reglab/statecodes huggingface dataset:
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-66 - Washington medicare supplement insurance regulation › Section 284-66-068 - Standard medicare supplemental plans issued for delivery to individuals newly eligible for medicare on or after January 1, 2020

Current through Register Vol. 24-14, July 15, 2024
The Medicare Access and CHIP Reauthorization Act of 2015
				(MACRA) requires the following standards are applicable to all medicare
				supplemental policies or certificates delivered or issued for delivery in the
				state to individuals newly eligible for medicare on or after January 1, 2020.
				No policy or certificate that provides coverage of the medicare Part B
				deductible may be advertised, solicited, delivered or issued for delivery in
				this state as a medicare supplemental policy or certificate to individuals
				newly eligible for medicare on or after January 1, 2020. All policies must
				comply with the following benefit standards. Benefit plan standards to medicare
				supplemental policies and certificates issued to individuals eligible for
				medicare before January 1, 2020, remain subject to the requirements of WAC
				284-66-067.
(1) Benefit requirements. The standards and
			 requirements of WAC
			 284-66-067
			 shall apply to all medicare supplemental policies or certificates delivered or
			 issued for delivery to those newly eligible for medicare on or after January 1,
			 2020, with the following exceptions:
(a)
			 Standardized medicare supplemental benefit plan C is redesignated as plan D and
			 must provide the benefits contained in WAC
			 284-66-067(5)(c)
			 but shall not provide coverage for one hundred percent or any portion of the
			 medicare Part B deductible;
(b)
			 Standardized medicare supplemental benefit plan F is redesignated as plan G and
			 must provide the benefits contained in WAC
			 284-66-067(5)(e)
			 but shall not provide coverage for one hundred percent or any portion of the
			 medicare Part B deductible;
(c)
			 Standardized medicare supplemental plans C, F, and F with high deductible may
			 not be offered to individuals newly eligible for medicare on or after January
			 1, 2020;
(d) Standardized medicare
			 supplemental benefit plan F with high deductible is redesignated as plan G with
			 high deductible and must provide the benefits contained in WAC
			 284-66-067(5)(f)
			 but shall not provide coverage for one hundred percent or any portion of the
			 medicare Part B deductible; provided further that, the medicare Part B
			 deductible paid by the beneficiary shall be considered an out-of-pocket expense
			 in meeting the annual high deductible; and
(e) The reference to plans C or F contained
			 in WAC
			 284-66-067(1)(b)
			 is deemed a reference to plans D or G for purposes of this section.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-66 - Washington medicare supplement insurance regulation › Section 284-66-071 - Prohibition against use of genetic information and requests for genetic testing

Current through Register Vol. 24-14, July 15, 2024
Effective May 21, 2009, except as provided in subsection (3) of
				this section:
(1) An issuer of a
			 medicare supplement insurance policy or certificate must not deny or condition
			 the issuance of effectiveness of the policy or certificate and must not
			 discriminate in the pricing of the policy or certificate of an individual on
			 the basis of the genetic information with respect to any individual. This
			 includes the imposition of any exclusion of benefits under the policy based on
			 a preexisting condition or adjustment of premium rates based on genetic
			 information. This subsection shall not be construed to limit the ability of an
			 issuer, to the extent otherwise permitted by law from:
(a) Denying or conditioning the issuance or
			 effectiveness of the policy or certificate or increasing the premium based on
			 the manifestation of a disease or disorder of the insured or applicant;
			 or
(b) Increasing the premium for
			 any policy issued to an individual based on the manifestation of a disease or
			 disorder of an individual who is covered under the policy. The manifestation of
			 a disease or disorder in one individual must not be used as genetic information
			 about other group members or to increase the premium for the group.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-66 - Washington medicare supplement insurance regulation › Section 284-66-073 - Medicare SELECT policies and certificates

Current through Register Vol. 24-14, July 15, 2024
(1)
(a)
			 This section applies to medicare SELECT policies and certificates, as defined
			 in this section.
(b) No policy or
			 certificate may be advertised as a medicare SELECT policy or certificate unless
			 it meets the requirements of this section.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-66 - Washington medicare supplement insurance regulation › Section 284-66-110 - Buyer's guide

