reglab/statecodes huggingface dataset:
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-78 - Joint underwriting association for day care insurance › Section 284-78-050 - Administration

Current through Register Vol. 24-14, July 15, 2024
(1) The association
			 shall be administered by a governing board, subject to the supervision of the
			 commissioner, and operated by a manager appointed by the board.
(2) The board shall consist of nine members.
			 Five board members shall be insurers, one of which shall be appointed by the
			 commissioner from each of the following: American Insurance Association,
			 Alliance of American Insurers, National Association of Independent Insurers,
			 all other stock insurers, and all other nonstock insurers. A sixth board member
			 shall be the insurer designated as the service insurer for the association (or,
			 if there is more than one service insurer, the sixth board member shall be such
			 service insurer as the commissioner designates as the board member). The other
			 three board members shall be licensees who are appointed by the commissioner to
			 so serve, none of whom shall be interested, directly or indirectly, in any
			 insurer except as a policyholder. Board members shall serve for a period of one
			 year or until their successors are appointed. Not more than one insurer in a
			 group under the same management or ownership shall serve on the board at the
			 same time. At least one of the six insurers on the board shall be a domestic
			 insurer. All members of the board shall serve at the pleasure of the
			 commissioner.
(3) Each person
			 serving on the board or any subcommittee thereof, each member insurer of the
			 association, and each officer and employee of the association shall be
			 indemnified by the association against all costs and expenses actually and
			 necessarily incurred by him, her, or it in connection with the defense of any
			 action, suit, or proceeding in which he, she, or it is made a party by reason
			 of his, her, or its being or having been a member of the board, or a member or
			 officer or employee of the association, except in relation to matters as to
			 which he, she, or it has been judged in such action, suit, or proceeding to be
			 liable by reason of wilful misconduct in the performance of his, her, or its
			 duties as a member of such board, or member, officer, or employee of the
			 association. This indemnification shall not be exclusive of other rights as to
			 which such member, or officer, or employee may be entitled as a matter of
			 law.
Statutory Authority:
				  RCW
				  48.02.060(3)(a). 86-18-043
				  (Order R 86-3), §
										284-78-050, filed
				  8/29/86.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-78 - Joint underwriting association for day care insurance › Section 284-78-060 - General powers and duties of the board

Current through Register Vol. 24-14, July 15, 2024
(1) Within thirty days after the appointment
			 of its members by the commissioner, the board shall prepare and adopt articles
			 of association consistent with this chapter, subject to approval by the
			 commissioner. In a timely manner thereafter, the board shall take all actions
			 necessary to prepare the association to receive applications and issue
			 policies, when and if the commissioner activates the association as provided in
			 WAC 284-78-040. These actions shall
			 include the preparation of all necessary policy forms and rating information to
			 be filed with the commissioner for approval and all necessary operating manuals
			 and procedures to be followed.
(2)
			 The board shall meet as often as may be required to perform the general duties
			 of the administration of the association or on the call of the commissioner.
			 Three insurer members of the board shall constitute a quorum.
(3) The board may appoint a manager, who
			 shall serve at the pleasure of the board, to perform any duties necessary or
			 incidental to the proper administration of the association, including the
			 hiring of necessary staff.
(4) The
			 board shall annually furnish to all insurer members of the association and to
			 the commissioner a written report of operations.
Statutory Authority:
				  RCW
				  48.02.060(3)(a). 86-18-043
				  (Order R 86-3), §
										284-78-060, filed
				  8/29/86.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-78 - Joint underwriting association for day care insurance › Section 284-78-070 - Assessments

Current through Register Vol. 24-14, July 15, 2024
(1) The board may
			 calculate, levy, and collect assessments from member insurers whenever
			 necessary for the orderly operation of the association.
(2) After its formation, the board may
			 calculate, levy, and collect from member insurers a start up assessment to pay
			 initial expenses of the association and to establish any necessary reserves.
			 The start up assessment shall not exceed one million dollars. For ease of
			 administration, the share of the start up assessment levied upon and collected
			 from each member insurer shall be the same for each member insurer, regardless
			 of size and regardless of whether it is actively writing business in this
			 state.
(3) Any assessment
			 subsequent to the initial start up assessment shall be used to offset losses
			 and/or expenses in excess of income received by the association. These
			 assessments may be made as often as the board determines is necessary. To the
			 extent such an assessment exceeds one million dollars, each member insurer
			 shall be assessed a proportionate share relating to premium volume. The first
			 one million dollars of such an assessment shall be levied and collected in
			 equal amounts from each member insurer.
(4) Any member insurer failing to remit its
			 assessment when due is subject to revocation of its certificate of authority to
			 write property and casualty insurance in this state.
Statutory Authority:
				  RCW
				  48.02.060(3)(a). 86-18-043
				  (Order R 86-3), §
										284-78-070, filed
				  8/29/86.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-78 - Joint underwriting association for day care insurance › Section 284-78-080 - Statistics, records, and reports

