reglab/statecodes huggingface dataset:
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-55 - Medicare supplement insurance regulation › Section 284-55-090 - Form for "replacement notice" by direct response insurer

Current through Register Vol. 24-14, July 15, 2024
NOTICE TO APPLICANT REGARDING REPLACEMENT OF ACCIDENT AND
				SICKNESS INSURANCE
According to (your application) (information you have
				furnished) you intend to lapse or otherwise terminate existing accident and
				sickness insurance and replace it with the policy delivered herewith issued by
				(company name) insurance company. Federal and state law provides thirty days
				within which you may decide without cost whether you desire to keep the policy.
				For your own information and protection, you should be aware of and seriously
				consider certain factors which may affect the insurance protection available to
				you under the new policy.
(1)
Health conditions which you may presently have
							 (preexisting conditions) may not be immediately or fully covered under the new
							 policy. This could result in denial or delay of a claim for benefits under the
							 new policy, whereas a similar claim might have been payable under your present
							 policy.
(2)
You may wish to secure the advice of your present
							 insurer or its agent regarding the proposed replacement of your present policy.
							 This is not only your right, but it is also in your best interest to make sure
							 you understand all the relevant factors involved in replacing your present
							 coverage.
(3)
(To be included only if the application is attached
							 to the policy.) If, after due consideration, you still wish to terminate your
							 present policy and replace it with new coverage, read the copy of the
							 application attached to your new policy and be sure that all questions are
							 answered fully and correctly. Omissions or misstatements in the application
							 could cause an otherwise valid claim to be denied. Carefully check the
							 application and write to (company name and address) within thirty days if any
							 information is not correct and complete, or if any past medical history has
							 been left out of the application.
. . . . . . . . . . ..
(Company Name)
Statutory Authority:
				  RCW
				  48.02.060(3)(a) and
				  48.30.010(2).
				  88-22-061 (Order R 88-9), §
										284-55-090, filed 11/1/88.
				  Statutory Authority:
				  RCW
				   48.02.060,
				  48.44.050 and
				  48.46.200. 82-01-016 (Order R
				  81-6), §
										284-55-090, filed
				  12/9/81.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-55 - Medicare supplement insurance regulation › Section 284-55-095 - Prohibited compensation for replacement with the same insurer

Current through Register Vol. 24-14, July 15, 2024
No insurer shall provide compensation to its agents or other
				producers which is greater than the renewal compensation which would have been
				paid on an existing medicare supplement insurance policy if an existing
				medicare supplement insurance policy is replaced by another such policy where
				the new benefits are substantially similar to the benefits under the old
				medicare supplement insurance policy and such old policy was issued by the same
				insurer or insurer group.
Statutory Authority:
				  RCW
				  48.02.060(3)(a) and
				  48.30.010(2).
				  88-22-061 (Order R 88-9), §
										284-55-095, filed
				  11/1/88.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-55 - Medicare supplement insurance regulation › Section 284-55-120 - Attained age rating prohibited

Current through Register Vol. 24-14, July 15, 2024
Effective January 1, 1989, with respect to medicare supplement
				insurance policies initially sold to residents of this state on or after that
				date, it is an unfair practice and an unfair method of competition for any
				insurer, and a prohibited practice for any health care service contractor or
				health maintenance organization, to use the increasing age of an insured,
				subscriber, or participant as the basis for increasing premiums or prepayment
				charges.
Statutory Authority:
				  RCW
				  48.02.060(3)(a) and
				  48.30.010(2).
				  88-22-061 (Order R 88-9), §
										284-55-120, filed
				  11/1/88.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-55 - Medicare supplement insurance regulation › Section 284-55-125 - Riders and endorsements

Current through Register Vol. 24-14, July 15, 2024
(1) In
			 order to assure the orderly implementation and conversion of medicare
			 supplement insurance benefits due to changes in the federal medicare program
			 and to eliminate provisions which may duplicate medicare:
(a) No later than January 1, 1990, all
			 insurers must substitute new policies for all medicare supplement insurance
			 policies or contracts sold to residents of this state prior to January 1, 1990,
			 where policies were amended by riders or endorsements to comply with changes to
			 medicare.
(b) Effective January 1,
			 1990, subject to
			 RCW
			  48.66.050(2), and except for
			 riders or endorsements issued in accordance with subsection (2) of this
			 section, no rider, endorsement, waiver, or any other means of contractual
			 modification may be used by an insurer to exclude, limit, or reduce the
			 coverage or benefits of a medicare supplement insurance policy issued to a
			 resident of this state.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-55 - Medicare supplement insurance regulation › Section 284-55-150 - Filing requirements and premium adjustments

