §
											284-92-240, filed 12/22/10,
					 effective 1/22/11. Statutory Authority:
					 RCW
					  48.02.060 and
					 48.92.140. 93-19-006 (Order R
					 93-10), §
											284-92-240, filed 9/1/93,
					 effective 10/2/93.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-92 - Liability risk retention › PURCHASING GROUPS › Section 284-92-250 - Insurers and agents

Current through Register Vol. 24-14, July 15, 2024
(1)
				Insurance for a purchasing group may be provided only by one or more of the
				following: An insurer holding a certificate of authority to transact the
				relevant line of business in Washington; a risk retention group registered in
				Washington; or an insurer acting lawfully in accordance with chapter 48.15 RCW
				and the regulations thereunder (except as provided in chapter 48.92 RCW or this
				regulation). Insurance for a domestic purchasing group may be provided only by
				an insurer holding a Washington certificate of authority to transact that type
				of insurance.
(2)Chapters 48.15 and
				48.17 RCW require that certain acts
				and functions be performed only by a person licensed thereunder. Those
				requirements apply equally to transactions involving purchasing groups, except
				as provided in
				RCW
				 48.92.120(3) and WAC
				284-15-100.
Statutory Authority:
					 RCW
					 48.02.060 and
					 48.92.140. 93-19-006 (Order R
					 93-10), §
											284-92-250, filed 9/1/93,
					 effective 10/2/93.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-92 - Liability risk retention › PURCHASING GROUPS › Section 284-92-260 - Forms

Current through Register Vol. 24-14, July 15, 2024
(1) The
				requirements for filing and approval of policy rates and forms apply to forms
				issued to or in connection with purchasing groups to the same extent as they
				apply in other situations.
(2)
				Notwithstanding subsection (1) of this section, forms that have been properly
				issued in Washington before the effective date of this regulation may continue
				to be issued or renewed until February 1, 1994, or such later date as the
				commissioner approves. After that date, those forms are subject to subsection
				(1) of this section.
Statutory Authority:
					 RCW
					 48.02.060 and
					 48.92.140. 93-19-006 (Order R
					 93-10), §
											284-92-260, filed 9/1/93,
					 effective 10/2/93.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-92 - Liability risk retention › PURCHASING GROUPS › Section 284-92-270 - Disclosure that there is no guaranty association coverage and that some laws may not apply

Current through Register Vol. 24-14, July 15, 2024
(1) Under
				RCW
				 48.92.050(3) and (4), in
				some situations there is no coverage by the Washington Insurance Guaranty
				Association for some insurance obtained by a purchasing group. Under
				RCW
				 48.92.090(2), the purchasing
				group must inform its members of the lack of that protection and that the
				insurer or risk retention group may not be subject to all insurance laws and
				regulations of this state. In any such situation, the disclosure must be in
				writing. It must be given when the application is taken. The disclosure must be
				reasonably calculated to make the individual aware of the lack of guaranty
				coverage and the inapplicability of some laws and regulations. The lack of
				coverage and that inapplicability may not be presented as an advantage or as a
				technical oddity, nor may it be downplayed by references to the solvency of the
				insurer or otherwise.
(2) If the
				insurance is to be issued by a risk retention group, compliance with WAC
				284-92-700 and
				RCW
				 48.92.040(7) is sufficient
				compliance with this rule and with
				RCW
				 48.92.090(2).
(3) The insurer, for a domestic purchasing
				group on risks located in Washington, must be an insurer holding a Washington
				certificate of authority for that type of insurance, or a registered risk
				retention group.
Statutory Authority:
					 RCW
					 48.02.060 and
					 48.92.140. 93-19-006 (Order R
					 93-10), §
											284-92-270, filed 9/1/93,
					 effective 10/2/93.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-92 - Liability risk retention › PURCHASING GROUPS › Section 284-92-280 - Notice of changes

Current through Register Vol. 24-14, July 15, 2024
If any information included in the request for registration,
				  or otherwise provided to the commissioner, changes or is found to have been
				  incorrect when submitted, the commissioner must be notified within ten days of
				  the change or the discovery of the inaccuracy.
Statutory Authority:
					 RCW
					 48.02.060 and
					 48.92.140. 93-19-006 (Order R
					 93-10), §
											284-92-280, filed 9/1/93,
					 effective 10/2/93.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-92 - Liability risk retention › PURCHASING GROUPS › Section 284-92-290 - Domestic purchasing groups

