reglab/statecodes huggingface dataset:
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-49 - Washington basic coverage policy (small group) insurance regulation › Section 284-49-010 - Reservation of chapter

Current through Register Vol. 24-14, July 15, 2024
Chapter 284-49 WAC is reserved for future small group health
				regulations.
Statutory Authority:
				  RCW
				  48.02.060,
				  48.18.110,
				  48.44.020,
				  48.44.050,
				  48.46.060,
				  48.46.200. 05-02-074 (Matter No. R
				  2004-07), §
										284-49-010, filed 1/4/05,
				  effective 2/4/05. Statutory Authority:
				  RCW
				   48.02.060 [(3)](a), 48.18.110(2),48.44.020
				  (2)(d), 48.44.050, 48.46.060 (3)(d), 48.46.200 and 1990 c 187. 90-18-076 (Order
				  90-10), §
										284-49-010, filed 9/4/90,
				  effective 10/5/90.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-50 - Washington disability insurance regulations › ADVERTISING › Section 284-50-010 - Title and purpose

Current through Register Vol. 24-14, July 15, 2024
(1) This
				regulation, WAC
				284-50-010 through
				284-50-230, shall be known and
				may be cited as the "Washington disability insurance advertising
				regulation."
(2) The purpose of
				this regulation is to assure truthful and adequate disclosure of all material
				and relevant information in the advertising of disability insurance (as defined
				in RCW
				 48.11.030), health care service contractors'
				agreements (as defined in
				RCW
				 48.44.020), and health maintenance
				agreements (as defined in
				RCW
				 48.46.020). This purpose is intended to be
				accomplished by the establishment of, and adherence to, certain minimum
				standards and guidelines of conduct in the advertising of disability insurance
				and health care agreements in a manner which prevents unfair competition among
				insurers and is conducive to the accurate presentation and description to the
				insurance buying public of a policy or agreement of such insurance offered
				through various advertising media.
				RCW
				 48.30.040,
				48.44.110 and
				48.46.130 prohibit false,
				deceptive or misleading advertising in the conduct of the business of insurance
				and in the conduct of the business of a health care service contractor and a
				health maintenance organization. Because those statutes establish only general
				standards, this regulation establishes specific standards for advertisements
				relating to individual, group, blanket, and franchise disability, insurance and
				individual and group health care service contractors' agreements and health
				maintenance agreements.
Order R-76-2, §
											284-50-010, filed 3/4/76; Order
					 R-73-1, §
											284-50-010, filed 2/28/73,
					 effective 4/1/73.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-50 - Washington disability insurance regulations › ADVERTISING › Section 284-50-020 - Applicability

Current through Register Vol. 24-14, July 15, 2024
(1) These rules
				shall apply to every "advertisement," as that term is hereinafter defined, in
				WAC 284-50-030, subsections (1), (7),
				(8) and (9), unless otherwise specified in these rules, intended for
				presentation distribution, or dissemination in this state when such
				presentation, distribution, or dissemination is made either directly or
				indirectly by or on behalf of an insurer, or insurance producer as those terms
				are defined in the insurance code of this state and these rules.
(2) Every insurer shall establish and at all
				times maintain a system of control over the content, form, and method of
				dissemination of all advertisements of its policies. All such advertisements,
				regardless of by whom written, created, designed, or presented, shall be the
				responsibility of the insurer for whom such advertisements are
				prepared.
Statutory Authority:
					 RCW
					 48.02.060(3)(a) and
					 48.17.010(5).
					 11-01-159 (Matter No. R 2010-09), §
											284-50-020, filed 12/22/10,
					 effective 1/22/11; Order R-76-2, §
											284-50-020, filed 3/4/76; Order
					 R-73-1, §
											284-50-020, filed 2/28/73,
					 effective 4/1/73.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-50 - Washington disability insurance regulations › ADVERTISING › Section 284-50-030 - Definitions

Current through Register Vol. 24-14, July 15, 2024
(1) An
				advertisement for the purpose of these rules shall include:
(a) Printed and published material, audio
				visual material, and descriptive literature of an insurer used in direct mail,
				newspapers, magazines, radio scripts, television scripts, billboards, and
				similar displays; and
(b)
				Descriptive literature and sales aids of all kinds issued by an insurer, or
				insurance producer for presentation to members of the insurance buying public,
				including but not limited to circulars, leaflets, booklets, depictions,
				illustrations, and form letters; and
(c) Prepared sales talks, presentations, and
				material for use by insurance producers.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-50 - Washington disability insurance regulations › ADVERTISING › Section 284-50-040 - Method of disclosure of required information