Current through Register Vol. 24-14, July 15, 2024
(1) Issuers of
			 disability insurance policies or certificates that provide hospital or medical
			 expense coverage on an expense incurred or indemnity basis to persons eligible
			 for medicare must provide to all such applicants the pamphlet "Guide to Health
			 Insurance for People with Medicare," developed jointly by the National
			 Association of Insurance Commissioners and the Centers for Medicare and
			 Medicaid Services, (CMS), or any reproduction or official revision of that
			 pamphlet. The guide must be printed in a style and with a type character that
			 is easily read by an average person eligible for medicare supplement insurance
			 and in no case may the type size be smaller than 12-point type. (Specimen
			 copies may be obtained from the Superintendent of Documents, United States
			 Government Printing Office, Washington, D.C.)
(2) Delivery of the guide must be made
			 whether or not the policies or certificates are advertised, solicited, or
			 issued as medicare supplement insurance policies or certificates.
(3) Except in the case of a direct response
			 issuers, delivery of the guide must be made to the applicant at the time of
			 application and acknowledgement of receipt of the guide must be obtained by the
			 issuer. Direct response issuers must deliver the guide to the applicant upon
			 request but not later than at the time the policy is delivered.
(4) The guide must be reproduced in a form
			 that is substantially identical in language, format, type size, type
			 proportional spacing, bold character, and line spacing to the guide developed
			 jointly by the National Association of Insurance Commissioners and
			 CMS.
Statutory Authority:
				  RCW
				  48.02.060 and
				  48.66.165. 05-17-019 (Matter No. R
				  2004-08), §
										284-66-110, filed 8/4/05,
				  effective 9/4/05. Statutory Authority:
				  RCW
				   48.02.060,
				  48.66.041 and
				  48.66.165. 96-09-047 (Matter No. R
				  96-2), §
										284-66-110, filed 4/11/96,
				  effective 5/12/96. Statutory Authority:
				  RCW
				   48.02.060,
				  48.20.450,
				  48.20.460,
				  48.20.470,
				  48.30.010,
				  48.44.020,
				  48.44.050,
				  48.44.070,
				  48.46.030,
				  48.46.130 and
				  48.46.200. 92-06-021 (Order R
				  92-1), §
										284-66-110, filed 2/25/92,
				  effective 3/27/92. Statutory Authority:
				  RCW
				   48.02.060,
				  48.20.450,
				  48.20.460,
				  48.20.470,
				  48.30.010,
				  48.44.020,
				  48.44.050,
				  48.44.070,
				  48.46.030,
				  48.46.130,
				  48.46.200,
				  48.66.041,
				  48.66.050,
				  48.66.100,
				  48.66.110,
				  48.66.120,
				  48.66.130,
				  48.66.150 and
				  48.66.160. 90-07-059 (Order R
				  90-4), §
										284-66-110, filed 3/20/90,
				  effective 4/20/90.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-66 - Washington medicare supplement insurance regulation › Section 284-66-120 - Notice regarding policies that are not medicare supplement policies

Current through Register Vol. 24-14, July 15, 2024
Any disability insurance policy or certificate (other than a
				medicare supplement policy or certificate or a policy issued according to a
				contract under Section 1876 of the federal Social Security Act (42 U.S.C. Section 1395  et seq.)), disability income protection policy or other policy
				identified in
				RCW
				 48.66.020(1), whether issued
				on an individual or group basis, that purports to provide coverage to residents
				of this state eligible for medicare, must notify policyholders or certificate
				holders that the policy is not a medicare supplement insurance policy or
				certificate. The notice must be printed or attached to the first page of the
				outline of coverage or equivalent disclosure form, and must be delivered to the
				policyholder or certificate holder. If no outline of coverage is delivered, the
				notice must be attached to the first page of the policy or certificate
				delivered to insureds. The notice must be in no less than twelve point type and
				contain the following language: "This (policy, certificate or subscriber
				contract) is not a medicare supplement (policy, certificate or subscriber
				contract). If you are eligible for medicare, review the "Guide to Health
				Insurance for People with Medicare" available from the
				company."
Statutory Authority:
				  RCW
				  48.02.060 and
				  48.66.165. 05-17-019 (Matter No. R
				  2004-08), §
										284-66-120, filed 8/4/05,
				  effective 9/4/05. Statutory Authority:
				  RCW
				   48.02.060,
				  48.66.041 and
				  48.66.165. 96-09-047 (Matter No. R
				  96-2), §
										284-66-120, filed 4/11/96,
				  effective 5/12/96. Statutory Authority:
				  RCW
				   48.02.060,
				  48.20.450,
				  48.20.460,
				  48.20.470,
				  48.30.010,
				  48.44.020,
				  48.44.050,
				  48.44.070,
				  48.46.030,
				  48.46.130 and
				  48.46.200. 92-06-021 (Order R
				  92-1), §
										284-66-120, filed 2/25/92,
				  effective 3/27/92. Statutory Authority:
				  RCW
				   48.02.060,
				  48.20.450,
				  48.20.460,
				  48.20.470,
				  48.30.010,
				  48.44.020,
				  48.44.050,
				  48.44.070,
				  48.46.030,
				  48.46.130,
				  48.46.200,
				  48.66.041,
				  48.66.050,
				  48.66.100,
				  48.66.110,
				  48.66.120,
				  48.66.130,
				  48.66.150 and
				  48.66.160. 90-07-059 (Order R
				  90-4), §
										284-66-120, filed 3/20/90,
				  effective 4/20/90.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-66 - Washington medicare supplement insurance regulation › Section 284-66-135 - Disclosure statements to be used with policies that are not medicare supplement policies