Current through Register Vol. 24-14, July 15, 2024
(1) The association shall maintain separate
			 statistics on business written and shall make the following quarterly report to
			 the commissioner:
(a) Number of applications
			 received by the association;
(b)
			 Number of applications accepted by the association and the total and average
			 premiums charged, including the high and low premiums;
(c) Number of risks declined;
(d) Number of risks conditionally declined
			 and the number ultimately accepted after having been conditionally declined;
			 and
(e) Number of risks
			 cancelled.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-78 - Joint underwriting association for day care insurance › Section 284-78-090 - Eligibility of licensees for coverage

Current through Register Vol. 24-14, July 15, 2024
Any licensee that is unable to obtain day care insurance with
				liability limits of at least one hundred thousand dollars per occurrence from
				the voluntary insurance market or from any market assistance plan organized
				pursuant to section 906, chapter 305, Laws of 1986, is eligible to apply for
				coverage through the association. The association's service insurer shall
				promptly process such application and, if the licensee is judged to be an
				acceptable insurable risk, offer coverage to the licensee. In view of the
				purpose of chapter 141, Laws of 1986, every licensee will be presumed to be an
				acceptable insurable risk for the association. To refuse coverage to any
				licensee meeting the other eligibility requirements of this section, the
				association must have the prior written approval of the commissioner. The
				commissioner will grant such approval only if the association demonstrates that
				extraordinary circumstances justify refusing coverage to such individual
				licensee.
Statutory Authority:
				  RCW
				  48.02.060(3)(a). 86-18-043
				  (Order R 86-3), §
										284-78-090, filed
				  8/29/86.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-78 - Joint underwriting association for day care insurance › Section 284-78-100 - Standard policy coverage - Premiums

Current through Register Vol. 24-14, July 15, 2024
(1) All policies issued by the association
			 shall have liability limits of at least one hundred thousand dollars per
			 occurrence and shall be issued for a term of one year.
(2) Premiums shall be based on the
			 association's rate filings approved by the commissioner in accordance with
			 chapter
			 48.19 RCW. Such rate
			 filings shall provide for modification of rates for licensees according to the
			 type, size, and past loss experience of each licensee, and any other
			 differences among licensees that can be demonstrated to have a probable effect
			 upon losses.
(3) A policy shall be
			 offered which provides liability coverage with respect to child abuse, whether
			 a sexual nature or not. In the discretion of the association, such policy may
			 exclude from coverage an individual who directly commits or participates in the
			 actual abuse, but it may not exclude from coverage other persons who may be
			 liable only vicariously for such abuse. In addition, the association may offer
			 coverage with a broader exclusion with respect to coverage for child
			 abuse.
Statutory Authority:
				  RCW
				  48.02.060(3)(a). 86-18-043
				  (Order R 86-3), §
										284-78-100, filed
				  8/29/86.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-78 - Joint underwriting association for day care insurance › Section 284-78-110 - Renewal of policies

Current through Register Vol. 24-14, July 15, 2024
(1) Policies
			 written by the association will not automatically renew. To obtain continuing
			 coverage by the association, a licensee must again satisfy initial eligibility
			 requirements under WAC
			 284-78-090 at the end of the
			 expiring policy term.
(2) The
			 association shall notify covered licensees at least forty-five days prior to
			 the expiration of a policy term of the need to submit a new application for
			 coverage to the association to continue coverage.
(3) If the association fails to provide the
			 required notice, the existing policy shall continue in force until the
			 association has provided the required notice. In such case, premium shall be
			 charged the licensee on a pro rata basis for coverage during the extended
			 coverage period.
Statutory Authority:
				  RCW
				  48.02.060(3)(a). 86-18-043
				  (Order R 86-3), §
										284-78-110, filed
				  8/29/86.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-78 - Joint underwriting association for day care insurance › Section 284-78-120 - Cancellation of policies

Current through Register Vol. 24-14, July 15, 2024
(1) No
			 policy or binder issued pursuant to this chapter shall be cancelled except:
(a) For nonpayment of premium, in which case
			 cancellation of the policy shall be effected by providing ten days written
			 notice in advance of the date of cancellation. Payment to the association of
			 all premiums due, prior to the effective date of the cancellation, shall
			 continue coverage as if no cancellation notice had been issued; or
(b) With the prior written approval of the
			 commissioner upon the request of the board, for cause which would have been
			 grounds for refusal of coverage under WAC
			 284-78-090.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-78 - Joint underwriting association for day care insurance › Section 284-78-130 - Right of appeal