Current through Register Vol. 24-14, July 15, 2024
(1) For medicare supplement insurance
			 policies initially sold to residents of this state on or after January 1, 1989:
(a) Within ninety days of the effective date
			 of this rule, every insurer required to file its medicare supplement insurance
			 policy forms with the commissioner shall file with the commissioner new
			 medicare supplement insurance policy forms which eliminate any duplication of
			 medicare supplement benefits with benefits provided by medicare and which
			 provide a clear description of the policy or contract benefit; and
(b) The filing required under this subsection
			 shall provide for loss ratios which are at least as favorable to the insured as
			 the minimum loss ratio standards established by WAC
			 284-55-115.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-55 - Medicare supplement insurance regulation › Section 284-55-155 - Filing requirements for out-of-state group policies

Current through Register Vol. 24-14, July 15, 2024
Every insurer providing group medicare supplement insurance
				benefits to a resident of this state shall, within thirty days of its use in
				this state, file with the commissioner a copy of the master policy and any
				certificate used in this state.
Statutory Authority:
				  RCW
				  48.02.060(3)(a) and
				  48.30.010(2).
				  88-22-061 (Order R 88-9), §
										284-55-155, filed
				  11/1/88.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-55 - Medicare supplement insurance regulation › Section 284-55-160 - Annual adjustment notice to conform existing medicare supplement policies to medicare changes

Current through Register Vol. 24-14, July 15, 2024
No later than thirty days prior to the annual effective date of
				changes required by the Medicare Catastrophic Coverage Act of 1988, every
				insurer providing medicare supplement insurance policies to a resident of this
				state shall notify its insureds of modifications it has made to medicare
				supplement insurance policies in an annual adjustment notice. For the years
				1989 and 1990, and in 1990 only if outpatient prescription drugs are covered by
				the policy or contract, such notice shall be substantially in the format
				prescribed by the commissioner at WAC
				284-55-165 through 284-55-177.
				The annual adjustment notice is intended to be informational only and for the
				sole purpose of informing policy and certificate holders about changes in
				medicare benefits, indexed deductible and copayment provisions, premium
				adjustments, and the like. The forms of annual adjustment notices provided to
				residents of this state shall be filed with the commissioner prior to
				use.
(1) Such notice shall include a
			 description of revisions to the medicare program and a description of each
			 modification made to the coverage provided under the medicare supplement
			 insurance policy.
(2) Such notice
			 shall inform each covered person as to when any premium adjustment due to
			 changes in medicare benefits will be made.
(3) Such annual adjustment notice of benefit
			 modifications and any premium adjustment shall be furnished in outline form and
			 in clear and simple terms so as to facilitate comprehension.
(4) Such notice shall not contain or be
			 accompanied by any solicitation.
Statutory Authority:
				  RCW
				  48.02.060(3)(a) and
				  48.66.050. 89-11-096 (Order R
				  89-7), §
										284-55-160, filed 5/24/89.
				  Statutory Authority:
				  RCW
				   48.02.060(3)(a) and
				  48.30.010(2).
				  88-22-061 (Order R 88-9), §
										284-55-160, filed
				  11/1/88.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-55 - Medicare supplement insurance regulation › Section 284-55-180 - Requirements for advertising

Current through Register Vol. 24-14, July 15, 2024
(1) At
			 least thirty days prior to use in this state, every insurer who provides
			 medicare supplement insurance coverage to a resident of this state shall
			 provide the commissioner with a copy of any advertisement, as defined at WAC
			 284-50-030, intended for use in
			 this state, whether through written, radio, or television medium. In the case
			 of radio or television advertising, an audio cassette or VHS video cassette
			 shall be supplied on request of the commissioner.
(2) Advertisements shall comply with the
			 Washington disability advertising regulation,
			 RCW
			  48.30.040 through
			 48.30.090, and all other
			 applicable state laws.
Statutory Authority:
				  RCW
				  48.02.060(3)(a) and
				  48.30.010(2).
				  88-22-061 (Order R 88-9), §
										284-55-180, filed
				  11/1/88.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-55 - Medicare supplement insurance regulation › Section 284-55-185 - Compliance with Omnibus Budget Reconciliation Act of 1987

Current through Register Vol. 24-14, July 15, 2024
Every insurer to whom it applies shall certify to the
				commissioner on the medicare supplement experience exhibit of its annual
				statement that it has complied with Section 4081 of the Omnibus Budget
				Reconciliation Act of 1987, P.L. 100-203, (1987).
Statutory Authority:
				  RCW
				  48.02.060(3)(a) and
				  48.30.010(2).
				  88-22-061 (Order R 88-9), §
										284-55-185, filed
				  11/1/88.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-55 - Medicare supplement insurance regulation › Section 284-55-190 - Chapter not exclusive

Current through Register Vol. 24-14, July 15, 2024
Nothing contained in this chapter shall be construed to limit
				the authority of the commissioner to regulate a medicare supplement insurance
				policy under other sections of
				Title
				48 RCW.
Statutory Authority:
				  RCW
				  48.02.060(3)(a) and
				  48.30.010(2).
				  88-22-061 (Order R 88-9), §
										284-55-190, filed
				  11/1/88.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-55 - Medicare supplement insurance regulation › Section 284-55-205 - Medicare supplement loss ratio experience form required