Current through Register Vol. 24-14, July 15, 2024
Applications for the purchase of disability or other medical
				insurance policies or certificates, that are provided to persons eligible for
				medicare, must disclose the extent to which the policy duplicates medicare. The
				disclosure must be in the form provided by this section. The applicable
				disclosure statement must be provided as a part of, or together with, the
				application for the policy or certificate.
(1)
Instructions for use of the
			 disclosure statements for health insurance policies sold to medicare
			 beneficiaries that duplicate medicare.
(a) Section 1882(d) of the federal Social
			 Security Act  [42 U.S.C.
			 1395 ss] prohibits the sale of a disability
			 or other health insurance policy (the term "policy" or "policies" includes
			 certificates and contracts of all issuers) that duplicate medicare benefits
			 unless it will pay benefits without regard to other disability or other health
			 coverage and it includes the prescribed disclosure statement on or together
			 with the application.
(b) All types
			 of disability or other health insurance policies that duplicate medicare must
			 include one of the attached disclosure statements, according to the particular
			 policy type involved, on the application or together with the application. The
			 disclosure statement may not vary substantially from the attached statements in
			 terms of language or format (type size, type proportional spacing, bold
			 character, line spacing, and usage of boxes around text).
(c) State and federal law prohibits insurers
			 from selling a medicare supplement policy to a person that already has a
			 medicare supplement policy except as a replacement.
(d) Property/casualty and life insurance
			 policies are not considered disability or other health insurance.
(e) Disability income policies are not
			 considered to provide benefits that duplicate medicare.
(f) Long-term care insurance policies that
			 coordinate with medicare and other health insurance are not considered to
			 provide benefits that duplicate medicare.
(g) The federal law does not preempt state
			 laws that are more stringent than the federal requirements.
(h) The federal law does not preempt existing
			 state form filing requirements.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-66 - Washington medicare supplement insurance regulation › Section 284-66-160 - Adjustment notice to conform existing medicare supplement policies to changes in medicare