Current through Register Vol. 24-14, July 15, 2024
(1) Any applicant
			 or insured, currently licensed pursuant to
			 chapter
			 74.15 RCW, shall have a
			 right of appeal to the commissioner, including the right to appear personally
			 before the commissioner or his or her designee, if requested by the person
			 seeking appeal, from any decision by the board to deny, cancel, or nonrenew
			 coverage.
(2) Appeals to the
			 commissioner under this provision shall be handled in accordance with chapters
			 48.04 and 34.04 RCW.
Statutory Authority:
				  RCW
				  48.02.060(3)(a). 86-18-043
				  (Order R 86-3), §
										284-78-130, filed
				  8/29/86.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-78 - Joint underwriting association for day care insurance › Section 284-78-140 - Cooperation of producers

Current through Register Vol. 24-14, July 15, 2024
All licensed insurance agents and brokers shall provide full
				cooperation in carrying out the aims and the operation of the
				association.
Statutory Authority:
				  RCW
				  48.02.060(3)(a). 86-18-043
				  (Order R 86-3), §
										284-78-140, filed
				  8/29/86.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-78 - Joint underwriting association for day care insurance › Section 284-78-150 - Commissions

Current through Register Vol. 24-14, July 15, 2024
The association shall pay commissions as established by the
				board on policies issued pursuant to this chapter to the licensed agent or
				broker designated by the applicant.
Statutory Authority:
				  RCW
				  48.02.060(3)(a). 86-18-043
				  (Order R 86-3), §
										284-78-150, filed
				  8/29/86.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-78 - Joint underwriting association for day care insurance › Section 284-78-160 - Additional notice required

Current through Register Vol. 24-14, July 15, 2024
Any notice of cancellation or nonrenewal of day care insurance
				given by an insurer to a licensee potentially eligible for coverage through the
				association shall include or be accompanied by an explanation of the licensee's
				right and procedure to obtain insurance through the
				association.
Statutory Authority:
				  RCW
				  48.02.060(3)(a). 86-18-043
				  (Order R 86-3), §
										284-78-160, filed
				  8/29/86.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-78 - Joint underwriting association for day care insurance › Section 284-78-170 - Termination of association

Current through Register Vol. 24-14, July 15, 2024
The association shall have perpetual existence, subject to
				repeal or modification of this chapter.
Statutory Authority:
				  RCW
				  48.02.060(3)(a). 86-18-043
				  (Order R 86-3), §
										284-78-170, filed
				  8/29/86.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-78 - Joint underwriting association for day care insurance › Section 284-78-180 - Effective date

Current through Register Vol. 24-14, July 15, 2024
This chapter is effective July 1, 1986.
Statutory Authority:
				  RCW
				  48.02.060(3)(a). 86-18-043
				  (Order R 86-3), §
										284-78-180, filed
				  8/29/86.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-83 - Long-term care insurance rules › Section 284-83-005 - Applicability and scope

Current through Register Vol. 24-14, July 15, 2024
(1) Except as otherwise specifically provided, this chapter applies to all long-term care insurance policies delivered or issued for delivery in this state on or after January 1, 2009, including qualified long-term care policies and life insurance policies that accelerate benefits for long-term care. This chapter applies to insurance companies, fraternal benefit societies, health care service contractors, health maintenance organizations and all similar entities (collectively called "issuers" in this chapter).
(2) Some sections of this chapter apply only to qualified long-term care insurance policies, as provided for by the Health Insurance Portability and Accountability Act of 1996 and by Section  7702B(b) of the Internal Revenue Code of 1986, as amended.
(3) This chapter applies to policies delivered or issued for delivery in this state having indemnity benefits that are triggered by activities of daily living and sold as disability income insurance, if:
(a) The benefits of the disability income policy are dependent upon or vary in amount based on the receipt of long-term care services;
(b) The disability income policy is advertised, marketed or offered as insurance for long-term care services; or
(c) Benefits under the policy commence after the policyholder has reached Social Security's normal retirement age, unless the benefits are designed to replace lost income or pay for specific expenses other than long-term care services.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-83 - Long-term care insurance rules › Section 284-83-020 - Standards for policy provisions