Current through Register Vol. 24-14, July 15, 2024
(1) No
				domestic purchasing group will be registered unless the purchasing group has
				and maintains in Washington the records applicable to its business, including
				records as to insured persons, financial matters, and the like. There must also
				be resident in Washington an officer of the purchasing group who is able and
				qualified to present, interpret, and explain those records to the commissioner
				or the commissioner's representative on demand.
(2) Each domestic purchasing group shall
				submit an annual report to the commissioner. That report shall state the number
				of policies, amount of insurance coverage, and amount of premium provided, the
				number and types of insured persons, and such other matters as the commissioner
				shall direct. The report shall be submitted for each calendar year, and shall
				be submitted no later than January 31 of the following year unless the
				commissioner allows a later filing. Any other information requested by the
				commissioner shall be promptly provided.
Statutory Authority:
					 RCW
					 48.02.060 and
					 48.92.140. 93-19-006 (Order R
					 93-10), §
											284-92-290, filed 9/1/93,
					 effective 10/2/93.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-92 - Liability risk retention › RISK RETENTION GROUPS › Section 284-92-410 - Registration required

Current through Register Vol. 24-14, July 15, 2024
No risk retention group may provide insurance, offer to
				  provide insurance, or solicit or invite applications for insurance, as to
				  Washington residents, or otherwise transact insurance in Washington or with
				  respect to Washington residents, until it is registered.
Statutory Authority:
					 RCW
					 48.02.060 and
					 48.92.140. 93-19-006 (Order R
					 93-10), §
											284-92-410, filed 9/1/93,
					 effective 10/2/93.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-92 - Liability risk retention › RISK RETENTION GROUPS › Section 284-92-420 - Registration effective upon notice by commissioner

Current through Register Vol. 24-14, July 15, 2024
No risk retention group is registered until it has been
				  notified by the Commissioner that it is registered. There is no
				  "deemer."
Statutory Authority:
					 RCW
					 48.02.060 and
					 48.92.140. 93-19-006 (Order R
					 93-10), §
											284-92-420, filed 9/1/93,
					 effective 10/2/93.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-92 - Liability risk retention › RISK RETENTION GROUPS › Section 284-92-430 - Registration - Appointment for service of process

Current through Register Vol. 24-14, July 15, 2024
(1) The request for registration must include
				an appointment of the commissioner as agent for service of process, as provided
				in chapter 48.92 RCW.
(2) The doing
				of business as a risk retention group in Washington, or as to Washington
				residents, in itself constitutes such an appointment of the commissioner. This
				automatic appointment operates in all cases, whether or not an explicit
				appointment was made or was valid or effective.
Statutory Authority:
					 RCW
					 48.02.060 and
					 48.92.140. 93-19-006 (Order R
					 93-10), §
											284-92-430, filed 9/1/93,
					 effective 10/2/93.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-92 - Liability risk retention › RISK RETENTION GROUPS › Section 284-92-440 - Suspension and revocation of registration

Current through Register Vol. 24-14, July 15, 2024
The grounds for suspension or revocation mentioned in this
				  section are in addition to those mentioned elsewhere in this regulation or in
				  other applicable law or regulation. In addition, a domestic risk retention
				  group is subject to the same sanctions, on the same grounds, as a domestic
				  insurer, including revocation of its certificate of authority. The registration
				  of a risk retention group may be suspended or revoked if:
(1) Any basis exists on which, if the risk
				retention group were an authorized insurer, its certificate of authority could
				be suspended or revoked, under
				chapter
				48.05 RCW or
				otherwise.
(2) If the risk
				retention group has any order of supervision, receivership, conservation, or
				liquidation, or any order similar to such an order, entered against it in any
				state or country by a court or insurance commissioner (or equivalent
				supervisory official); or any such court or official finds that the risk
				retention group is in a hazardous financial or financially impaired
				condition.
(3) If the risk
				retention group solicits or accepts, or permits the solicitation or acceptance,
				of insurance applications by anyone not appropriately licensed as an insurance
				producer or surplus line broker; or does or permits any other act by a person
				not appropriately licensed as an insurance producer or surplus line broker, if
				that act may be performed only by one so licensed.
(4) An order is entered by a court enjoining
				the risk retention group from soliciting or selling insurance, or
				operating.
(5) If the risk
				retention group fails to respond fully, accurately, and in writing to an
				inquiry of the commissioner.
Statutory Authority:
					 RCW
					 48.02.060(3)(a) and
					 48.17.010(5).
					 11-01-159 (Matter No. R 2010-09), §
											284-92-440, filed 12/22/10,
					 effective 1/22/11. Statutory Authority:
					 RCW
					  48.02.060 and
					 48.92.140. 93-19-006 (Order R
					 93-10), §
											284-92-440, filed 9/1/93,
					 effective 10/2/93.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-92 - Liability risk retention › RISK RETENTION GROUPS › Section 284-92-450 - Insurance producers