Current through Register Vol. 24-14, July 15, 2024
All information required to be disclosed by these rules shall
				  be set out conspicuously and in close conjunction with the statement to which
				  such information relates or under appropriate captions of such prominence that
				  it shall not be minimized, rendered obscure, or presented in an ambiguous
				  fashion or intermingled with the context of the advertisement so as to be
				  confusing or misleading.
Order R-73-1, §
											284-50-040, filed 2/28/73,
					 effective 4/1/73.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-50 - Washington disability insurance regulations › ADVERTISING › Section 284-50-050 - Form and content of advertisements

Current through Register Vol. 24-14, July 15, 2024
(1) The format and content of an
				advertisement to which these rules apply shall be sufficiently complete and
				clear to avoid deception or the capacity or tendency to mislead or deceive.
				Whether an advertisement has a capacity or tendency to mislead or deceive shall
				be determined by the insurance commissioner from the overall impression that
				the advertisement may be reasonably expected to create upon a person of average
				education or intelligence, within the segment of the public to which it is
				directed.
(2) Advertisements shall
				be truthful and not misleading in fact or in implication. Words or phrases, the
				meaning of which is clear only by implication or by familiarity with insurance
				terminology, shall not be used.
Order R-73-1, §
											284-50-050, filed 2/28/73,
					 effective 4/1/73.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-50 - Washington disability insurance regulations › ADVERTISING › Section 284-50-070 - Exceptions, reductions, and limitations to be disclosed

Current through Register Vol. 24-14, July 15, 2024
(1) When an advertisement which is an
				invitation to contract refers to either a dollar amount, or a period of time
				for which any benefit is payable, or the cost of the policy, or specific policy
				benefit, or the loss for which such benefit is payable, it shall also disclose
				those exceptions, reductions, and limitations affecting the basic provisions of
				the policy without which the advertisement would have the capacity or tendency
				to mislead or deceive.
(2) When a
				policy contains a waiting, elimination, probationary, or similar time period
				between the effective date of the policy and the effective date of coverage
				under the policy or a time period between the date a loss occurs and the date
				benefits begin to accrue for such loss, an advertisement which is subject to
				the requirements of the preceding subsection (1) shall disclose the existence
				of such periods.
(3) An
				advertisement shall not use the words "only"; "just"; "merely"; "minimum"; or
				similar words or phrases to deceptively describe or unfairly minimize the
				applicability of any exceptions and reductions contained in the policy
				advertised.
(4) When a policy
				contains a provision permitted by
				RCW
				 48.20.192,
				48.20.202, or
				48.20.212 (Optional standard
				provisions No. 15, 16, and 17), an advertisement which is subject to the
				requirements of WAC
				284-50-070(1)
				 shall disclose clearly the effect of such provisions.
Order R-76-2, §
											284-50-070, filed 3/4/76; Order
					 R-73-1, §
											284-50-070, filed 2/28/73,
					 effective 4/1/73.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-50 - Washington disability insurance regulations › ADVERTISING › Section 284-50-080 - Preexisting conditions

Current through Register Vol. 24-14, July 15, 2024
(1) An
				advertisement which is subject to the requirements of WAC
				284-50-070 shall, in negative
				terms, disclose the extent to which any loss is traceable to a condition
				existing prior to the effective date of the policy. The use of the term
				"preexisting condition" without an appropriate definition or description shall
				not be used.
(2) When a policy does
				not cover losses resulting from preexisting conditions, no advertisement of the
				policy shall state or imply that the applicant's physical condition or medical
				history will not affect the issuance of the policy or payment of a claim
				thereunder. This rule prohibits the use of the phrase "no medical examination
				required" and phrases of similar import, but does not prohibit explaining
				"automatic issue." If an insurer requires a medical examination for a specified
				policy, the advertisement if it is an invitation to contract shall disclose
				that a medical examination is required.
(3) When an advertisement contains an
				application form to be completed by the applicant and returned by mail for a
				direct response insurance product, such application form shall contain a
				question requiring a response by the applicant or a statement in prominent
				type, all in capital letters, which reflects the preexisting condition
				provisions of the policy immediately preceding the blank space for the
				applicant's signature. For example, such an application form shall contain a
				question substantially as follows:
"Do you understand that this policy will not pay
								benefits during the first . . . . year(s) after the issue date for a disease or
								physical condition which you now have or have had in the past?" [] YES
Or a statement in prominent type, all capitalized,
				  substantially as follows:
"I UNDERSTAND THAT THE POLICY APPLIED FOR WILL NOT PAY
				  BENEFITS FOR ANY LOSS INCURRED DURING THE FIRST . . . . YEAR(S) AFTER THE ISSUE
				  DATE ON ACCOUNT OF DISEASE OR PHYSICAL CONDITION WHICH I NOW HAVE OR HAVE HAD
				  IN THE PAST."
Order R-76-2, §
											284-50-080, filed 3/4/76; Order
					 R-73-1, §
											284-50-080, filed 2/28/73,
					 effective 4/1/73.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-50 - Washington disability insurance regulations › ADVERTISING › Section 284-50-090 - Disclosure of provisions relating to renewability, cancellability, and termination