Current through Register Vol. 24-14, July 15, 2024
The form provided at WAC
				284-55-210 shall be filed with
				the commissioner annually not later than June 30th of each calendar year
				beginning June 30, 1990. The form is to be filed in addition to the NAIC
				experience exhibit and not in lieu thereof.
The following instructions must be followed when completing the
				form:
(1) The data shall be furnished
			 in the same format and order as that shown at WAC
			 284-55-210;
(2) The name of the insurer must be clearly
			 shown at the top of each page;
(3)
			 Separate data must be shown for each policy form number and for each policy
			 duration of each form;
(4) The
			 current approved rate schedule for each policy form number shall be attached to
			 the experience form and shall show the policy form number for purposes of
			 identification;
(5) Incurred losses
			 shall include claims paid and the change in claim reserves and liabilities. A
			 list of items that are not to be included in incurred losses is provided at WAC
			 284-55-115(4);
(6) The loss ratio shall be the ratio of
			 incurred losses to earned premium;
(7) The experience form shall be certified by
			 an officer of the insurer;
(8)
			 Complete data is required for each policy form on both a national basis and for
			 policies sold in the state of Washington;
(9) Policy reserves shall include:
(a) Active life reserves;
(b) Contingency and additional
			 reserves;
(c) Increased reserves
			 which may be required by the commissioner.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-55 - Medicare supplement insurance regulation › Section 284-55-210 - Form of medicare supplement loss ratio experience

Current through Register Vol. 24-14, July 15, 2024
The following form of medicare supplement loss ratio experience
				shall be used by all insurers:
MEDICARE SUPPLEMENT LOSS RATIO EXPERIENCE
(SUMMARIZED BY POLICY YEAR)
Experience reported for January 1 to December 31 of
							 19
To be filed on or before June 30
of the
Address (City, State, and Zip Code)
NAIC Group Code
NAIC Company Code
CIC Code
National Experience
Form No.
No. of
Contracts
in Force
Policy
Duration
Incurred
Losses
Earned
Premiums
Loss Ratio
Unearned
Premium
Reserve
Policy
Reserves
Claim
Reserves
Washington Experience
Form No.
No. of
Contracts
in Force
Policy
Duration
Incurred
Losses
Earned
Premiums
Loss Ratio
Unearned
Premium
Reserve
Policy
Reserves
Claim
Reserves
I hereby certify that I have supervised the
							 preparation of this experience exhibit, that it is complete and accurate to the
							 best of my knowledge, and it is in compliance with RCW 48-66-150, and WAC
							 284-55-115, and WAC
							 284-55-150.
Signature of Officer
Date
Name and Title of Officer
Prepared by
Phone Number
Statutory Authority:
				  RCW
				  48.02.060(3)(a) and
				  48.66.050. 89-11-096 (Order R
				  89-7), §
										284-55-210, filed
				  5/24/89.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-58 - Life and disability form and rate filings › Section 284-58-005 - Definitions that apply to this chapter

Current through Register Vol. 24-14, July 15, 2024
The definitions in this section apply throughout this
				chapter.
(1) "Complete filing" means a
			 package of information containing insurance forms, supporting information,
			 documents and exhibits submitted to the commissioner electronically using the
			 System for Electronic Rate and Form Filing (SERFF).
(2) "Credit insurance" means the types of
			 insurance defined in
			 RCW
			  48.34.030(1) and
			 (2).
(3) "Date filed" means the date a complete
			 filing has been received and accepted by the commissioner.
(4) "Disability insurance" means the same as
			 in RCW
			  48.11.030.
(5) "Filer" means a person, organization or
			 other entity that files insurance forms or rates with the commissioner for an
			 insurer.
(6) "Insurance" means the
			 same as in
			 RCW
			  48.01.040.
(7) "Insurer" means an insurer defined in
			 RCW
			  48.01.050 that has been issued a certificate
			 of authority by the commissioner under
			 chapter
			 48.05 RCW.
(8) "Life insurance" means the same as in
			 RCW
			  48.11.020.
(9) "NAIC" means the National Association of
			 Insurance Commissioners.
(10)
			 "Objection letter" means correspondence created in SERFF and sent by the
			 commissioner to the filer that:
(a) Requests
			 clarification, documentation or other information;
(b) Explains errors or omissions in the
			 filing; or
(c) Disapproves a form
			 under RCW
			  48.18.110.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-58 - Life and disability form and rate filings › Section 284-58-010 - Purpose of this chapter