Current through Register Vol. 24-14, July 15, 2024
The following standards for policy provisions apply to all long-term care insurance policies delivered or issued for delivery in this state.
(1) Renewability. The terms "guaranteed renewable" and "noncancellable" must not be used in any individual long-term care insurance policy or certificate without further explanatory language in accordance with the disclosure requirements of WAC 284-83-035.
(a) A policy or certificate issued to an individual must not contain renewal provisions other than "guaranteed renewable" or "noncancellable."
(b) The term "guaranteed renewable" may be used only if the insured has the right to continue the long-term care insurance in force by the timely payment of premiums, if the issuer has no unilateral right to make any change in any provision of the policy or rider while the insurance is in force, and the issuer cannot decline to renew, except that rates may be revised by the issuer on a class basis.
(c) The term "noncancellable" may be used only if the insured has the right to continue the long-term care insurance in force by the timely payment of premiums during which period the issuer has no right to unilaterally make any change in any provision of the insurance and has no right to unilaterally make any change in the premium rate.
(d) The term "level premium" may be used only if the issuer does not have the right to change the premium.
(e) In addition to the other requirements of this subsection, a qualified long-term care insurance policy or certificate must be guaranteed renewable, within the meaning of Section  7702B(b)(1)(C) of the Internal Revenue Code of 1986, as amended.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-83 - Long-term care insurance rules › Section 284-83-025 - Unintentional lapse

Current through Register Vol. 24-14, July 15, 2024
As a protection against unintentional lapse, each issuer
				offering long-term care insurance must comply with all of the following:
(1)
(a)
			 Notice before lapse or termination. No individual long-term care policy or
			 certificate may be issued until the issuer has received from the applicant
			 either a written designation of at least one person in addition to the
			 applicant to receive notice of lapse or termination of the policy or
			 certificate for nonpayment of premium, or a written waiver dated and signed by
			 the applicant electing not to designate additional persons to receive notice.
(i) The applicant has the right to designate
			 at least one person to receive the notice of termination, in addition to the
			 insured.
(ii) Designation does not
			 constitute acceptance of any liability on the third party for services provided
			 to the insured.
(iii) The form used
			 for the written designation must provide space clearly designated for listing
			 at least one person.
(iv) The
			 designation must include each person's full name and home address.
(v) If the applicant elects not to designate
			 an additional person, the waiver must state: "Protection against unintended
			 lapse. I understand that I have the right to designate at least one person
			 other than myself to receive notice of lapse or termination of this long-term
			 care insurance policy for nonpayment of premium. I understand that notice will
			 not be given until thirty days after a premium is due and unpaid. I elect NOT
			 to designate a person to receive this notice."
(vi) No less frequently than once every year
			 the issuer must notify the insured of the right to change this written
			 designation or to add a lapse designee, if the insured has not already
			 designated a lapse designee.
(A) Issuers must
			 print this notice in not less than twelve point type either:
(I) On the front side of the first page of
			 the billing statement; or
(II) On a
			 separate document that is not printed on the billing statement.
(B) If the insured has named a
			 lapse designee for the account, then the issuer must print on the notice the
			 name and contact information that the issuer has on record for the lapse
			 designee.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-83 - Long-term care insurance rules › Section 284-83-030 - Required disclosure provisions

Current through Register Vol. 24-14, July 15, 2024
(1) Renewability. Long-term care insurance policies must contain a renewability provision.
(a) The renewability provision must be appropriately captioned, must appear on the first page of the policy, and must clearly state that the coverage is guaranteed renewable or noncancellable. This provision does not apply to policies that do not contain a renewability provision, and under which the right to nonrenew is reserved solely to the policyholder, such as long-term care policies which are part of or combined with life insurance policies because life insurance policies generally do not contain renewability provisions.
(b) A long-term care insurance policy or certificate, other than one where the issuer does not have the right to change the premium, must include a statement that premium rates may change.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-83 - Long-term care insurance rules › Section 284-83-035 - Required disclosure of rating practices to consumers

Current through Register Vol. 24-14, July 15, 2024
(1)
(a)
			 Except as provided in (b) of this subsection, this section applies to any
			 long-term care policy or certificate issued for delivery in this state on or
			 after January 1, 2009.
(b)
			 Certificates issued on or after January 1, 2009, under a group long-term care
			 insurance policy as defined in
			 RCW
			  48.83.020(6)(a), that were
			 in force prior to January 1, 2009, the provisions of this section apply on the
			 policy anniversary first following January 1, 2009.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-83 - Long-term care insurance rules › Section 284-83-040 - Initial rate filing requirements