Current through Register Vol. 24-14, July 15, 2024
When an advertisement which is an invitation to contract
				  refers to either a dollar amount or a period of time for which any benefit is
				  payable, or the cost of the policy, or specific policy benefit, or the loss for
				  which such benefit is payable, it shall disclose the provisions relating to
				  renewability, cancellability, and termination and any modification of benefits,
				  losses covered, or premiums because of age or for other reasons, in a manner
				  which shall not minimize or render obscure the qualifying
				  conditions.
Order R-76-2, §
											284-50-090, filed 3/4/76; Order
					 R-73-1, §
											284-50-090, filed 2/28/73,
					 effective 4/1/73.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-50 - Washington disability insurance regulations › ADVERTISING › Section 284-50-100 - Testimonials or endorsements by third parties

Current through Register Vol. 24-14, July 15, 2024
(1) Testimonials used in advertisements must
				be genuine, represent the current opinion of the author, be applicable to the
				policy advertised, and be accurately reproduced. The insurer, in using a
				testimonial, makes as its own all of the statements contained therein, and the
				advertisement, including such statement is subject to all the provisions of
				these rules.
(2) If the person
				making a testimonial, an endorsement, or an appraisal has a financial interest
				in the insurer or a related entity as a stockholder, director, officer,
				employee, or otherwise, such fact shall be disclosed in the advertisement. If a
				person is compensated for making a testimonial, endorsement, or appraisal, such
				fact shall be disclosed in the advertisement by language substantially as
				follows: "Paid endorsement." This rule does not require disclosure of union
				"scale" wages required by union rules if the payment is actually for such
				"scale" for television or radio performance. The payment of substantial
				amounts, directly or indirectly for "travel and entertainment" for filming or
				recording of television or radio advertisements removes the filming or
				recording from the category of an unsolicited testimonial and requires
				disclosure of such compensation. This subsection (2) does not apply to an
				institutional advertisement which has as its sole purpose the promotion of the
				insurer.
(3) An advertisement shall
				not state or imply that any insurer or a policy has been approved or endorsed
				by an individual, group of individuals, society, association, or other
				organizations, unless such is the fact, and unless any proprietary relationship
				between an organization and the insurer is disclosed. If the entity making the
				endorsement or testimonial has been formed by the insurer or is owned or
				controlled by the insurer or the person or persons who own or control the
				insurer, such fact shall be disclosed in the advertisement.
(4) When a testimonial refers to benefits
				received under a policy, the specific claim data, including claim number, date
				of loss, and other pertinent information shall be retained by the insurer for
				inspection for a period of four years or until the filing of the next regular
				report on examination of the insurer, whichever is the longer period of
				time.
Order R-76-2, §
											284-50-100, filed 3/4/76; Order
					 R-73-1, §
											284-50-100, filed 2/28/73,
					 effective 4/1/73.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-50 - Washington disability insurance regulations › ADVERTISING › Section 284-50-110 - Use of statistics

Current through Register Vol. 24-14, July 15, 2024
(1) An
				advertisement relating to the dollar amounts of claims paid, the number of
				persons insured, or similar statistical information relating to any insurer or
				policy shall not use irrelevant facts, and shall not be used unless it
				accurately reflects all of the relevant facts. Such an advertisement shall not
				imply that such statistics are derived from the policy advertised unless such
				is the fact, and when applicable to other policies or plans shall specifically
				so state.
(2) An advertisement
				shall not represent or imply that claim settlements by the insurer are
				"liberal" or "generous," or use words of similar import, or that claim
				settlements are or will be beyond the actual terms of the contract. An unusual
				amount paid for an uncommon claim for the policy advertised is misleading and
				shall not be used.
(3) The source
				of any statistics used in an advertisement shall be identified in such
				advertisement.
Order R-73-1, §
											284-50-110, filed 2/28/73,
					 effective 4/1/73.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-50 - Washington disability insurance regulations › ADVERTISING › Section 284-50-120 - Identification of plan or number of policies

Current through Register Vol. 24-14, July 15, 2024
(1) When a choice of the amount of benefits
				is referred to, an advertisement which is an invitation to contract shall
				disclose that the amount of benefits provided depends upon the plan selected
				and that the premium will vary with the amount of the benefits
				selected.
(2) When an advertisement
				which is an invitation to contract refers to various benefits which may be
				contained in two or more policies, other than group master policies, the
				advertisement shall disclose that such benefits are provided only through a
				combination of such policies.
Order R-76-2, §
											284-50-120, filed 3/4/76; Order
					 R-73-1, §
											284-50-120, filed 2/28/73,
					 effective 4/1/73.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-50 - Washington disability insurance regulations › ADVERTISING › Section 284-50-130 - Disparaging comparisons and statements