Current through Register Vol. 24-14, July 15, 2024
Only appropriately licensed insurance producers or surplus
				  line brokers may solicit or accept applications for insurance to be issued by a
				  risk retention group.
Statutory Authority:
					 RCW
					 48.02.060(3)(a) and
					 48.17.010(5).
					 11-01-159 (Matter No. R 2010-09), §
											284-92-450, filed 12/22/10,
					 effective 1/22/11. Statutory Authority:
					 RCW
					  48.02.060 and
					 48.92.140. 93-19-006 (Order R
					 93-10), §
											284-92-450, filed 9/1/93,
					 effective 10/2/93.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-92 - Liability risk retention › RISK RETENTION GROUPS › Section 284-92-460 - Tax

Current through Register Vol. 24-14, July 15, 2024
The premium tax under chapter 48.14 RCW applies to insurance
				  issued by risk retention groups. Failure to pay the tax when due is grounds for
				  suspension or revocation of the registration of the risk retention group, in
				  addition to other fines, penalties, interest, and other consequences provided
				  by law or regulation.
Statutory Authority:
					 RCW
					 48.02.060 and
					 48.92.140. 93-19-006 (Order R
					 93-10), §
											284-92-460, filed 9/1/93,
					 effective 10/2/93.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-92 - Liability risk retention › RISK RETENTION GROUPS › Section 284-92-470 - Notice of changes

Current through Register Vol. 24-14, July 15, 2024
If any information included in the request for registration,
				  or otherwise provided to the commissioner, changes or is found to have been
				  incorrect when submitted, the commissioner must be notified within ten days of
				  the change or the discovery of the inaccuracy.
Statutory Authority:
					 RCW
					 48.02.060 and
					 48.92.140. 93-19-006 (Order R
					 93-10), §
											284-92-470, filed 9/1/93,
					 effective 10/2/93.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-92 - Liability risk retention › RISK RETENTION GROUPS › Section 284-92-480 - Reports

Current through Register Vol. 24-14, July 15, 2024
Each registered risk retention group shall submit to the
				  commissioner copies of any annual statements or reports, or other reports on
				  operations and financial results or condition, that are filed by it with the
				  insurance regulatory official of its state of domicile or with the National
				  Association of Insurance Commissioners. Quarterly and other reports are not
				  required and should not be submitted unless requested by the commissioner. See
				  WAC 284-92-710 as to reports required of domestic risk retention groups.
				  Reports shall be on disk as well as in paper form. These reports are in
				  addition to those required by
				  RCW
				   48.92.030(2).
Statutory Authority:
					 RCW
					 48.02.060 and
					 48.92.140. 93-19-006 (Order R
					 93-10), §
											284-92-480, filed 9/1/93,
					 effective 10/2/93.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-92 - Liability risk retention › RISK RETENTION GROUPS › Section 284-92-490 - Required disclosure "notice."

Current through Register Vol. 24-14, July 15, 2024
The "notice" requirement of
				  RCW
				   48.92.040(7) is to be
				  applied as follows:
(1) On an
				application form, the notice must appear on the first page. On a policy, the
				notice must appear both on the first page and on the declaration page; if the
				declaration page is the first page, one appearance of the notice
				suffices.
(2) The notice or a
				similar disclosure may be repeated elsewhere.
(3) The disclosure and the information in it
				may not be presented as an advantage or as a technical oddity, nor downplayed
				by references to the solvency of the insurer or otherwise.
Statutory Authority:
					 RCW
					 48.02.060 and
					 48.92.140. 93-19-006 (Order R
					 93-10), §
											284-92-490, filed 9/1/93,
					 effective 10/2/93.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-92 - Liability risk retention › RISK RETENTION GROUPS › Section 284-92-500 - Domestic risk retention groups - Formation

Current through Register Vol. 24-14, July 15, 2024
A domestic risk retention group must be formed in compliance
				  with chapter 48.06 RCW. It must meet the capital and surplus requirements
				  applicable under
				  RCW
				   48.05.340 to insurers transacting the kind or
				  kinds of insurance that the domestic risk retention group proposes to transact.
				  It must comply with the other requirements for domestic insurers and with
				  chapter 48.92 RCW.
Statutory Authority:
					 RCW
					 48.02.060 and
					 48.92.140. 93-19-006 (Order R
					 93-10), §
											284-92-500, filed 9/1/93,
					 effective 10/2/93.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-92 - Liability risk retention › RISK RETENTION GROUPS › Section 284-92-510 - Domestic risk retention groups - Reports