Current through Register Vol. 24-14, July 15, 2024
As soon as practicable, but no later than thirty days before
				the effective date of any medicare benefit changes, every issuer providing
				medicare supplement insurance coverage to a resident of this state must notify
				its insureds of modifications it has made to medicare supplement policies. The
				adjustment notice is intended to be informational only and for the sole purpose
				of informing policyholders and certificate holders about changes in medicare
				benefits, indexed deductible and copayment provisions, premium adjustments, and
				the like. The form of an adjustment notice provided to residents of this state
				must be filed with the commissioner before being used.
(1) The notice must include a description of
			 revisions to the medicare program and a description of each modification made
			 to the coverage provided under the medicare supplement insurance
			 policy.
(2) The notice must inform
			 each covered person of the approximate date when premium adjustments due to
			 changes in medicare benefits will be made.
(3) The notice of benefit modifications and
			 any premium changes must be furnished in outline form and in clear and simple
			 terms so as to facilitate comprehension.
(4) The notice must not contain or be
			 accompanied by any solicitation.
(5) Issuers must comply with any notice
			 requirements of the Medicare Prescription Drug, Improvement, and Modernization
			 Act of 2003.
Statutory Authority:
				  RCW
				  48.06.060 and
				  48.66.165. 07-06-014 (Matter No. R
				  2006-13), §
										284-66-160, filed 2/26/07,
				  effective 3/29/07. Statutory Authority:
				  RCW
				   48.02.060 and
				  48.66.165. 05-17-019 (Matter No. R
				  2004-08), §
										284-66-160, filed 8/4/05,
				  effective 9/4/05. Statutory Authority:
				  RCW
				   48.02.060,
				  48.20.450,
				  48.20.460,
				  48.20.470,
				  48.30.010,
				  48.44.020,
				  48.44.050,
				  48.44.070,
				  48.46.030,
				  48.46.130 and
				  48.46.200. 92-06-021 (Order R
				  92-1), §
										284-66-160, filed 2/25/92,
				  effective 3/27/92. Statutory Authority:
				  RCW
				   48.02.060,
				  48.20.450,
				  48.20.460,
				  48.20.470,
				  48.30.010,
				  48.44.020,
				  48.44.050,
				  48.44.070,
				  48.46.030,
				  48.46.130,
				  48.46.200,
				  48.66.041,
				  48.66.050,
				  48.66.100,
				  48.66.110,
				  48.66.120,
				  48.66.130,
				  48.66.150 and
				  48.66.160. 90-07-059 (Order R
				  90-4), §
										284-66-160, filed 3/20/90,
				  effective 4/20/90.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-66 - Washington medicare supplement insurance regulation › Section 284-66-170 - Prohibition against preexisting conditions, waiting periods, elimination periods, and probationary periods in replacement policies or certificates

Current through Register Vol. 24-14, July 15, 2024
(1) If a medicare
			 supplement policy or certificate replaces another medicare supplement policy or
			 certificate, the replacing issuer must waive any time periods applicable to
			 preexisting conditions, waiting periods, elimination periods and probationary
			 periods in the new medicare supplement policy or certificate to the extent the
			 time was spent under the original policy.
(2) If a medicare supplement policy or
			 certificate replaces another medicare supplement policy or certificate that has
			 been in effect for at least three months, the replacing policy may not provide
			 any time period applicable to preexisting conditions, waiting periods,
			 elimination periods, and probationary periods.
Statutory Authority:
				  RCW
				  48.02.060 and
				  48.66.165. 05-17-019 (Matter No. R
				  2004-08), §
										284-66-170, filed 8/4/05,
				  effective 9/4/05. Statutory Authority:
				  RCW
				   48.02.060,
				  48.20.450,
				  48.20.460,
				  48.20.470,
				  48.30.010,
				  48.44.020,
				  48.44.050,
				  48.44.070,
				  48.46.030,
				  48.46.130 and
				  48.46.200. 92-06-021 (Order R
				  92-1), §
										284-66-170, filed 2/25/92,
				  effective 3/27/92. Statutory Authority:
				  RCW
				   48.02.060,
				  48.20.450,
				  48.20.460,
				  48.20.470,
				  48.30.010,
				  48.44.020,
				  48.44.050,
				  48.44.070,
				  48.46.030,
				  48.46.130,
				  48.46.200,
				  48.66.041,
				  48.66.050,
				  48.66.100,
				  48.66.110,
				  48.66.120,
				  48.66.130,
				  48.66.150 and
				  48.66.160. 90-07-059 (Order R
				  90-4), §
										284-66-170, filed 3/20/90,
				  effective 4/20/90.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-66 - Washington medicare supplement insurance regulation › Section 284-66-210 - Policy reserves required