Current through Register Vol. 24-14, July 15, 2024
An advertisement shall not directly or indirectly make unfair
				  or incomplete comparisons of policies or benefits or comparisons of
				  non-comparable policies of other insurers, and shall not disparage competitors,
				  their policies, services, or business methods, and shall not disparage or
				  unfairly minimize competing methods of marketing insurance.
Order R-73-1, §
											284-50-130, filed 2/28/73,
					 effective 4/1/73.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-50 - Washington disability insurance regulations › ADVERTISING › Section 284-50-140 - Jurisdictional licensing and status of insurer

Current through Register Vol. 24-14, July 15, 2024
(1) An advertisement which reasonably is
				expected to be seen or heard beyond the limits of the jurisdiction in which the
				insurer is licensed shall not imply licensing beyond those limits.
(2) An advertisement shall not create the
				impression directly or indirectly that the insurer, its financial condition or
				status, or the payment of its claims, or the merits, desirability, or
				advisability of its policy forms or kinds or plans of insurance are approved,
				endorsed, or accredited by any division or agency of this state or the United
				States government.
Order R-73-1, §
											284-50-140, filed 2/28/73,
					 effective 4/1/73.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-50 - Washington disability insurance regulations › ADVERTISING › Section 284-50-150 - Identity of insurer

Current through Register Vol. 24-14, July 15, 2024
(1) The full
				legal name (and, where required by
				RCW
				 48.30.050, the home office) of the actual
				insurer shall be shown in each advertisement. The form number or numbers of any
				specific policy or policies advertised shall be stated in each advertisement
				which is an invitation to contract. An advertisement shall not use a trade
				name, any insurance group designation, name of the parent company of the
				insurer, name of a particular division of the insurer, service mark, slogan,
				symbol, or other device in a manner which would have the capacity and tendency
				to mislead or deceive as to the true identity of the insurer.
(2) No advertisement shall use any
				combination of words, symbols, or physical materials which by their content,
				phraseology, shape, color, or other characteristics are so similar to
				combination of words, symbols, or physical materials, used by agencies of the
				federal government or of this state, or otherwise appear to be of such a nature
				that it tends to confuse or mislead prospective insureds into believing that
				the solicitation is in some manner connected with an agency of the municipal,
				state, or federal government.
Order R-76-2, §
											284-50-150, filed 3/4/76; Order
					 R-73-1, §
											284-50-150, filed 2/28/73,
					 effective 4/1/73.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-50 - Washington disability insurance regulations › ADVERTISING › Section 284-50-160 - Group or quasi-group implications

Current through Register Vol. 24-14, July 15, 2024
An advertisement of a particular policy shall not state or
				  imply that prospective insureds become group or quasi-group members covered
				  under a group policy and as such enjoy special rates or underwriting
				  privileges, unless such is the fact.
Order R-73-1, §
											284-50-160, filed 2/28/73,
					 effective 4/1/73.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-50 - Washington disability insurance regulations › ADVERTISING › Section 284-50-180 - Reduced initial premium rates

Current through Register Vol. 24-14, July 15, 2024
An advertisement shall not offer a policy which utilizes a
				  reduced initial premium rate in a manner which over-emphasizes the availability
				  and the amount of the initial reduced premium. When an insurer charges an
				  initial premium that differs in amount from the amount of the renewal premium
				  payable on the same mode, the advertisement shall not display the amount of the
				  reduced initial premium either more frequently or more prominently than the
				  renewal premium, and both the initial reduced premium and the renewal premium
				  must be stated in juxtaposition in each portion of the advertisement where the
				  initial reduced premium appears.
Order R-73-1, §
											284-50-180, filed 2/28/73,
					 effective 4/1/73.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-50 - Washington disability insurance regulations › ADVERTISING › Section 284-50-190 - Statements about an insurer

Current through Register Vol. 24-14, July 15, 2024
An advertisement shall not contain statements which are
				  untrue in fact, or by implication misleading, with respect to the assets,
				  corporate structure, financial standing, age, or relative position of the
				  insurer in the insurance business. An advertisement shall not contain a
				  recommendation by any commercial rating system unless it clearly indicates the
				  purpose of the recommendation and the limitations of the scope and extent of
				  the recommendation.
Order R-73-1, §
											284-50-190, filed 2/28/73,
					 effective 4/1/73.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-50 - Washington disability insurance regulations › ADVERTISING › Section 284-50-200 - Advertising file to be maintained