Current through Register Vol. 24-14, July 15, 2024
Domestic risk retention groups shall file the reports
				  required by
				  RCW
				   48.92.030. In addition, domestic risk
				  retention groups shall file quarterly financial reports and any other
				  statements or reports required by the commissioner for such groups in general
				  or for any one or more such groups. The commissioner may require any reports
				  from any one or more risk retention groups, at any time and from time to time.
				  Reports shall be both on paper and on diskette.
Statutory Authority:
					 RCW
					 48.02.060 and
					 48.92.140. 93-19-006 (Order R
					 93-10), §
											284-92-510, filed 9/1/93,
					 effective 10/2/93.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-95 - Transfer of insurance contracts › Section 284-95-010 - Title

Current through Register Vol. 24-14, July 15, 2024
This regulation, WAC
				284-95-010 through
				284-95-060, inclusive, shall be
				known and may be cited as "the Washington regulation on transfer of insurance
				contracts."
Statutory Authority:
				  RCW
				  48.02.060(3)(a),
				  48.01.030 and
				  48.30.010. 91-23-064 (Order R
				  91-9), §
										284-95-010, filed 11/18/91,
				  effective 12/19/91.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-95 - Transfer of insurance contracts › Section 284-95-020 - Purpose and scope

Current through Register Vol. 24-14, July 15, 2024
(1) This regulation
			 establishes procedures to be followed with respect to the transfer of insurance
			 contracts from a transferring company to an assuming company, establishes
			 notice and disclosure requirements to protect the rights of policyowners, and
			 defines unfair or deceptive acts and practices and unfair methods of
			 competition in the conduct of the business of insurance, pursuant to
			 RCW
			  48.30.010.
(2) This regulation applies to any transfer
			 of insurance contracts from a transferring company to an assuming company
			 where:
(a) The policyowner, as defined in WAC
			 284-95-030(5),
			 is a resident of this state at the time of the proposed transfer; or
(b) The holder of a certificate of group
			 insurance is a resident of this state at the time of the proposed transfer and
			 meets the criteria set forth in WAC
			 284-95-030(5).
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-95 - Transfer of insurance contracts › Section 284-95-040 - Notice requirements

Current through Register Vol. 24-14, July 15, 2024
(1) The
			 transferring company shall provide to each policyowner at least thirty days
			 advance written notice of its intent to transfer the insurance contract to an
			 assuming company. The written notice shall be deposited in the United States
			 mail, postage prepaid, addressed to the last known address for the
			 policyowner.
(2) The transferring
			 company shall keep records of all notices which are returned as undeliverable
			 and also of all responses which are signed and returned by the policyowner,
			 regardless of whether those responses are consents or refusals to
			 consent.
(3) The transferring
			 company shall provide advance notice of the proposed transfer to the
			 commissioner, which shall include a complete set of the forms and materials to
			 be sent to policyowners. The notice shall be sent at least thirty days before
			 it is sent to the policyowner.
Statutory Authority:
				  RCW
				  48.02.060(3)(a),
				  48.01.030 and
				  48.30.010. 91-23-064 (Order R
				  91-9), §
										284-95-040, filed 11/18/91,
				  effective 12/19/91.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-95 - Transfer of insurance contracts › Section 284-95-050 - Requirement of full disclosure

Current through Register Vol. 24-14, July 15, 2024
(1) At a minimum, the notice sent to the
			 policyowner shall state the following in language easily understood by a
			 policyowner:
(a) The date upon which the
			 transfer of liabilities arising under the insurance contract is to take
			 place.
(b) The name and address of
			 the proposed assuming company.
(c)
			 The fact that the policyowner has a legal right to either consent to the
			 proposed transfer, or to refuse to consent to it.
(d) The fact that if the policyowner wishes
			 to accept the proposed transfer, that person must affirmatively do so by
			 signing and returning the enclosed consent form.
(e) The fact that unless the policyowner
			 signs and returns the enclosed consent form, the proposed transfer will not
			 take place as to the insurance contract in his or her case, and that as a
			 result the liabilities arising under that insurance contract will remain with
			 the transferring company.
(f)
			 Depending upon the intent of the transferring company, the policyowner should
			 be told whether the transferring company will or may utilize the services of
			 the proposed assuming company or another entity for administratively servicing
			 the insurance contract, if consent to the transfer is not given, even though
			 the obligations and liabilities under the insurance contract will remain with
			 the transferring company. Examples of such servicing should be
			 illustrated.
(g) The reason or
			 reasons for the proposed transfer.
(h) Enough information about both the
			 transferring company and the assuming company for the policyowner to make an
			 informed choice about whether to consent to the proposed transfer or not.
			 Necessary information will vary from one situation to another. However, it
			 shall include, although it is not limited to, the following: The assets and
			 liabilities of each company, and the business experience of each, particularly
			 with respect to the kind of insurance involved in the proposed
			 transfer.
(i) Whether the assuming
			 company holds a valid certificate of authority or registration for the kind of
			 insurance involved in the proposed transfer, issued by the state of which the
			 policyowner is a resident.
(j)
			 Whether the proposed transfer would have any effect upon availability and
			 extent of protection afforded by any state guaranty fund, in the event of
			 insolvency of the proposed assuming company.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-95 - Transfer of insurance contracts › Section 284-95-060 - Prohibited policy provisions