Current through Register Vol. 24-14, July 15, 2024
This section applies to every group and individual policy of an
				issuer that relates its benefits to medicare. The term "policy reserve" is
				intended to apply to all types and forms of insurance equally, whether they are
				called policies, contracts, or certificates. For all forms that are issued on a
				level premium basis, policy reserves will be required. The policy reserve is in
				addition to claim reserves and premium reserves. The definition of the date of
				incurral must be the same for both claim reserves and policy reserves. Policy
				reserves must be based upon the following minimum standards:
(1) Morbidity should be based upon a
			 reasonable expectation of future claim costs for the benefits being provided.
			 At time of policy issue this would be the morbidity assumptions used to price
			 the contract. For later durations the morbidity should reflect the experience
			 that emerges including the effects of inflation and utilization. All morbidity
			 assumptions must be reasonable in the view of the commissioner.
(2) The interest rate used may not exceed the
			 maximum rate permitted by statute in the valuation of life insurance issued on
			 the same date as the medicare supplement policy.
(3) Termination rates must be on the same
			 basis as the mortality table permitted by statute in the valuation of life
			 insurance issued on the same date as the medicare supplement policy or on
			 another basis satisfactory to the commissioner.
(4) The minimum reserve is that calculated on
			 the one-year full preliminary term method. This method produces a terminal
			 reserve of zero at the first policy anniversary. The preliminary term method
			 may be applied only in relation to the date of issue of a policy. Reserve
			 adjustments introduced later as a result of rate increases, revisions in
			 assumptions, or for other reasons, are to be applied immediately as of the
			 effective date of adoption of the adjusted basis. The adjustments must be
			 determined as follows:
(a) Present value of
			 future payments of claim costs for benefits, determined using revised
			 assumptions based on anticipated experience;
(b) Less the present value of future net
			 premiums, determined using revised assumptions based on anticipated
			 experience;
(c) Less the liability
			 for contract reserves at the valuation date.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-66 - Washington medicare supplement insurance regulation › Section 284-66-220 - Medicare supplement refund calculation form required

Current through Register Vol. 24-14, July 15, 2024
The form provided in WAC
				284-66-232 must be filed with the
				commissioner annually by May 31st of each calendar year beginning May 31, 1993.
				The form is to be filed in addition to the NAIC experience exhibit and not in
				lieu thereof.
Statutory Authority:
				  RCW
				  48.02.060 and
				  48.66.165. 05-17-019 (Matter No. R
				  2004-08), §
										284-66-220, filed 8/4/05,
				  effective 9/4/05. Statutory Authority:
				  RCW
				  48.02.060. 92-17-078 (Order R 92-7), §
										284-66-220, filed 8/19/92,
				  effective 9/19/92. Statutory Authority:
				  RCW
				   48.02.060,
				  48.20.450,
				  48.20.460,
				  48.20.470,
				  48.30.010,
				  48.44.020,
				  48.44.050,
				  48.44.070,
				  48.46.030,
				  48.46.130 and
				  48.46.200. 92-06-021 (Order R
				  92-1), §
										284-66-220, filed 2/25/92,
				  effective 3/27/92. Statutory Authority:
				  RCW
				   48.02.060,
				  48.20.450,
				  48.20.460,
				  48.20.470,
				  48.30.010,
				  48.44.020,
				  48.44.050,
				  48.44.070,
				  48.46.030,
				  48.46.130,
				  48.46.200,
				  48.66.041,
				  48.66.050,
				  48.66.100,
				  48.66.110,
				  48.66.120,
				  48.66.130,
				  48.66.150 and
				  48.66.160. 90-07-059 (Order R
				  90-4), §
										284-66-220, filed 3/20/90,
				  effective 4/20/90.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-66 - Washington medicare supplement insurance regulation › Section 284-66-240 - Filing requirements and premium adjustments