Current through Register Vol. 24-14, July 15, 2024
Each insurer shall maintain at its home or principal office a
				  complete file containing every printed, published, or prepared advertisement of
				  its individual policies and typical printed, published, or prepared
				  advertisements of its blanket, franchise, and group policies hereafter
				  disseminated in this or any other state whether or not licensed in such state,
				  with a notation attached to each such advertisement which shall indicate the
				  manner and extent of distribution and the form number of any policy advertised.
				  Such file shall be subject to regular and periodical inspection by the
				  insurance commissioner. All such advertisements shall be maintained in said
				  file for a period of either four years or until the filing of the next regular
				  report on examination of the insurer, whichever is the longer period of
				  time.
Order R-73-1, §
											284-50-200, filed 2/28/73,
					 effective 4/1/73.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-50 - Washington disability insurance regulations › ADVERTISING › Section 284-50-210 - Violation defined as unfair practice

Current through Register Vol. 24-14, July 15, 2024
A violation of these rules, WAC
				  284-50-010 through
				  284-50-230, is hereby defined to
				  be an unfair method of competition and an unfair or deceptive act or practice
				  in the conduct of the business of insurance, pursuant to
				  RCW
				   48.30.010.
Order R-73-1, §
											284-50-210, filed 2/28/73,
					 effective 4/1/73.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-50 - Washington disability insurance regulations › ADVERTISING › Section 284-50-220 - Severability provision

Current through Register Vol. 24-14, July 15, 2024
If any section or portion of a section of these rules, or the
				  applicability thereof to any person or circumstances is held invalid by a
				  court, the remainder of the rules, or the applicability of such provision to
				  other persons or circumstances, shall not be affected
				  thereby.
Order R-73-1, §
											284-50-220, filed 2/28/73,
					 effective 4/1/73.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-50 - Washington disability insurance regulations › ADVERTISING › Section 284-50-230 - Effective date

Current through Register Vol. 24-14, July 15, 2024
The effective date of this regulation, WAC
				  284-50-010 through
				  284-50-230, shall be April 1,
				  1973.
Order R-73-1, §
											284-50-230, filed 2/28/73,
					 effective 4/1/73.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-50 - Washington disability insurance regulations › MISCELLANEOUS › Section 284-50-260 - PKU formula coverage requirements and exceptions

Current through Register Vol. 24-14, July 15, 2024
(1) The purpose of this section is to
				effectuate the provisions of sections 1 and 2, chapter 173, Laws of 1988, by
				establishing the requirements and exceptions with respect to coverage for the
				formulas necessary for the treatment of phenylketonuria (PKU).
(2) Every group disability insurance
				contract, which is delivered or issued for delivery or renewed in this state on
				or after September 1, 1988, that insures for hospital or medical expenses shall
				provide coverage for the formulas necessary for the treatment of
				phenylketonuria, with the exception of the following contracts, which need not
				provide such coverage:
(a) A contract of
				"blanket disability insurance" as defined in RCW  48.21.040;
(b) A group contract designed to provide
				benefits on an "accident only" or "specified disease only" basis;
(c) A group contract subject to chapter 48.66
				RCW and providing medicare supplemental insurance;
(d) A group contract subject to
				chapter
				48.84 RCW and providing
				long-term care insurance; and
(e) A
				group contract as to which the commissioner, in writing, consents to the
				exclusion of PKU formula coverage, upon a finding that such coverage would be
				inappropriate to the contract.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-50 - Washington disability insurance regulations › MISCELLANEOUS › Section 284-50-270 - Mammograms-Coverage requirements and exceptions

Current through Register Vol. 24-14, July 15, 2024
(1) The purpose of
				this regulation is to effectuate the provisions of
				RCW
				 48.20.393 and
				48.21.225, by establishing
				definitions for the exceptions to coverage for mammograms. This regulation
				shall apply to every group and individual disability insurance contract, which
				is delivered or issued for delivery or renewed in this state on or after
				September 1, 1992, that provides coverage for hospital or medical
				expenses.
(2) For the purposes of
				RCW
				 48.20.393 and
				48.21.225 and this regulation,
				supplemental contracts covering specified disease shall be defined to mean and
				include only those contracts or policies which provide benefits to a
				policyholder only in the event that the policy-holder contracts the disease or
				diseases specifically named in the policy. Also for the purposes of
				RCW
				 48.20.393 and
				48.21.225 and this regulation,
				supplemental contracts covering limited benefits shall be defined to mean and
				include only those contracts providing only one of the following benefits:
				Hospital indemnity, accident only coverage, dental care, vision care, mental
				health care, chemical dependency care, pharmaceutical care, and podiatric
				care.
(3) Coverage of mammograms
				may be subject to standard policy provisions, other than the cost-sharing
				provisions prohibited by
				RCW
				 48.43.076, which may be applicable to other
				diagnostic X-ray benefits.
(4) For
				purposes of
				RCW
				 48.20.393 and
				48.21.225 and this regulation, a
				contract is "renewed" when it is continued beyond the earliest date, after
				September 1, 1992, upon which, at the insurer's sole option:
(a) The contract's termination could have
				been effectuated, for other than nonpayment of premium; or
(b) The contract could have been amended to
				add the mammogram coverage, with, if justified, an appropriate rate increase
				for any increased cost in providing mammogram coverage under the contract.
The failure of the insurer to take any such steps does not
				  prevent the contract from being "renewed." The intent of this section is to
				  bring the mammogram coverage under the maximum number of contracts possible at
				  the earliest possible time, by permitting the insurer to exclude such coverage
				  from only those contracts as to which there exists a right of renewal on the
				  part of the insured without any change in any provision of the contract.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-50 - Washington disability insurance regulations › MINIMUM STANDARDS FOR INDIVIDUAL POLICIES › Section 284-50-300 - Purpose