Current through Register Vol. 24-14, July 15, 2024
No insurance contract, or other contractual document pertaining
				to any such insurance contract, shall contain any waiver or disclaimer of any
				of the rights recognized or protected by this regulation.
Statutory Authority:
				  RCW
				  48.02.060(3)(a),
				  48.01.030 and
				  48.30.010. 91-23-064 (Order R
				  91-9), §
										284-95-060, filed 11/18/91,
				  effective 12/19/91.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-95 - Transfer of insurance contracts › Section 284-95-070 - Transfers to unauthorized insurers

Current through Register Vol. 24-14, July 15, 2024
Where a Washington resident owns an insurance contract issued
				by a company authorized to do business in Washington, that company may not
				transfer such insurance contract to a company which is not authorized to do
				business in Washington. Acting as the assuming company in a transfer of
				insurance involving a Washington risk constitutes the transaction of insurance
				for which a Washington certificate of authority, license, or registration is
				required.
Statutory Authority:
				  RCW
				  48.02.060(3)(a),
				  48.01.030 and
				  48.30.010. 91-23-064 (Order R
				  91-9), §
										284-95-070, filed 11/18/91,
				  effective 12/19/91.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-95 - Transfer of insurance contracts › Section 284-95-080 - Unfair or deceptive acts or practices

Current through Register Vol. 24-14, July 15, 2024
It is an unfair or deceptive act or practice, pursuant to
				RCW
				 48.30.010, for any transferring company
				to:
(1) Be a party to a transfer of
			 insurance contracts which is in violation of the provisions of this regulation;
			 or
(2) Represent to policyowners,
			 either verbally or in writing, that the commissioner has approved a transfer of
			 insurance contracts. It shall be a false representation in advertising, in the
			 sense of RCW  48.44.110, for a health care
			 service contractor to represent to policyowners, either verbally or in writing,
			 that the commissioner has approved any transfer of insurance contracts. It
			 shall be a false or misleading practice in advertising, in the sense of
			 RCW
			  48.46.400, and a deceptive, misleading, or
			 unfair practice in advertising, in the sense of
			 RCW
			  48.46.130(1)(e), for a
			 health maintenance organization to represent to policyowners, either verbally
			 or in writing, that the commissioner has approved any transfer of insurance
			 contracts; or
(3) Unfairly
			 discriminate against policyowners who do not consent to the proposed transfer
			 of insurance contracts.
Statutory Authority:
				  RCW
				  48.02.060(3)(a),
				  48.01.030 and
				  48.30.010. 91-23-064 (Order R
				  91-9), §
										284-95-080, filed 11/18/91,
				  effective 12/19/91.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-96 - Group and blanket disability insurance › Section 284-96-010 - Purpose

Current through Register Vol. 24-14, July 15, 2024
The purpose of this chapter is to provide a consolidated
				location within Title 284 of the Washington Administrative Code for regulations
				applying to disability insurance companies marketing group and blanket
				disability insurance as it is defined in
				chapter
				48.21
				RCW.
Statutory Authority:
				  RCW
				  48.02.060(3)(a) and
				  48.18.120. 92-21-100 (Order R
				  92-16), §
										284-96-010, filed 10/21/92,
				  effective 11/21/92.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-96 - Group and blanket disability insurance › Section 284-96-012 - Discretionary clauses prohibited

Current through Register Vol. 24-14, July 15, 2024
(1) No disability insurance policy may
			 contain a discretionary clause. "Discretionary clause" means a provision that
			 purports to reserve discretion to an insurer, its agents, officers, employees,
			 or designees in interpreting the terms of a policy or deciding eligibility for
			 benefits, or requires deference to such interpretations or decisions, including
			 a provision that provides for any of the following results:
(a) That the insurer's interpretation of the
			 terms of the policy is binding;
(b)
			 That the insurer's decision regarding eligibility or continued receipt of
			 benefits is binding;
(c) That the
			 insurer's decision to deny, modify, reduce or terminate payment, coverage,
			 authorization, or provision of health care service or benefits, is
			 binding;
(d) That there is no
			 appeal or judicial remedy from a denial of a claim;
(e) That deference must be given to the
			 insurer's interpretation of the contract or claim decision; and
(f) That the standard of review of an
			 insurer's interpretation of the policy or claim decision is other than a de
			 novo review.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-96 - Group and blanket disability insurance › Section 284-96-015 - Experimental and investigational prescriptions, treatments, procedures, or services - Definition required - Standard for definition - Written notice of denial required - Appeal process required