Current through Register Vol. 24-14, July 15, 2024
This chapter contains the Washington state life, disability and
				credit insurance form and rate filing requirements.
The purpose of this chapter is to adopt processes and
				procedures for insurers and filers to use when submitting life, disability and
				credit insurance products with the commissioner. Rules in this chapter:
(1) Establish the necessary contents of a
			 form filing;
(2) Establish the
			 filing requirements for credit and disability insurance classification plan and
			 rate and rule manuals; and
(3)
			 Effective February 1, 2009, designate SERFF as the method by which filers must
			 submit life, credit and disability filings to the commissioner.
Statutory Authority:
				  RCW
				  48.02.060,
				  48.110.150. 08-21-091 (Matter No.
				  2007-11), §
										284-58-010, filed 10/15/08,
				  effective 2/1/09. Statutory Authority:
				  RCW
				  48.02.060. 98-13-094 (Matter No. R 98-11),
				  §
										284-58-010, filed 6/16/98,
				  effective 7/17/98; 82-23-009 (Order R 82-5), §
										284-58-010, filed
				  11/5/82.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-58 - Life and disability form and rate filings › Section 284-58-020 - Scope of this chapter

Current through Register Vol. 24-14, July 15, 2024
(1) This
			 chapter applies to all life and disability insurers that must file forms and
			 rates under
			 RCW
			  48.18.100,
			 48.19.010(2) and
			 48.34.100.
(2) Under
			 RCW
			  48.18.100, the commissioner is required to
			 act within thirty days to approve or disapprove a form. The commissioner may
			 extend the review period to forty-five days under
			 RCW
			  48.18.100(3). If the
			 commissioner does not act within the review period, the form is deemed approved
			 and the insurer may use the form. The commissioner may subsequently withdraw
			 approval of a form for cause.
Statutory Authority:
				  RCW
				  48.02.060,
				  48.110.150. 08-21-091 (Matter No.
				  2007-11), §
										284-58-020, filed 10/15/08,
				  effective 2/1/09. Statutory Authority:
				  RCW
				  48.02.060. 98-13-094 (Matter No. R 98-11),
				  §
										284-58-020, filed 6/16/98,
				  effective 7/17/98; 82-23-009 (Order R 82-5), §
										284-58-020, filed
				  11/5/82.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-58 - Life and disability form and rate filings › Section 284-58-023 - Certification process does not apply to life, disability or credit insurance forms

Current through Register Vol. 24-14, July 15, 2024
Insurers may not use the certification process described in
				RCW
				 48.18.100(2) to file life,
				disability or credit insurance forms. Insurers must file these forms under
				RCW
				 48.18.100(1) or
				48.34.100.
Statutory Authority:
				  RCW
				  48.02.060,
				  48.110.150. 08-21-091 (Matter No.
				  2007-11), §
										284-58-023, filed 10/15/08,
				  effective 2/1/09.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-58 - Life and disability form and rate filings › Section 284-58-025 - Filing instructions that are incorporated into this chapter

Current through Register Vol. 24-14, July 15, 2024
SERFF is a dynamic application that the NAIC will revise and
				enhance over time. To be consistent with NAIC filing standards and provide
				timely instructions to filers, the commissioner will incorporate documents
				posted on the SERFF website into this chapter. By reference, the commissioner
				incorporates these documents into this chapter:
(1) The
SERFF Industry
			 Manual
available within the SERFF application; and
(2) State specific rate and form filing
			 instructions posted on the commissioner's website (
www.insurance.wa.gov
), including the:
(a)
Washington State SERFF Life and
			 Disability Form Filing General Instructions
;
(b)
Washington State Life, Health and
			 Disability Rate Filing General Instructions;
(c)
Washington State SERFF Health and
			 Disability Form Filing General Instructions;
(d)
Washington State SERFF Health and
			 Disability Binder Filing General Instructions
(also called "plan
			 management instructions"); and
(e)
Washington State SERFF Carrier Provider Agreement and HCBM Contract
			 Filing General Instructions
.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-58 - Life and disability form and rate filings › Section 284-58-030 - General form and rate filing rules

Current through Register Vol. 24-14, July 15, 2024
(1) Each credit, life or disability insurance
			 form or rate filing must be submitted to the commissioner electronically using
			 SERFF.
(a) Every form filed in SERFF must be
			 attached to the form schedule.
(b)
			 Filers must send all written correspondence related to a form or rate filing in
			 SERFF.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-58 - Life and disability form and rate filings › Section 284-58-033 - Specific rate filing rules

Current through Register Vol. 24-14, July 15, 2024
(1) If a
			 rate filing is required under
			 RCW
			  48.19.010(2) or
			 48.34.100, it must be submitted:
(a) Separate from any corresponding form
			 filing; and
(b) Concurrently with
			 the corresponding form filing if new forms are being introduced.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-58 - Life and disability form and rate filings › Section 284-58-037 - The commissioner may reject filings

Current through Register Vol. 24-14, July 15, 2024
(1) The commissioner may reject and close any
			 filing that does not comply with WAC
			 284-58-030 or
			 284-58-033. If the commissioner
			 rejects a filing, the insurer has not filed forms or rates with the
			 commissioner.
(2) If the
			 commissioner rejects a filing and the filer resubmits it as a new filing, the
			 date filed will be the date the commissioner receives and accepts the new
			 filing.
Statutory Authority:
				  RCW
				  48.02.060,
				  48.110.150. 08-21-091 (Matter No.
				  2007-11), §
										284-58-037, filed 10/15/08,
				  effective 2/1/09.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-58 - Life and disability form and rate filings › Section 284-58-043 - Filing authorization rules