Current through Register Vol. 24-14, July 15, 2024
The purpose of this regulation, WAC 285-50-300 through
				  284-50-435, is to implement
				  RCW
				   48.20.450 through
				  48.20.470 so as to provide
				  reasonable standardization and simplification of terms and coverages of
				  individual disability insurance policies in order to facilitate public
				  understanding and comparison and to eliminate provisions contained in
				  individual disability insurance policies which may be misleading or confusing
				  in connection either with the purchase of such coverages or with the settlement
				  of claims and to provide for full disclosure in the sale of such
				  coverages.
Order R-76-4, §
											284-50-300, filed 10/29/76,
					 effective 3/1/77.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-50 - Washington disability insurance regulations › MINIMUM STANDARDS FOR INDIVIDUAL POLICIES › Section 284-50-305 - Applicability and scope

Current through Register Vol. 24-14, July 15, 2024
This regulation shall apply to all individual disability
				  insurance policies delivered or issued for delivery in this state on and after
				  the effective date hereof, except it shall not apply to individual policies
				  issued pursuant to a conversion privilege under a policy of group or individual
				  insurance when such group or individual policy includes provisions which are
				  inconsistent with the requirements of this regulation, nor to policies being
				  issued to employees or members as additions to franchise plans in existence on
				  the effective date of this regulation. The requirements contained in this
				  regulation shall be in addition to any other applicable regulations previously
				  adopted. This regulation shall not apply to medicare supplement insurance
				  policies, as such policies are defined in the Medicare Supplemental Health
				  Insurance Act, chapter 153, Laws of 1981. This regulation shall not apply to
				  long-term care insurance policies or contracts, as such policies or contracts
				  are defined in the Long-Term Care Insurance Act,
				  chapter
				  48.84
				  RCW.
Statutory Authority:
					 RCW
					 48.02.060(3),
					 48.20.450 through
					 48.20.470 and
					 chapter
					 48.84 RCW. 87-15-028
					 (Order R 87-8), §
											284-50-305, filed 7/9/87,
					 effective 1/1/88. Statutory Authority:
					 RCW
					  48.02.060,
					 48.44.050 and
					 48.46.200. 82-01-017 (Order R
					 81-7), §
											284-50-305, filed 12/9/81; Order
					 R-76-4, §
											284-50-305, filed 10/29/76,
					 effective 3/1/77.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-50 - Washington disability insurance regulations › MINIMUM STANDARDS FOR INDIVIDUAL POLICIES › Section 284-50-310 - Effective date

Current through Register Vol. 24-14, July 15, 2024
This regulation shall be effective on March 1, 1977, and
				  shall be applicable to all individual disability insurance policies (except
				  those specifically excluded from the scope of this regulation) delivered or
				  issued for delivery in this state on and after such date: Provided, however,
				  That policies which have been approved prior to January 1, 1977, and which are
				  not in compliance with this regulation may be issued until May 1, 1977, unless
				  approval is specifically withdrawn pursuant to
				  RCW
				   48.18.110.
Order R-76-4, §
											284-50-310, filed 10/29/76,
					 effective 3/1/77.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-50 - Washington disability insurance regulations › MINIMUM STANDARDS FOR INDIVIDUAL POLICIES › Section 284-50-315 - Policy definitions