Current through Register Vol. 24-14, July 15, 2024
(1) Every group disability insurance policy
			 which excludes or limits, or reserves the right to exclude or limit, benefits
			 for any treatment, procedure, facility, equipment, drug, drug usage, medical
			 device, or supply (hereinafter individually and collectively referred to as
			 services) for one or more medical condition or illness because such services
			 are deemed to be experimental or investigational must include within the policy
			 and any certificate of coverage issued thereunder, a definition of experimental
			 or investigational.
(2) The
			 definition of experimental or investigational services must include an
			 identification of the authority or authorities which will make a determination
			 of which services will be considered to be experimental or investigational. If
			 the group disability insurer specifies that it, or an affiliated entity, is the
			 authority making the determination, the criteria it will utilize to determine
			 whether a service is experimental or investigational must be set forth in the
			 policy and any certificate of coverage issued thereunder. As an example, and
			 not by way of limitation, the requirement to set forth criteria in the policy
			 and any certificate of coverage issued thereunder may be satisfied by using one
			 or more of the following statements, or other similar statements:
(a) "In determining whether services are
			 experimental or investigational, we will consider whether the services are in
			 general use in the medical community in the state of Washington, whether the
			 services are under continued scientific testing and research, whether the
			 services show a demonstrable benefit for a particular illness or disease, and
			 whether they are proven to be safe and efficacious."
(b) "In determining whether services are
			 experimental or investigational, we will consider whether the services result
			 in greater benefits for a particular illness or disease than other generally
			 available services, and do not pose a significant risk to health or safety of
			 the patient."
The supporting documentation upon which the criteria are
				established must be made available for inspection upon written request in all
				instances and may not be withheld as proprietary.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-96 - Group and blanket disability insurance › Section 284-96-020 - Temporomandibular joint disorders - Specified offer of coverage required - Terms of specified offer defined - Proof of offer must be maintained - Discrimination prohibited - Terms defined

Current through Register Vol. 24-14, July 15, 2024
(1)
			 Pursuant to
			 RCW
			  48.21.320, each offer of new or renewal group
			 disability coverage made on or after January 1, 1993, must include one or more
			 offers of optional coverage for the treatment of temporomandibular joint
			 disorders. Group disability insurers are encouraged to exercise broad
			 flexibility in designing benefits for these optional temporomandibular joint
			 disorder coverage offerings. However, compliance with the statute shall be
			 demonstrated only when one of the optional temporomandibular joint disorder
			 coverage offerings provides benefits as follows:
(a) Offers limited to only medical coverage
			 shall provide coverage for medical services related to the treatment of
			 temporomandibular joint disorders in the amount of one thousand dollars per
			 covered individual, after the application of deductibles, coinsurance, and
			 copayments, in any calendar year, and a lifetime benefit of five thousand
			 dollars per covered individual, after the application of deductibles,
			 coinsurance and copayments. Other than the benefit amount, coverage for medical
			 services shall be the same as are generally provided in the policy for other
			 injuries or musculoskeletal disorders. The coverage provisions may require:
(i) That services either be rendered or
			 referred by the covered individual's primary care physician; and
(ii) A second opinion, provided that the
			 covered individual shall not be financially responsible for any costs relating
			 to this second opinion and that such costs shall be in excess of the required
			 benefit levels; and
(iii)
			 Prenotification or preauthorization.
Except
that the coverage provisions shall not require either
							 a second opinion or prenotification or preauthorization for treatment
							 commencing within forty-eight hours, or as soon as is reasonably possible,
							 after the occurrence of an accident or trauma to the temporomandibular
							 joint.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-96 - Group and blanket disability insurance › Section 284-96-500 - Alternative care - General rules as to minimum standards