Current through Register Vol. 24-14, July 15, 2024
The issuer must provide the following information to the
				commissioner no fewer than thirty days prior to making a long-term care
				insurance form available for sale in this state:
(1) A copy of each disclosure document
			 required in WAC
			 284-83-035; and
(2) An actuarial certification consisting of
			 at least the following:
(a) A statement that
			 the initial premium rate schedule is sufficient to cover anticipated costs
			 under moderately adverse experience and that the premium rate schedule is
			 reasonably expected to be sustainable over the life of the form with no future
			 premium increases anticipated;
(b)
			 A statement that the policy design and coverage provided have been reviewed and
			 taken into consideration;
(c) A
			 statement that the underwriting and claims adjudication processes have been
			 reviewed and taken into consideration;
(d) A complete description of the basis for
			 policy reserves that are anticipated to be held under the form, including:
(i) Sufficient detail or sample calculations
			 provided so as to have a complete depiction of the reserve amounts to be
			 held;
(ii) A statement that the
			 assumptions used for reserves contain reasonable margins for adverse
			 experience;
(iii) A statement that
			 the net valuation premium for renewal years does not increase (except for
			 attained-age rating, where permitted); and
(iv) A statement that the difference between
			 the gross premium and the net valuation premium for renewal years is sufficient
			 to cover expected renewal expenses; or, if such a statement cannot be made, a
			 complete description of the situations where this does not occur;
(A) An aggregate distribution of anticipated
			 issues may be used as long as the underlying gross premiums maintain a
			 reasonably consistent relationship;
(B) If the gross premiums for certain age
			 groups appear to be inconsistent with this requirement, the commissioner may
			 request a demonstration based on a standard age distribution; and
(e)
(i) A statement that the premium rate
			 schedule is not less than the premium rate schedule for existing similar policy
			 forms also available from the issuer except for reasonable differences
			 attributable to benefits; or
(ii) A
			 comparison of the premium schedules for similar policy forms that are currently
			 available from the issuer with an explanation of the differences.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-83 - Long-term care insurance rules › Section 284-83-045 - Prohibition against post-claims underwriting

Current through Register Vol. 24-14, July 15, 2024
(1) All applications for long-term care
			 insurance policies or certificates except those that are guaranteed issue must
			 contain clear and unambiguous questions designed to ascertain the health
			 condition of the applicant.
(2)
(a) If an application for long-term care
			 insurance includes a question that asks whether the applicant has had
			 medication prescribed by a physician, it must also ask the applicant to list
			 the prescribed medications.
(b) If
			 the medications listed in the application were known by the issuer, or should
			 have been known by the issuer at the time of application, to be directly
			 related to a medical condition for which coverage would otherwise be denied,
			 then the policy or certificate cannot be rescinded based on that
			 condition.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-83 - Long-term care insurance rules › Section 284-83-050 - Minimum standards for home health and community care benefits in long-term care insurance policies

Current through Register Vol. 24-14, July 15, 2024
(1) If a long-term care insurance policy or
			 certificate provides benefits for home health care or community care services,
			 it must not limit or exclude benefits:
(a) By
			 requiring that the insured or claimant would need care in a nursing facility if
			 home health care services were not provided;
(b) By requiring that the insured or claimant
			 first or simultaneously receive nursing or therapeutic services, or both, in a
			 home, community, or institutional setting before home health care services are
			 covered;
(c) By limiting eligible
			 services to services provided by registered nurses or licensed practical
			 nurses;
(d) By requiring that a
			 nurse or therapist provide services covered under the policy that can be
			 provided by a home health aide or other licensed or certified home care worker
			 acting within the scope of his or her licensure or certification;
(e) By excluding coverage for personal care
			 services provided by a home health aide;
(f) By requiring that the provision of home
			 health care services be at a level of certification or licensure greater than
			 that required by the eligible service;
(g) By requiring that the insured or claimant
			 have an acute condition before home health care services are covered;
(h) By limiting benefits to services provided
			 by medicare-certified agencies or providers; or
(i) By excluding coverage for adult day care
			 services.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-83 - Long-term care insurance rules › Section 284-83-055 - Requirement to offer inflation protection

Current through Register Vol. 24-14, July 15, 2024
(1) No issuer may offer a long-term care
			 insurance policy in this state unless the issuer also offers to the
			 policyholder, in addition to any other inflation protection, the option to
			 purchase a policy that provides for benefit levels to increase with benefit
			 maximums or reasonable durations which are meaningful to account for reasonably
			 anticipated increases in the costs of long-term care services covered by the
			 policy. Issuers must offer to each policyholder, at the time of purchase, the
			 option to purchase a policy with an inflation protection feature no less
			 favorable than one of the following:
(a)
			 Increases benefit levels annually in a manner so that the increases are
			 compounded annually at a rate of not less than five percent.
(b) Guarantees the insured individual the
			 right to periodically increase benefit levels without providing evidence of
			 insurability or health status so long as the option for the previous period has
			 not been declined. The amount of the additional benefit must be no less than
			 the difference between the existing policy benefit and that benefit compounded
			 annually at a rate of at least five percent for the period beginning with the
			 purchase of the existing benefit and extending until the year in which the
			 offer is made.
(c) Covers a
			 specified percentage of actual or reasonable charges and does not include a
			 maximum specified indemnity amount or limit.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-83 - Long-term care insurance rules › Section 284-83-060 - Requirements for application forms and replacement coverage

