Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-52 - Conversion regulation › Section 284-52-020 - Mandated conversion plans minimum standards

Current through Register Vol. 24-14, July 15, 2024
(1) Every insurer and every health care
			 service contractor which issues group hospital or medical benefit plans shall
			 make available to covered persons a choice of three conversion benefit plans
			 which meet the requirements of WAC
			 284-52-040,
			 284-52-050, and
			 284-52-060, and every health
			 maintenance organization which issues group hospital or medical benefit plans
			 shall make available a conversion benefit plan which meets the requirements of
			 WAC 284-52-060.
(2)Chapter 190, Laws of 1984, permits a
			 denial of conversion coverage "to a person who is covered under another group
			 plan, policy, contract, or agreement providing benefits for hospital or medical
			 care." For such denial provision to apply, such other coverage must not contain
			 operable exclusions for preexisting conditions or waiting periods greater than
			 those remaining under the terminated plan.
(3) Such conversion benefit plans:
(a) May provide that their benefits will be
			 excess to any group hospital or medical plan, governmental program, or
			 automobile medical, automobile no-fault, automobile uninsured and/or
			 underinsured motorist or similar coverage issued to or on behalf of the covered
			 person.
(b) Shall provide that
			 deductible amounts will be determined on a calendar year basis.
(c) Shall provide that expenses incurred or
			 the cost of services rendered and applied toward the annual deductible amount
			 during the last three months of such calendar year shall be applied toward the
			 deductible amount in the ensuing calendar year.
(d) May be rated based upon attained
			 age.
(e) Which provide coverage for
			 dependent children, may require evidence of insurability for newly acquired
			 dependents except that newborn infants shall be covered from the moment of
			 birth without evidence of insurability provided application therefor and
			 payment of applicable rates, if any, are made within sixty days of
			 birth.
(f) Shall permit the covered
			 person to pay the premium monthly.
(g) Shall provide that an insured, subscriber
			 or enrollee may continue to renew the conversion coverage until such person
			 fails to pay a necessary premium or fee, becomes eligible for medicare, or is
			 covered under another group plan providing benefits for hospital and medical
			 care, but only after preexisting conditions are covered and waiting periods
			 have been satisfied under such plan.
(h) Which are written to cover all members of
			 a family under one contract, shall contain a provision to assure that each
			 member, in the event that he or she ceases to be a qualified family member for
			 purposes of coverage, as, for example, by attaining a particular age, or
			 through a marriage or a divorce, or by reason of death of the principal covered
			 person, shall have the right to continue the coverage without a physical
			 examination, statement of health, or other proof of insurability.