Current through Register Vol. 24-14, July 15, 2024
(1) As an alternative to hospitalization or
			 institutionalization of an insured and with the intent to cover placement of
			 the insured patient in the most appropriate and cost-effective setting, every
			 group or blanket disability insurance policy, contract or certificate issued,
			 amended, or renewed on or after January 1, 1995, which provides coverage for
			 hospitalization or other institutional expenses to a resident of this state
			 shall include substitution of home health care, provided in lieu of
			 hospitalization or other institutional care, furnished by home health, hospice
			 and home care agencies licensed under chapter 70.127 RCW, at equal or lesser
			 cost.
(2) In addition, such
			 expenses may include coverage for durable medical equipment which permits the
			 insured to stay at home, care provided in Alzheimer's centers, adult family
			 homes, assisted living facilities, congregate care facilities, adult day health
			 care, home health, hospice and home care, or similar alternative care
			 arrangements which provide necessary care in less restrictive or less expensive
			 environments.
(3) Substitution of
			 less expensive or less intensive services shall be made only with the consent
			 of the insured and upon the recommendation of the insured's attending physician
			 or licensed health care provider that such services will adequately meet the
			 insured patient's needs. The decision to substitute less expensive or less
			 intensive services shall be determined based on the medical needs of the
			 individual insured patient.
(4) An
			 insurer may require that home health agencies or similar alternative care
			 providers have written treatment plans which are approved by the insured
			 patient's attending physician or other licensed health care provider.
(5) Coverage may be limited to no less than
			 the maximum benefits which would be payable for hospital or other institutional
			 expenses under the policy or contract, and may include all deductibles and
			 coinsurances which would be payable by the insured under the hospital or other
			 institutional expense coverage of the insured's policy or contract.
(6) This section shall not apply to long-term
			 care, medicare supplement, or disability income protection insurance policies
			 or contracts. This section shall not apply to guaranteed renewable disability
			 insurance policies issued prior to January 1, 1995.
Statutory Authority:
				  RCW
				  48.01.030,
				  48.02.060,
				  48.44.050,
				  48.44.020,
				  48.46.200 and
				  48.46.060. 94-19-015 (Order R
				  94-16), §
										284-96-500, filed 9/9/94,
				  effective 10/10/94.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-97 - Life settlement regulation › Section 284-97-010 - Purpose and scope

Current through Register Vol. 24-14, July 15, 2024
(1) The purpose of
			 this chapter is to effectuate chapter 48.102 RCW, by establishing minimum
			 standards and disclosure requirements to be met by life settlement providers
			 and life settlement brokers with respect to life settlement contracts
			 advertised, solicited, or issued for delivery in this state, and licensing
			 requirements for life settlement providers and life settlement
			 brokers.
(2) This regulation is not
			 exclusive, and acts or omissions, whether or not specific in this chapter, may
			 also be violations of other sections of the insurance code or other regulations
			 promulgated thereunder.
Statutory Authority:
				  RCW
				  48.02.060,
				  48.102.011,
				  48.102.046,
				  48.102.100,
				  48.102.170,
				  48.102.021,
				  48.102.041, and
				  48.102.080. 10-04-042 (Matter No.
				  R 2009-14), §
										284-97-010, filed 1/27/10,
				  effective 2/27/10. Statutory Authority:
				  RCW
				   48.02.060,
				  48.30.010 and 1995 c 161
				  §§ 2, 4, 5 and 10. 95-22-016 (Order R 95-2), §
										284-97-010, filed 10/20/95,
				  effective 11/20/95.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-97 - Life settlement regulation › Section 284-97-015 - Definitions

Current through Register Vol. 24-14, July 15, 2024
For purposes of this chapter:
(1) "Domestic life settlement provider" means
			 a provider as defined in
			 RCW
			  48.102.006(19) who if:
(a) A natural person either resides or has
			 their principal place of business in this state, or both; or
(b) A legal entity that either has their
			 principal place of business in this state, or is incorporated in or otherwise
			 formed under the laws of the state of Washington, or both.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-97 - Life settlement regulation › Section 284-97-025 - Annual reporting requirements for life settlement providers

Current through Register Vol. 24-14, July 15, 2024
(1) Every licensed
			 life settlement provider must file with the commissioner an annual statement on
			 or before March 1st for the immediately preceding calendar year ending December
			 31st. For good cause shown, the commissioner may grant an extension of time to
			 file if the request for extension is received by the commissioner more than
			 five business days prior to March 1st.
(2) The annual statement forms and
			 instructions are on the commissioner's web site at
www.insurance.wa.gov
.
(3) In addition to any other requirements,
			 for any policy settled within five years of policy issuance, the annual
			 statement shall specify the total number, aggregate face amount, and life
			 settlement proceeds of policies settled during the immediately preceding
			 calendar year, together with a breakdown of the information by policy issue
			 year.
(4) Annual statements filed
			 by a life settlement provider with the commissioner must be filed in electronic
			 form. Electronic form shall mean in pdf format and according to the
			 instructions on the commissioner's web site.
(5) As a demonstration of financial
			 responsibility, life settlement providers must comply with WAC
			 284-07-100 through
			 284-07-230, except WAC
			 284-07-100(5), (6), and
			 (7), to the extent reasonably applicable, and
			 the applicant shall not be required to file any report, letter, or other
			 document required by WAC
			 284-07-100 through
			 284-07-230 with the National
			 Association of Insurance Commissioners (NAIC).
Statutory Authority:
				  RCW
				  48.02.060,
				  48.102.011,
				  48.102.046,
				  48.102.100,
				  48.102.170,
				  48.102.021,
				  48.102.041, and
				  48.102.080. 10-04-042 (Matter No.
				  R 2009-14), §
										284-97-025, filed 1/27/10,
				  effective 2/27/10.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-97 - Life settlement regulation › Section 284-97-030 - Licensing life settlement brokers