Current through Register Vol. 24-14, July 15, 2024
(1) Application
			 forms must include questions designed to elicit information as to whether, as
			 of the date of the application, the applicant has another long-term care
			 insurance policy or certificate in force or whether a long-term care policy or
			 certificate is intended to replace any other health or long-term care policy or
			 certificate presently in force.
(a) A
			 supplementary application or other form, signed by the applicant and insurance
			 producer, except where the coverage is sold without an insurance producer,
			 containing the questions may be used. With regard to a replacement policy
			 issued to a group defined by
			 RCW
			  48.83.020(6)(a), the
			 required questions may be modified only to the extent necessary to elicit
			 information about health or long-term care insurance policies other than the
			 group policy being replaced, provided that the certificate holder has been
			 notified of the replacement.
(b)
			 The following questions, or words substantially similar to the following, must
			 be used:
(i) "Do you have another long-term
			 care insurance policy or certificate in force (including health care service
			 contract, health maintenance organization contract)?
(ii) Did you have another long-term care
			 insurance policy or certificate in force during the last twelve months? If so,
			 with which company? If that policy lapsed, when did it lapse?
(iii) Are you covered by medicaid?
(iv) Do you intend to replace any of your
			 medical or health insurance coverage with this policy [certificate]?"
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-83 - Long-term care insurance rules › Section 284-83-070 - Reporting requirements

Current through Register Vol. 24-14, July 15, 2024
(1)
			 Every issuer must maintain records for each insurance producer of that
			 producer's amount of replacement sales as a percent of the insurance producer's
			 total annual sales and the amount of lapses of long-term care insurance
			 policies sold by the insurance producer as a percent of the insurance
			 producer's total annual sales.
(2)
			 Every issuer must report annually by June 30 the ten percent of its insurance
			 producers with the highest percentages of lapses and replacements as measured
			 by subsection (1) of this section on the form set forth in WAC
			 284-83-195.
(3) Reported replacement and lapse rates do
			 not alone constitute a violation of insurance laws or necessarily imply
			 wrongdoing. The reports are for the purpose of reviewing more closely insurance
			 producer activities regarding the sale of long-term care insurance.
(4) Every issuer must report annually by June
			 30 the number of lapsed policies as a percent of its total annual sales and as
			 a percent of its total number of policies in force as of the end of the
			 preceding calendar year on the form set forth in WAC
			 284-83-195.
(5) Every issuer must report annually by June
			 30 the number of replacement policies sold as a percent of its total annual
			 sales and as a percent of its total number of policies in force as of the
			 preceding calendar year on the form set forth in WAC
			 284-83-195.
(6) Every issuer must report annually by June
			 30, for qualified long-term care insurance policies, the number of claims
			 denied for each class of business, expressed as a percentage of claims denied
			 on the form set forth in WAC
			 284-83-185.
(7) As used in this section:
(a) "Policy" refers only to long-term care
			 insurance policies;
(b) "Claim"
			 means a request for payment of benefits under an in-force policy regardless of
			 whether the benefit claimed is covered under the policy or any terms or
			 conditions of the policy have been met;
(c) "Denied" means that the issuer refuses to
			 pay a claim for any reason other than for claims not paid for failure to meet
			 the waiting period or because of an applicable preexisting condition;
			 and
(d) "Report" means on a
			 statewide basis.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-83 - Long-term care insurance rules › Section 284-83-075 - Discretionary powers of commissioner

Current through Register Vol. 24-14, July 15, 2024
Upon written request and after an administrative hearing, the
				commissioner may enter an order to modify or suspend a specific provision or
				provisions of this chapter with respect to a specific long-term care insurance
				policy or certificate upon a written finding that:
(1) The modification or suspension would be
			 in the best interest of the insureds;
(2) The purposes to be achieved could not be
			 effectively or efficiently achieved without the modification or suspension;
			 and
(3)
(a) The modification or suspension is
			 necessary to the development of an innovative and reasonable approach for
			 insuring long-term care; or
(b) The
			 policy or certificate is to be issued to residents of a life care or continuing
			 care retirement community or some other residential community for the elderly
			 and the modification or suspension is reasonably related to the special needs
			 or nature of such a community; or
(c) The modification or suspension is
			 necessary to permit long-term care insurance to be sold as part of, or in
			 conjunction with, another insurance product.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-83 - Long-term care insurance rules › Section 284-83-080 - Reserve standards