Current through Register Vol. 24-14, July 15, 2024
An insurer may authorize a third-party filer to file forms or
				rates on its behalf. For the purposes of this section, a "third-party filer"
				means a person or entity in the business of providing insurance regulatory
				compliance services.
(1) If an insurer
			 delegates filing authority to a third-party filer, each filing must include a
			 letter as supporting documentation signed by an officer of the insurer
			 authorizing the third-party filer to make filings on behalf of the
			 insurer.
(2) The insurer may not
			 delegate responsibility for the content of a filing to a third-party filer. The
			 commissioner considers errors and omissions made by the third-party filer to be
			 errors and omissions of the insurer.
(3) If a third-party filer has a pattern of
			 making filings that do not comply with this chapter, the commissioner may
			 reject a delegation of filing authority from the insurer.
Statutory Authority:
				  RCW
				  48.02.060,
				  48.110.150. 08-21-091 (Matter No.
				  2007-11), §
										284-58-043, filed 10/15/08,
				  effective 2/1/09.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-58 - Life and disability form and rate filings › Section 284-58-047 - Rules for responding to an objection letter

Current through Register Vol. 24-14, July 15, 2024
An objection letter may ask the filer to revise a noncompliant
				form or rate filing or provide clarification or additional information. The
				objection letter will state the reason(s) for disapproval, including relevant
				case law, statutes and rules. Filers must:
(1) Provide a complete response to an
			 objection letter. A complete response must include:
(a) A separate response to each objection,
			 and if appropriate;
(b) A
			 description of changes proposed to noncompliant forms, and a replacement form
			 attached to the form schedule; or
(c) Revised exhibits and supporting
			 documentation.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-58 - Life and disability form and rate filings › Section 284-58-053 - Rules for revised or replaced insurance policy forms

Current through Register Vol. 24-14, July 15, 2024
If an insurer files a revised or replaced form, the filer must
				provide the supporting documentation described below:
(1) If a form is revised due to an
			 objection(s) from the commissioner, the filer must provide a detailed
			 explanation of all material changes to the disapproved form.
(2) If a previously approved form is replaced
			 with a new version, the filer must submit an exhibit that marks and identifies
			 each change or revision to the replaced form using one of these methods:
(a) A draft form that strikes through
			 deletions and underlines additions or changes in the form;
(b) A draft form that includes comments in
			 the margins explaining the changes in the forms; or
(c) A side-by-side comparison of current and
			 proposed policy language.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-58 - Life and disability form and rate filings › Section 284-58-057 - Effective date rules

Current through Register Vol. 24-14, July 15, 2024
(1)
			 Filers must include a common approval date for all forms or rates submitted in
			 a filing.
(2) Filers may submit a
			 request to change the approval date of a filing as a note to
			 reviewer.
Statutory Authority:
				  RCW
				  48.02.060,
				  48.110.150. 08-21-091 (Matter No.
				  2007-11), §
										284-58-057, filed 10/15/08,
				  effective 2/1/09.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-58 - Life and disability form and rate filings › Section 284-58-061 - Reference copies of amendatory endorsements

Current through Register Vol. 24-14, July 15, 2024
If an insurer will use a previously approved Washington
				amendatory endorsement with a new form, the filer must:
(1) Provide a copy of the amendatory
			 endorsement attached as supporting documentation; or
(2) Include the SERFF tracking number under
			 which the endorsement was filed and approved in the filing description;
			 and
(3) Explain how the insurer
			 will use the amendatory endorsement with the new form.
Statutory Authority:
				  RCW
				  48.02.060,
				  48.110.150. 08-21-091 (Matter No.
				  2007-11), §
										284-58-061, filed 10/15/08,
				  effective 2/1/09.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-58 - Life and disability form and rate filings › Section 284-58-066 - Rules that apply to insurance forms translated from English to another language

Current through Register Vol. 24-14, July 15, 2024
Insurers may issue insurance policy forms written in languages
				other than English.
(1) If an insurer
			 translates an insurance policy form from English to another language, the
			 insurer must:
(a) File the translated version
			 of the form.
(b) Include written
			 disclosure statements on the translated policy form that the insurer is issuing
			 the translated form on an informational basis and the English version is
			 controlling for the purposes of application and interpretation. The disclosure
			 statements must be in English and the language of the translated form and
			 printed in bold face type of at least twelve-point font.
(c) Submit a certification with the filing by
			 an officer employed by the insurer that the insurer will issue the English
			 version of the policy form with the translated policy form.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-60 - Disability insurance loss ratios › Section 284-60-010 - Scope

