Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-54 - Long-term care insurance rules › Section 284-54-300 - Information to be furnished, style

Current through Register Vol. 24-14, July 15, 2024
(1) Each insurance producer, or other
			 representative of an insurer selling or offering benefits that are designed, or
			 represented as being designed, to provide long-term care insurance benefits,
			 shall deliver the disclosure form as set forth in WAC
			 284-54-350 not later than the
			 time of application for the contract. If an insurance producer has solicited
			 the coverage, the disclosure form shall be signed by that insurance producer
			 and a copy left with the applicant. The insurer shall maintain a copy in its
			 files.
(2) The disclosure form
			 required by this section shall identify the insurer issuing the contract and
			 may contain additional appropriate information in the heading. The
			 informational portion of the form shall be substantially as set forth in WAC
			 284-54-350 and words emphasized
			 therein shall be underlined or otherwise emphasized in each form issued. The
			 form shall be printed in a style and with a type character that is easily read
			 by an average person eligible for long-term care insurance.
(3) Where inappropriate terms are used in the
			 disclosure form, such as "insurance," "policy," or "insurance company," a
			 fraternal benefit society, health care service contractor, or health
			 maintenance organization shall substitute appropriate terminology.
(4) In completing the form, each subsection
			 shall contain information which succinctly and fairly informs the purchaser as
			 to the contents or coverage in the contract. If the contract provides no
			 coverage with respect to the item, that shall be so stated. Address the form to
			 the reasonable person likely to purchase long-term care insurance.
(5) A policy which provides for the payment
			 of benefits based on standards described as "usual," "customary," or
			 "reasonable" (or any combination thereof), or words of similar import, shall
			 include an explanation of such terms in its disclosure form and in the
			 definitions section of the contract.
(6) If the contract contains any gatekeeper
			 provision which limits benefits or precludes the insured from receiving
			 benefits, such gatekeeper provision shall be fully described.
(7) All insurers shall use the same
			 disclosure form. It is intended that the information provided in the disclosure
			 form will appear in substantially the same format provided to enable a
			 purchaser to compare competing contracts easily.
(8) The information provided shall include
			 the statement: "This is NOT a medicare supplement policy," and shall otherwise
			 comply with WAC
			 284-66-120.
(9) The required disclosure form shall be
			 filed by the insurer with the commissioner prior to use in this
			 state.
(10) In any case where the
			 prescribed disclosure form is inappropriate for the coverage provided by the
			 contract, an alternate disclosure form shall be submitted to the commissioner
			 for approval or acceptance prior to use in this state.
(11) Upon request of an applicant or insured,
			 insurers shall make available a disclosure form in a format which meets the
			 requirements of the Americans With Disabilities Act and which has been approved
			 in advance by the commissioner.
Statutory Authority:
				  RCW
				  48.02.060(3)(a) and
				  48.17.010(5).
				  11-01-159 (Matter No. R 2010-09), §
										284-54-300, filed 12/22/10,
				  effective 1/22/11. Statutory Authority:
				  RCW
				   48.02.060,
				  48.84.030 and
				  48.84.050. 95-19-028 (Order R
				  95-5), §
										284-54-300, filed 9/11/95,
				  effective 10/12/95. Statutory Authority:
				  RCW
				   48.02.060(3),
				  48.30.010 and
				  48.84.910. 87-15-027 (Order R
				  87-7), §
										284-54-300, filed
				  7/9/87.