Current through Register Vol. 24-14, July 15, 2024
(1) All policy forms issued or delivered on
			 or after January 1, 1990, and before July 1, 1992, as well as any future rate
			 adjustments to such forms, must demonstrate compliance with the loss ratio
			 requirements of WAC
			 284-66-200 and policy reserve
			 requirements of WAC
			 284-66-210, unless the forms meet
			 the standards of WAC
			 284-66-063 and
			 284-66-203. All filings of rate
			 adjustments must be accompanied by the proposed rate schedule and an actuarial
			 memorandum completed and signed by a qualified actuary as defined in WAC
			 284-05-060. In addition to the
			 actuarial memorandum, the following supporting documentation must be submitted
			 to demonstrate to the satisfaction of the commissioner that rates are not
			 excessive, inadequate, or unfairly discriminatory and otherwise comply with the
			 requirements of this chapter. If any of the items listed below are
			 inappropriate due to the pricing methodology used by the pricing actuary, the
			 commissioner may waive the requirements upon request of the issuer.
(a) Filings of issue age level premium rates
			 must be accompanied by the following:
(i)
			 Anticipated loss ratios stated on a policy year basis for the period for which
			 the policy is rated. Filings of future rate adjustments must contain the actual
			 policy year loss ratios experienced since inception;
(ii) Anticipated total termination rates on a
			 policy year basis for the period for which the policy is rated. The termination
			 rates should be stated as a percentage and the source of the mortality
			 assumption must be specified. Filings of future rate adjustments must include
			 the actual total termination rates stated on a policy year basis since
			 inception;
(iii) Expense
			 assumptions including fixed and percentage expenses for acquisition and
			 maintenance costs;
(iv) Schedule of
			 total compensation payable to insurance producers and other producers as a
			 percentage of premium, if any;
(v)
			 Specimen copy of the compensation agreements or contracts between the issuer
			 and any insurance producers, or others whose compensation is based in whole or
			 in part on the sale of medicare supplement insurance policies, the agreements
			 demonstrating compliance with WAC
			 284-66-350 (where
			 appropriate);
(vi) Other data
			 necessary in the reasonable opinion of the commissioner to substantiate the
			 filing.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-66 - Washington medicare supplement insurance regulation › Section 284-66-243 - Filing and approval of policies and certificates and premium rates

Current through Register Vol. 24-14, July 15, 2024
(1) An issuer may
			 not deliver or issue for delivery a policy or certificate to a resident of this
			 state unless the policy form or certificate form has been filed with and
			 approved by the commissioner according to the filing requirements and
			 procedures prescribed by the commissioner.
(2) An issuer may not use or change premium
			 rates for a medicare supplement policy or certificate unless the rates, rating
			 schedule, and supporting documentation have been filed with and approved by the
			 commissioner according to the filing requirements and procedures prescribed by
			 the commissioner.
(3)
(a) Except as provided in (b) of this
			 subsection, an issuer may not file for approval more than one form of a policy
			 or certificate of each type for each standard medicare supplement benefit
			 plan.
(b) An issuer may offer, with
			 the approval of the commissioner, up to four additional policy forms or
			 certificate forms of the same type for the same standard medicare supplement
			 benefit plan, one for each of the following cases:
(i) The inclusion of new or innovative
			 benefits;
(ii) The addition of
			 either direct response or insurance producer marketing methods;
(iii) The addition of either guaranteed issue
			 or underwritten coverage;
(iv) The
			 offering of coverage to individuals eligible for medicare by reason of
			 disability. The form number for products offered to enrollees who are eligible
			 by reason of disability must be distinct from the form number used for a
			 corresponding standardized plan offered to an enrollee eligible for medicare by
			 reason of age.
(c) For
			 the purposes of this section, a "type" means an individual policy, a group
			 policy, an individual medicare SELECT policy, or a group medicare SELECT
			 policy.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-66 - Washington medicare supplement insurance regulation › Section 284-66-250 - Filing requirements for out-of-state group policies

Current through Register Vol. 24-14, July 15, 2024
Every issuer providing group medicare supplement insurance
				benefits to a resident of this state must file with the commissioner, within
				thirty days of its use in this state, a copy of the master policy and any
				certificate used in this state, according to the filing requirements and
				procedures that apply to medicare supplement policies issued in this
				state.
Statutory Authority:
				  RCW
				  48.02.060 and
				  48.66.165. 05-17-019 (Matter No. R
				  2004-08), §
										284-66-250, filed 8/4/05,
				  effective 9/4/05. Statutory Authority:
				  RCW
				   48.02.060,
				  48.20.450,
				  48.20.460,
				  48.20.470,
				  48.30.010,
				  48.44.020,
				  48.44.050,
				  48.44.070,
				  48.46.030,
				  48.46.130 and
				  48.46.200. 92-06-021 (Order R
				  92-1), §
										284-66-250, filed 2/25/92,
				  effective 3/27/92. Statutory Authority:
				  RCW
				   48.02.060,
				  48.20.450,
				  48.20.460,
				  48.20.470,
				  48.30.010,
				  48.44.020,
				  48.44.050,
				  48.44.070,
				  48.46.030,
				  48.46.130,
				  48.46.200,
				  48.66.041,
				  48.66.050,
				  48.66.100,
				  48.66.110,
				  48.66.120,
				  48.66.130,
				  48.66.150 and
				  48.66.160. 90-07-059 (Order R
				  90-4), §
										284-66-250, filed 3/20/90,
				  effective 4/20/90.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-66 - Washington medicare supplement insurance regulation › Section 284-66-260 - Riders and endorsements