Current through Register Vol. 24-14, July 15, 2024
The application form and instructions for obtaining a license
				as a life settlement broker are on the commissioner's web site at
www.insurance.wa.gov
.
Statutory Authority:
				  RCW
				  48.02.060,
				  48.102.011,
				  48.102.046,
				  48.102.100,
				  48.102.170,
				  48.102.021,
				  48.102.041, and
				  48.102.080. 10-04-042 (Matter No.
				  R 2009-14), §
										284-97-030, filed 1/27/10,
				  effective 2/27/10. Statutory Authority:
				  RCW
				   48.02.060,
				  48.30.010 and 1995 c 161
				  §§ 2, 4, 5 and 10. 95-22-016 (Order R 95-2), §
										284-97-030, filed 10/20/95,
				  effective 11/20/95.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-97 - Life settlement regulation › Section 284-97-035 - Prompt reply to the commissioner required

Current through Register Vol. 24-14, July 15, 2024
Every licensed life settlement provider and broker licensed
				under chapter 48.102 RCW, must promptly reply in writing to an inquiry of the
				commissioner relative to the business of life settlements. A timely response is
				one that is received by the commissioner within fifteen business days from
				receipt of the inquiry. Failure to make a complete and timely response
				constitutes a violation of this section.
Statutory Authority:
				  RCW
				  48.02.060,
				  48.102.011,
				  48.102.046,
				  48.102.100,
				  48.102.170,
				  48.102.021,
				  48.102.041, and
				  48.102.080. 10-04-042 (Matter No.
				  R 2009-14), §
										284-97-035, filed 1/27/10,
				  effective 2/27/10.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-97 - Life settlement regulation › Section 284-97-040 - Contract and form filing requirements for life settlement providers and life settlement brokers

Current through Register Vol. 24-14, July 15, 2024
All life settlement contracts as defined in
				RCW
				 48.102.006(12) and
				disclosure forms required by
				RCW
				 48.102.080 must be filed with and be approved
				by the commissioner prior to use in this state. No other forms shall be filed
				with the commissioner.
(1)
(a) Life settlement providers must file with
			 the commissioner:
(i) Their life settlement
			 contract form completed in John Doe fashion; and
(ii) The disclosure form required by
			 RCW
			  48.102.080(1).
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-97 - Life settlement regulation › Section 284-97-050 - Standards for evaluating reasonability of compensation

Current through Register Vol. 24-14, July 15, 2024
In order to assure that benefits offered to an owner who is
				terminally or chronically ill are reasonable in relation to the rate, fee, or
				other compensation that is charged, any payout shall be no less than the
				greater of the amounts defined in subsections (1) and (2) of this
				section.
(1) Payouts shall be no less
			 than the following percentage of the expected death benefit under the insurance
			 policy, net of loans. The following are minimum standards and shall not be
			 presumed to be proof of fairness as to any specific transaction.
(a) If the insured's life expectancy is less
			 than six months, then the percentage of the expected death benefit under the
			 insurance policy, net of loans, to be received by the owner shall be no less
			 than eighty percent.
(b) If the
			 insured's life expectancy is at least six months, but less than twelve months,
			 then the percentage of the expected death benefit under the insurance policy,
			 net of loans, to be received by the owner shall be no less than seventy
			 percent.
(c) If the insured's life
			 expectancy is at least twelve months, but less than eighteen months, then the
			 percentage of the expected death benefit under the insurance policy, net of
			 loans, to be received by the owner shall be no less than sixty-five
			 percent.
(d) If the insured's life
			 expectancy is at least eighteen months, but less than twenty-five months, then
			 the percentage of the expected death benefit under the insurance policy, net of
			 loans, to be received by the owner, shall be no less than sixty
			 percent.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-97 - Life settlement regulation › Section 284-97-900 - Savings clause

Current through Register Vol. 24-14, July 15, 2024
Amendments to WAC
				284-97-010 through
				284-97-050 effective on or after
				July 26, 2009, do not affect any rights acquired or liabilities or obligations
				incurred under WAC
				284-97-010 through
				284-97-050 that existed prior to
				July 26, 2009, nor affects any proceedings instituted under those
				sections.
Statutory Authority:
				  RCW
				  48.02.060,
				  48.102.011,
				  48.102.046,
				  48.102.100,
				  48.102.170,
				  48.102.021,
				  48.102.041, and
				  48.102.080. 10-04-042 (Matter No.
				  R 2009-14), §
										284-97-900, filed 1/27/10,
				  effective 2/27/10.