Current through Register Vol. 24-14, July 15, 2024
(1) This
			 regulation, WAC
			 284-60-010 through
			 284-60-100, applies to all
			 insurers and to every disability insurance policy form filed for approval in
			 this state after August 31, 1983, except:
(a)
			 Additional indemnity and premium waiver forms for use only in conjunction with
			 life insurance policies;
(b)
			 Medicare supplement policy forms which are regulated by chapter 284-55
			 WAC;
(c) Credit insurance policy
			 forms issued pursuant to chapter 48.34 RCW;
(d) Group policy forms other than:
(i) Specified disease policy forms;
(ii) Policy forms, other than loss of income
			 forms, as to which all or substantially all, of the premium is paid by the
			 individuals insured thereunder;
(iii) Policy forms, other than loss of income
			 forms, for issue to single employers insuring less than one hundred
			 employees.
(e) Policy
			 forms filed by health care service contractors or health maintenance
			 organizations;
(f) Policy forms
			 initially approved before September 1, 1983, including subsequent requests for
			 rate increases and modifications of rate manuals;
(g) Health plans other than:
(i) Grandfathered individual health
			 plans;
(ii) Grandfathered small
			 group health plans.
(h)
			 Stand-alone dental only plans; and
(i) Stand-alone vision only plans.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-60 - Disability insurance loss ratios › Section 284-60-020 - Purpose

Current through Register Vol. 24-14, July 15, 2024
The purpose of this regulation is to:
(1) Establish loss ratio standards for the
			 purpose of implementing the authority of the commissioner to disapprove and to
			 withdraw approval of disability policy forms which are not returning or are not
			 expected to return a reasonable proportion of the premiums in the form of
			 benefits, pursuant to
			 RCW
			  48.18.110(2),
			 48.19.010(2),
			 48.70.030 and
			 48.70.040.
(2) Define certain practices in the use of
			 policy forms and in the making of disability insurance rates to be unfair,
			 deceptive and discriminatory practices, pursuant to
			 RCW
			  48.01.030,
			 48.18.480 and
			 48.30.010.
Statutory Authority:
				  RCW
				  48.02.060. 83-14-002 (Order R 83-1), §
										284-60-020, filed 6/23/83,
				  effective 9/1/83.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-60 - Disability insurance loss ratios › Section 284-60-030 - Definitions

Current through Register Vol. 24-14, July 15, 2024
(1) The "expected
			 loss ratio" is a prospective calculation and shall be calculated as the
			 projected "benefits incurred" divided by the projected "premiums earned" and
			 shall be based on the actuary's best projections of the future experience
			 within the "calculating period."
(2) The "actual loss ratio" is a
			 retrospective calculation and shall be calculated as the "benefits incurred"
			 divided by the "premiums earned," both measured from the beginning of the
			 "calculating period" to the date of the loss ratio calculations.
(3) The "overall loss ratio" shall be
			 calculated as the "benefits incurred" divided by the "premiums earned" over the
			 entire "calculating period" and may involve both retrospective and prospective
			 data.
(4) The "calculating period"
			 shall be the time span over which the actuary expects the premium rates,
			 whether level or increasing, to remain adequate in accordance with his best
			 estimate of future experience and during which the actuary does not expect to
			 request a rate increase.
(5) The
			 "benefits incurred" shall be the "claims incurred" plus any increase (or less
			 any decrease) in the "reserves."
(6) The "claims incurred" shall mean:
(a) Claims paid during the accounting period;
			 plus
(b) The change in the
			 liability for claims which have been reported but not paid; plus
(c) The change in the liability for claims
			 which have not been reported but which may reasonably be expected.
The "claims incurred" shall not include expenses incurred in
				processing the claims, home office or field overhead, acquisition and selling
				costs, taxes or other expenses, contributions to surplus, or profit.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-60 - Disability insurance loss ratios › Section 284-60-070 - Experience records

Current through Register Vol. 24-14, July 15, 2024
Insurers shall maintain records of earned premiums and incurred
				benefits for each policy year for each policy, rider, endorsement and similar
				form which were combined for purposes of premium calculations, including the
				reserves. Records shall also be maintained of the experience expected in the
				premium calculations. Notwithstanding the foregoing, with proper justification,
				the commissioner may accept approximation of policy year experience based on
				calendar year data.
Statutory Authority:
				  RCW
				  48.02.060. 83-14-002 (Order R 83-1), §
										284-60-070, filed 6/23/83,
				  effective 9/1/83.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-60 - Disability insurance loss ratios › Section 284-60-080 - Evaluating experience data

Current through Register Vol. 24-14, July 15, 2024
In determining the credibility and appropriateness of
				experience data, due consideration shall be given to all relevant factors
				including:
(1) Statistical credibility
			 of premiums and benefits such as low exposure or low loss frequency;
(2) Past and projected trends relative to the
			 kind of coverage, such as inflation in medical expenses, economic cycles
			 affecting disability income experience, inflation in expense charges and
			 others;
(3) The concentration of
			 experience at early policy durations where select morbidity and preliminary
			 term reserves are applicable and where loss ratios are expected to be
			 substantially higher or lower than in later policy durations;
(4) The mix of business by risk
			 classification;
(5) The expected
			 lapses and antiselection at the time of rate increases.
Statutory Authority:
				  RCW
				  48.02.060. 83-14-002 (Order R 83-1), §
										284-60-080, filed 6/23/83,
				  effective 9/1/83.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-60 - Disability insurance loss ratios › Section 284-60-090 - Special circumstances