Current through Register Vol. 24-14, July 15, 2024
(1) If long-term
			 care benefits are provided through the acceleration of benefits under group or
			 individual life policies or riders to such policies, policy reserves for the
			 benefits must be determined in accordance with
			 RCW
			  48.74.030(1)(g). Claim
			 reserves must also be established in the case when the policy or rider is in
			 claim status. Reserves for policies and riders subject to this subsection
			 should be based on the multiple decrement model utilizing all relevant
			 decrements except for voluntary termination rates. Single decrement
			 approximations are acceptable if the calculation produces essentially similar
			 reserves, if the reserve is clearly more conservative, or if the reserve is
			 immaterial. The calculations may take into account the reduction in life
			 insurance benefits due to the payment of long-term care benefits; however, in
			 no event shall the reserves for the long-term care benefit and the life
			 insurance benefit be less than the reserves for the life insurance benefit
			 assuming no long-term care benefit. In the development and calculation of
			 reserves for policies and riders subject to this subsection, due regard must be
			 given to the applicable policy provisions, marketing methods, administrative
			 procedures and all other considerations which have an impact on projected claim
			 costs, including, but not limited to, the following:
(a) Definition of insured events;
(b) Covered long-term care
			 facilities;
(c) Existence of home
			 convalescence care coverage;
(d)
			 Definition of facilities;
(e)
			 Existence or absence of barriers to eligibility;
(f) Premium waiver provision;
(g) Renewability;
(h) Ability to raise premiums;
(i) Marketing method;
(j) Underwriting procedures;
(k) Claims adjustment procedures;
(l) Waiting period;
(m) Maximum benefit;
(n) Availability of eligible
			 facilities;
(o) Margins in claim
			 costs;
(p) Optional nature of
			 benefit;
(q) Delay in eligibility
			 for benefit;
(r) Inflation
			 protection provisions; and
(s)
			 Guaranteed insurability option.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-83 - Long-term care insurance rules › Section 284-83-090 - Premium rate schedule increases

Current through Register Vol. 24-14, July 15, 2024
(1)
(a)
			 Except as provided in (b) of this subsection, this section applies to any
			 long-term care policy or certificate issued in this state on or after January
			 1, 2009.
(b) For certificates
			 issued on or after January 1, 2009, under a group long-term care insurance
			 policy as defined in
			 RCW
			  48.83.020(6)(a), which
			 policy was in force before January 1, 2009, the provisions of this section
			 apply on the first policy anniversary following January 1, 2009.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-83 - Long-term care insurance rules › Section 284-83-095 - Filing requirements

Current through Register Vol. 24-14, July 15, 2024
Prior to offering group long-term care insurance to a resident
				of this state pursuant to RCW  48.83.030, the issuer or similar organization
				must file with the commissioner evidence that the group policy or certificate
				has been approved by a state having statutory or regulatory long-term care
				insurance requirements substantially similar to those of this
				state.
Statutory Authority:
				  RCW
				  48.02.060,
				  48.83.070,
				  48.83.110,
				  48.83.120,
				  48.83.130(1), and
				  48.83.140(4)(a).
				  08-24-019 (Matter No. R 2008-09), §
										284-83-095, filed 11/24/08,
				  effective 12/25/08.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-83 - Long-term care insurance rules › Section 284-83-100 - Filing requirements for advertising

Current through Register Vol. 24-14, July 15, 2024
(1) Every issuer or other entity issuing
			 long-term care insurance in this state must provide a copy of any long-term
			 care insurance advertisement intended for use in this state whether through
			 written, radio or television medium for review by the commissioner. In
			 addition, a copy of all advertisements must be retained by the issuer for at
			 least three years after the date the advertisement was first used.
(2) The commissioner may exempt from these
			 requirements any advertising form or material when, in the commissioner's
			 opinion, this requirement may not be reasonably applied.
Statutory Authority:
				  RCW
				  48.02.060,
				  48.83.070,
				  48.83.110,
				  48.83.120,
				  48.83.130(1), and
				  48.83.140(4)(a).
				  08-24-019 (Matter No. R 2008-09), §
										284-83-100, filed 11/24/08,
				  effective 12/25/08.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-83 - Long-term care insurance rules › Section 284-83-105 - Standards for marketing

Current through Register Vol. 24-14, July 15, 2024
(1)
			 Every issuer or entity marketing long-term care insurance coverage in this
			 state, directly or through its insurance producers, must:
(a) Establish marketing procedures and
			 insurance producer training requirements to ensure that:
(i) Any marketing activities, including any
			 comparison of policies, by its insurance producers, other representatives, or
			 employees are fair and accurate; and
(ii) Excessive insurance is not sold or
			 issued.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-83 - Long-term care insurance rules › Section 284-83-110 - Suitability