Current through Register Vol. 24-14, July 15, 2024
Except as provided hereinafter, no individual disability
				  insurance policy delivered or issued for delivery to any person in this state
				  shall contain definitions respecting the matters set forth in this section
				  unless such definitions comply with the requirements of this section.
(1) "One period of confinement" means
				consecutive days of in-hospital service received as an in-patient, or
				successive confinements due to the same or related causes when discharge from
				and readmission to the hospital occurs within a period of time not more than 90
				days or three times the maximum number of days of in-hospital coverage provided
				by the policy to a maximum of 180 days.
(2) "Hospital" may be defined in relation to
				its status, facilities and available services or to reflect its accreditation
				by the Joint Commission on Accreditation of Hospitals.
(a) The definition of the term "hospital"
				shall not be more restrictive than one requiring that the hospital:
(i) Be an institution operated pursuant to
				law; and
(ii) Be primarily and
				continuously engaged in providing or operating, either on its premises or in
				facilities available to the hospital on a prearranged basis and under the
				supervision of a staff of duly licensed physicians, medical, diagnostic and
				major surgical facilities for the medical care and treatment of sick or injured
				persons on an in-patient basis for which a charge is made; and
(iii) Provide 24-hour nursing service by or
				under the supervision of registered graduate professional nurses
				(R.N.'s).
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-50 - Washington disability insurance regulations › MINIMUM STANDARDS FOR INDIVIDUAL POLICIES › Section 284-50-321 - Discretionary clauses prohibited

Current through Register Vol. 24-14, July 15, 2024
(1) No disability insurance policy may
				contain a discretionary clause. "Discretionary clause" means a provision that
				purports to reserve discretion to an insurer, its agents, officers, employees,
				or designees in interpreting the terms of a policy or deciding eligibility for
				benefits, or requires deference to such interpretations or decisions, including
				a provision that provides for any of the following results:
(a) That the insurer's interpretation of the
				terms of the policy is binding;
(b)
				That the insurer's decision regarding eligibility or continued receipt of
				benefits is binding;
(c) That the
				insurer's decision to deny, modify, reduce or terminate payment, coverage,
				authorization, or provision of health care service or benefits, is
				binding;
(d) That there is no
				appeal or judicial remedy from a denial of a claim;
(e) That deference must be given to the
				insurer's interpretation of the contract or claim decision; and
(f) That the standard of review of an
				insurer's interpretation of the policy or claim decision is other than a de
				novo review.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-50 - Washington disability insurance regulations › MINIMUM STANDARDS FOR INDIVIDUAL POLICIES › Section 284-50-325 - Minimum standards for benefits

Current through Register Vol. 24-14, July 15, 2024
Minimum standards for benefits are prescribed for the
				  categories of coverage noted in WAC
				  284-50-330 through
				  284-50-370. No individual
				  disability insurance policy shall be delivered or issued for delivery in this
				  state which does not meet the required minimum standards for its specified
				  category. Nothing in this section shall preclude the issuance of any policy
				  combining two or more categories of coverage.
Order R-76-4, §
											284-50-325, filed 10/29/76,
					 effective 3/1/77.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-50 - Washington disability insurance regulations › MINIMUM STANDARDS FOR INDIVIDUAL POLICIES › Section 284-50-335 - Basic hospital expense coverage

Current through Register Vol. 24-14, July 15, 2024
"Basic hospital expense coverage" is a policy of disability
				  insurance which provides coverage for a period of not less than 31 days during
				  any continuous hospital confinement for each person insured under the policy
				  for expense incurred for necessary treatment and services rendered as a result
				  of accident or sickness for at least the following:
(1) Daily hospital room and board in an
				amount not less than the lesser of 80% of the charges for semi-private room
				accommodations or $50 per day;
(2)
				Miscellaneous hospital services for expenses incurred for the charges made by
				the hospital for services and supplies which are customarily rendered by the
				hospital and provided for use only during the period of confinement in an
				amount not less than either 80% of the charges incurred up to at least $1,000
				or ten times the daily hospital room and board benefits; and
(3) Hospital outpatient services consisting
				of:
(a) Hospital services on the day surgery
				is performed, and accidental injury, in an amount not less than $50;
				and
(b) Hospital services rendered
				within 72 hours after accidental injury, in an amount not less than $50;
				and
(c) X-ray and laboratory tests
				to the extent that benefits for such services would have been provided to an
				extent not less than $100 if rendered to an in-patient of the
				hospital.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-50 - Washington disability insurance regulations › MINIMUM STANDARDS FOR INDIVIDUAL POLICIES › Section 284-50-340 - Basic medical-surgical expense coverage

Current through Register Vol. 24-14, July 15, 2024
"Basic medical-surgical expense coverage" is a policy of
				  disability insurance which provides coverage for each person insured under the
				  policy for the expenses incurred for the necessary services rendered by a
				  physician for treatment of an injury or sickness for at least the
				  following:
(1) Surgical services:
(a) In amounts not less than those provided
				on a fee schedule based on the relative values contained in the state of New
				York certified surgical fee schedule, or the 1974 California relative value
				schedule or other acceptable relative value scale of surgical procedures, up to
				a maximum of at least $500 for any one procedure; or
(b) Not less than 80% of the reasonable
				charges.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-50 - Washington disability insurance regulations › MINIMUM STANDARDS FOR INDIVIDUAL POLICIES › Section 284-50-345 - Hospital confinement indemnity coverage