Current through Register Vol. 24-14, July 15, 2024
Loss ratios other than those indicated in WAC
				284-60-050 and
				284-60-060 may be approved with
				satisfactory actuarial demonstrations. Examples of coverages where the
				commissioner may grant special considerations are:
(1) Short term nonrenewable policy forms such
			 as airline trip or student accident.
(2) Policy forms exposed to high risk of
			 claim fluctuation because of the low loss frequency, or the catastrophic or
			 experimental nature of the coverage.
(3) Individual guaranteed renewable and
			 noncancellable policy forms, but the loss ratio shall not be less than those
			 set forth in the following table in lieu of those specified in WAC
			 284-60-050. In the calculation of
			 loss ratios for such policies the reserves, except those required by
			 RCW
			  48.12.030(3)(a), shall be
			 excluded from consideration as benefits incurred.
Guaranteed Renewable
Noncancellable
Medical Expense
55%
50%
Loss of Income and Other
50%
45%
(4)
			 Cases where higher than usual expenses are expected because of peculiar
			 administrative or geographic circumstances.
(5) Freestanding group or blanket contracts
			 for benefits which are normally written in conjunction with other
			 benefits.
Statutory Authority:
				  RCW
				  48.02.060. 83-14-002 (Order R 83-1), §
										284-60-090, filed 6/23/83,
				  effective 9/1/83.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-60 - Disability insurance loss ratios › Section 284-60-100 - Effective date

Current through Register Vol. 24-14, July 15, 2024
This regulation shall become effective on September 1, 1983,
				and shall apply to all policy, rider, endorsement, and similar forms and rate
				schedule filings subject to this regulation submitted on or after said
				date.
Statutory Authority:
				  RCW
				  48.02.060. 83-14-002 (Order R 83-1), §
										284-60-100, filed 6/23/83,
				  effective 9/1/83.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-66 - Washington medicare supplement insurance regulation › Section 284-66-010 - Purpose

Current through Register Vol. 24-14, July 15, 2024
The purpose of this chapter is to supplement the requirements
				of chapter 48.66 RCW, the Medicare Supplemental Health Insurance Act; to assure
				the orderly implementation and conversion of medicare supplement insurance
				benefits and premiums due to changes in the federal medicare program; to
				provide for the reasonable simplification and standardization of the coverage,
				terms, and benefits of medicare supplement insurance policies and certificates,
				and to eliminate policy provisions that may duplicate medicare benefits as the
				federal medicare program changes; to facilitate public understanding and
				comparison of policies and to eliminate provisions contained in policies that
				may be misleading or confusing; to establish minimum standards for medicare
				supplement insurance, an "outline of coverage" and other disclosure
				requirements; to prohibit the use of certain provisions in medicare
				supplemental insurance policies; to define and prohibit certain acts and
				practices as unfair methods of competition or unfair or deceptive acts or
				practices; and to establish loss ratio requirements, policy reserves, filing
				and reporting procedures.
Statutory Authority:
				  RCW
				  48.02.060 and
				  48.66.165. 05-17-019 (Matter No. R
				  2004-08), §
										284-66-010, 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), §
										284-66-010, 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), §
										284-66-010, filed 3/20/90,
				  effective 4/20/90.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-66 - Washington medicare supplement insurance regulation › Section 284-66-020 - Applicability and scope

Current through Register Vol. 24-14, July 15, 2024
(1) Subject to
			 subsection (2) of this section, except as provided by federal law, chapter
			 48.66 RCW, or as otherwise specifically provided by this chapter, this chapter
			 applies to every group and individual policy of disability insurance and to
			 every subscriber contract of an issuer (other than a policy issued under a
			 contract provided for in section 1876 of the Social Security Act [42 U.S.C. section 1395  et seq.] or an issued policy under a demonstration project
			 specified in  42 U.S.C. section 1395ss(g)(1)), that relates its benefits to
			 medicare, or is advertised, marketed, or designed primarily as a supplement to
			 reimbursements under medicare for the hospital, medical, or surgical expenses
			 of persons eligible for medicare. All such policies or contracts are referred
			 to in this chapter as "medicare supplemental insurance" or "medicare supplement
			 insurance policy" or "medicare supplement coverage."
(2)
(a)
			 Medicare supplement insurance policies delivered before January 1, 1989, that
			 are renewable solely at the option of the insured by the timely payment of
			 premium are subject to the provisions of this chapter except with respect to
			 WAC 284-66-060,
			 284-66-200,
			 284-66-210,
			 284-66-310, and
			 284-66-350. To the extent that
			 the provisions of this chapter do not apply to these policies, chapter 284-55
			 WAC applies.
(b) Medicare
			 supplement insurance policies delivered between January 1, 1989, and December
			 31, 1989, that are renewable solely at the option of the insured by the timely
			 payment of premium are governed by this chapter except with respect to the
			 requirements of WAC
			 284-66-210 and
			 284-66-350.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-66 - Washington medicare supplement insurance regulation › Section 284-66-030 - Definitions