Current through Register Vol. 24-14, July 15, 2024
(1) This section
			 does not apply to life insurance policies that accelerate benefits for
			 long-term care.
(2) Every issuer or
			 other entity marketing long-term care insurance must:
(a) Develop and use suitability standards to
			 determine whether the purchase or replacement of long-term care insurance is
			 appropriate for the needs of the applicant;
(b) Train its insurance producers in the use
			 of its suitability standards; and
(c) Maintain a copy of its suitability
			 standards and make it available for inspection upon request by the
			 commissioner.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-83 - Long-term care insurance rules › Section 284-83-115 - Prohibition against preexisting conditions and probationary periods in replacement policies or certificates

Current through Register Vol. 24-14, July 15, 2024
If a long-term care insurance policy or certificate replaces
				another long-term care policy or certificate, the replacing issuer must waive
				any time periods applicable to preexisting conditions and probationary periods
				in the new long-term care policy for similar benefits to the extent that
				similar exclusions have been satisfied under the original
				policy.
Statutory Authority:
				  RCW
				  48.02.060,
				  48.83.070,
				  48.83.110,
				  48.83.120,
				  48.83.130(1), and
				  48.83.140(4)(a).
				  08-24-019 (Matter No. R 2008-09), §
										284-83-115, filed 11/24/08,
				  effective 12/25/08.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-83 - Long-term care insurance rules › Section 284-83-120 - Availability of new services or providers

Current through Register Vol. 24-14, July 15, 2024
(1) The issuer must notify policyholders of
			 the availability of a new long-term policy series that provides coverage for
			 new long-term care services or providers material in nature and not previously
			 available through the issuer to the general public. The notice must be provided
			 within twelve months after the date the new policy series is made available for
			 sale in this state. Changes to policy structure or benefits or provisions that
			 are minor in nature are not "new long-term care services or providers material
			 in nature." Examples of when notification need not be provided include changes
			 in elimination periods, benefit periods or benefit amounts.
(2) Notwithstanding subsection (1) of this
			 section, notification is not required for any long-term care insurance policy
			 issued prior to January 1, 2009, or to any policyholder or certificate holder
			 who is currently eligible for benefits, within an elimination period or on a
			 claim, previously had been in claim status, or who would not be eligible to
			 apply for coverage due to issue age limitations under the new policy series.
			 The issuer may require that policyholders meet all eligibility requirements,
			 including underwriting and payment of the required premium in order to add the
			 new services or providers.
(3) The
			 issuer must make the new coverage available in one of the following ways:
(a) By adding a rider to the existing policy
			 and charging a separate premium for the new rider based on the insured's
			 attained age;
(b) By exchanging the
			 existing policy or certificate for one with an issue age based on the attained
			 age of the insured and recognizing past insured status by granting premium
			 credits toward the premiums for the new policy or certificate. The premium
			 credits must be based on premiums paid or reserves held for the prior policy or
			 certificate;
(c) By exchanging the
			 existing policy or certificate for a new policy or certificate in which
			 consideration for past insured status is recognized by setting the premium for
			 the new policy or certificate at the issue age of the policy or certificate
			 being exchanged. The cost for the new policy or certificate may recognize the
			 difference in reserves between the new policy or certificate and the original
			 policy or certificate; or
(d) By an
			 alternative program developed by the issuer that meets the intent of this
			 section if the program is filed with and approved by the
			 commissioner.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-83 - Long-term care insurance rules › Section 284-83-125 - Right to reduce coverage and lower premiums

Current through Register Vol. 24-14, July 15, 2024
(1)
(a)
			 Every long-term care insurance policy and certificate must include a provision
			 that allows the policyholder or certificate holder to reduce coverage and lower
			 the policy or certificate premium in at least one of the following ways:
(i) Reducing the maximum benefit;
			 or
(ii) Reducing the daily, weekly
			 or monthly benefit amount.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-83 - Long-term care insurance rules › Section 284-83-130 - Nonforfeiture benefit requirement

Current through Register Vol. 24-14, July 15, 2024
(1) This section does not apply to life
			 insurance policies or riders containing accelerated long-term care
			 benefits.
(2) To comply with the
			 requirement to offer a nonforfeiture benefit pursuant to the provisions of
			 RCW
			  48.83.120:
(a) A policy or certificate offered with
			 nonforfeiture benefits must have coverage elements, eligibility, benefit
			 triggers and benefit length that are the same as coverage issued by the issuer
			 without nonforfeiture benefits. The nonforfeiture benefit included in the offer
			 must be the benefit described in subsection (5) of this section; and
(b) The offer must be in writing if the
			 nonforfeiture benefit is not otherwise described in the outline of coverage or
			 other materials given to the prospective policyholder.