Current through Register Vol. 24-14, July 15, 2024
"Hospital confinement indemnity coverage" is a policy of
				  disability insurance which principally provides daily benefits for hospital
				  confinement on an indemnity basis in an amount not less than $10 per day and
				  not less than 31 days during any one period of confinement for each person
				  insured under the policy. Additional benefits may be provided in such
				  policy.
Order R-76-4, §
											284-50-345, filed 10/29/76,
					 effective 3/1/77.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-50 - Washington disability insurance regulations › MINIMUM STANDARDS FOR INDIVIDUAL POLICIES › Section 284-50-355 - Disability income protection coverage

Current through Register Vol. 24-14, July 15, 2024
(1) "Disability income protection coverage"
				is a policy which provides for periodic payments, weekly or monthly, for a
				specified period during the continuance of disability resulting from either
				sickness or injury or a combination thereof which:
(a) Provides that periodic payments which are
				payable at ages after 62 and reduced solely on the basis of age are at least
				50% of amounts payable immediately prior to age 62.
(b) Contains an elimination period no greater
				than:
(i) Ninety days in the case of coverage
				providing a benefit of one year or less;
(ii) One hundred eighty days in the case of
				coverage providing a benefit of more than one year but not greater than two
				years; or
(iii) Three hundred
				sixty-five days in all other cases during the continuance of disability
				resulting from sickness or injury.
(c) Has a maximum period of time for which it
				is payable during disability of at least six months except in the case of a
				policy covering disability arising out of pregnancy, childbirth, or miscarriage
				in which case the period for such disability may be one month.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-50 - Washington disability insurance regulations › MINIMUM STANDARDS FOR INDIVIDUAL POLICIES › Section 284-50-360 - Accident only coverage

Current through Register Vol. 24-14, July 15, 2024
"Accident only coverage" is a policy of accident insurance
				  which provides coverage, singly or combination, for death, dismemberment,
				  disability or hospital and medical care caused by accident. Accidental death
				  and double dismemberment amounts under such a policy shall be at least $1,000
				  and a single dismemberment amount shall be at least $500.
Order R-76-4, §
											284-50-360, filed 10/29/76,
					 effective 3/1/77.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-50 - Washington disability insurance regulations › MINIMUM STANDARDS FOR INDIVIDUAL POLICIES › Section 284-50-365 - Specified disease and specified accident coverage

Current through Register Vol. 24-14, July 15, 2024
(1) "Specified disease coverage" is a policy
				which meets one of the following definitions:
(a) A policy which provides coverage for each
				person insured under the policy for a specifically named disease (or diseases)
				with a deductible amount not in excess of $250 and an overall aggregate benefit
				limit of no less than $5,000 and a benefit period of not less than two years
				for at least the following incurred expenses:
(i) Hospital room and board and any other
				hospital furnished medical services or supplies;
(ii) Treatment by a legally qualified
				physician or surgeon;
(iii) Private
				duty services of a registered nurse (R.N.);
(iv) X-ray, radium and other therapy
				procedures used in diagnosis and treatment;
(v) Professional ambulance for local service
				to or from a local hospital;
(vi)
				Blood transfusions, including expense incurred for blood donors;
(vii) Drugs and medicines prescribed by a
				physician;
(viii) The rental of an
				iron lung or similar mechanical apparatus;
(ix) Braces, crutches and wheel chairs as are
				deemed necessary by the attending physician for the treatment of the
				disease;
(x) Emergency
				transportation if in the opinion of the attending physician it is necessary to
				transport the insured to another locality for treatment of the disease;
				and
(xi) May include coverage of
				any other expenses necessarily incurred in the treatment of the
				disease.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-50 - Washington disability insurance regulations › MINIMUM STANDARDS FOR INDIVIDUAL POLICIES › Section 284-50-370 - Limited benefit health insurance coverage

Current through Register Vol. 24-14, July 15, 2024
"Limited benefit health insurance coverage" is any policy
				  which provides benefits that are less than the minimum standards for benefits
				  required under WAC
				  284-50-335 through
				  284-50-365, and which the
				  commissioner approves as being in the public interest. Such policies may be
				  delivered or issued for delivery in this state only if the outline of coverage
				  required by WAC
				  284-50-425 is completed and
				  delivered as required by WAC
				  284-50-380.
Order R-76-4, §
											284-50-370, filed 10/29/76,
					 effective 3/1/77.