Current through Register Vol. 24-14, July 15, 2024
For purposes of this chapter:
(1) "Applicant" means:
(a) In the case of an individual medicare
			 supplement insurance policy, the person who seeks to contract for insurance
			 benefits; and
(b) In the case of a
			 group medicare supplement insurance policy, the proposed certificate
			 holder.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-66 - Washington medicare supplement insurance regulation › Section 284-66-040 - Policy definitions and terms

Current through Register Vol. 24-14, July 15, 2024
No policy or certificate may be advertised, solicited, issued
				for delivery in this state as a medicare supplement insurance policy or
				certificate unless the policy or certificate contains definitions or terms that
				conform to the requirements of this section.
(1) "Accident," "accidental injury," or
			 "accidental means" must be defined to employ "result" language and may not
			 include words that establish an accidental means test or use words such as
			 "external, violent, visible wounds" or similar words or description or
			 characterization.
(a) The definition may not
			 be more restrictive than the following: "Injury or injuries for which benefits
			 are provided means accidental bodily injury sustained by the insured person
			 that is the direct result of an accident, independent of disease or bodily
			 infirmity or any other cause, and occurs while insurance coverage is in
			 force."
(b) The definition may
			 provide that injuries do not include those injuries for which benefits are
			 provided under any workers' compensation, employer's liability or similar law,
			 or motor vehicle no-fault plan, unless prohibited by law.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-66 - Washington medicare supplement insurance regulation › Section 284-66-050 - Policy provisions

Current through Register Vol. 24-14, July 15, 2024
(1) No
			 policy may be advertised, solicited, or issued for delivery in this state as a
			 medicare supplement insurance policy unless it meets or exceeds the
			 requirements imposed by chapter 48.66 RCW.
(2) A medicare supplement policy or
			 certificate in force in this state may not contain benefits that duplicate
			 benefits provided by medicare.
(3)
			 Except for permitted preexisting condition clauses as described in WAC
			 284-66-063(1)(a) no policy or certificate may be advertised,
			 solicited, or issued for delivery in this state as a medicare supplement policy
			 if the policy or certificate contains limitations or exclusions on coverage
			 that are more restrictive than those of medicare.
(4) The terms "medicare supplement,"
			 "medicare wrap-around," "Medigap," or words of similar import may not be used
			 to describe an insurance policy unless the policy is issued in compliance with
			 chapter 48.66 RCW and this chapter.
(5) Subject to WAC
			 284-66-063(1)(c),
			 a medicare supplement policy with benefits for outpatient prescription drugs in
			 existence before January 1, 2006, must be renewed for current policyholders who
			 do not enroll in Part D at the option of the policyholder.
(6) A medicare supplement policy with
			 benefits for outpatient prescription drugs may not be issued after December 31,
			 2005.
(7) After December 31, 2005,
			 a medicare supplement policy with benefits for outpatient prescription drugs
			 may not be renewed after the policyholder enrolls in medicare Part D unless:
(a) The policy is modified to eliminate
			 outpatient prescription coverage for expenses of outpatient prescription drugs
			 incurred after the effective date of the individual's coverage under a Part D
			 plan; and
(b) Premiums are adjusted
			 to reflect the elimination of outpatient prescription drug coverage at the time
			 of medicare Part D enrollment, accounting for any claims paid, if
			 applicable.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-66 - Washington medicare supplement insurance regulation › Section 284-66-067 - Standard medicare supplement plans issued for delivery on or after June 1, 2010

Current through Register Vol. 24-14, July 15, 2024
No policy or certificate delivered or issued for delivery in
				this state on or after June 1, 2010, as a medicare supplement policy or
				certificate may be advertised, solicited, delivered or issued for delivery in
				this state as a medicare supplement policy or certificate unless it complies
				with these benefit plan standards. Benefit plan standards applicable to
				medicare supplement policies and certificates issued before June 1, 2010,
				remain subject to the requirements of WAC
				284-66-066.
(1)
(a) An
			 issuer must make available to each prospective policyholder and certificate
			 holder a policy form or certificate form containing only the basic or core
			 benefits, as defined in WAC
			 284-66-064.
(b) If an issuer makes available any of the
			 additional benefits described in WAC
			 284-66-064
			 or offers standardized benefit plan K or L as described in subsection (5) of
			 this section, then the issuer shall make available to each prospective
			 policyholder and certificate holder, in addition to a policy form or
			 certificate form with only the basic or core benefits as described in (a) of
			 this subsection, a policy form or certificate form containing either
			 standardized benefit plan C or standardized benefit plan F.