Current through Register Vol. 24-14, July 15, 2024
(1)
			 Effective January 1, 1990, subject to
			 RCW
			  48.66.050(2), and except for
			 riders or endorsements issued according to subsection (2) of this section, no
			 rider, endorsement, waiver, or any other means of modifying contractual
			 benefits may be used by an issuer to exclude, limit, or reduce the coverage or
			 benefits of a medicare supplement insurance policy or certificate issued to a
			 resident of this state. Only riders or endorsements that increase benefits or
			 coverage may be used in this state.
(2) Effective January 1, 1990, except for
			 riders or endorsements issued to bring a policy into compliance with changes to
			 the minimum benefit standards or other contractual benefits required by this
			 chapter or as amended:
(a) An amendment to a
			 medicare supplement insurance policy or certificate that increases the premium
			 must be requested or accepted by the policyholder in writing; and
(b) Where separate additional premium is
			 charged for a rider, endorsement or other amendment to the contractual benefits
			 of a medicare supplement insurance policy or certificate, the premium charged
			 must be set forth in the policy.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-66 - Washington medicare supplement insurance regulation › Section 284-66-270 - Standards for claims payment: Compliance with Omnibus Budget Reconciliation Act of 1987

Current through Register Vol. 24-14, July 15, 2024
(1) An issuer must
			 comply with Section 1882(c)(3) of the Social Security Act (as enacted by
			 Section 4081(b)(2)(C) of the Omnibus Budget Reconciliation Act of 1987
			 (OBRA'87), P.L. 100-203) by:
(a) Accepting a
			 notice from a medicare carrier on dually assigned claims submitted by
			 participating physicians and suppliers as a claim for benefits in place of any
			 other claim form otherwise required and making a payment determination on the
			 basis of the information contained in that notice;
(b) Notifying the participating physician or
			 supplier and the beneficiary of the payment determination;
(c) Paying the participating physician or
			 supplier directly;
(d) Furnishing,
			 at the time of enrollment, each enrollee with a card listing the policy name,
			 number, and a central mailing address to which notices from a medicare carrier
			 may be sent;
(e) Paying user fees
			 for claim notices that are transmitted electronically or otherwise;
			 and
(f) Providing to the Secretary
			 of Health and Human Services, at least annually, a central mailing address that
			 all claims may be sent by medicare carriers.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-66 - Washington medicare supplement insurance regulation › Section 284-66-300 - Requirements for advertising

Current through Register Vol. 24-14, July 15, 2024
(1) At
			 least thirty days before use in this state, every issuer who provides medicare
			 supplement insurance coverage to a resident of this state must provide the
			 commissioner with a copy of any medicare supplement advertisement (as
			 advertisement is defined in WAC
			 284-50-030)  intended for use in
			 this state whether through written, radio, or television medium. In the case of
			 radio or television advertising, an audio cassette or VHS cassette must be
			 supplied on request of the commissioner.
(2) Advertising must comply with the
			 standards of the Washington disability advertising regulation (WAC
			 284-50-010 through
			 284-50-230), and must identify
			 the name in full of the issuer and the location of its home office or principal
			 office in the United States (if an alien issuer).
Statutory Authority:
				  RCW
				  48.02.060 and
				  48.66.165. 05-17-019 (Matter No. R
				  2004-08), §
										284-66-300, filed 8/4/05,
				  effective 9/4/05. Statutory Authority:
				  RCW
				   48.02.060,
				  48.20.450,
				  48.20.460,
				  48.20.470,
				  48.30.010,
				  48.44.020,
				  48.44.050,
				  48.44.070,
				  48.46.030,
				  48.46.130 and
				  48.46.200. 92-06-021 (Order R
				  92-1), §
										284-66-300, filed 2/25/92,
				  effective 3/27/92. Statutory Authority:
				  RCW
				   48.02.060,
				  48.20.450,
				  48.20.460,
				  48.20.470,
				  48.30.010,
				  48.44.020,
				  48.44.050,
				  48.44.070,
				  48.46.030,
				  48.46.130,
				  48.46.200,
				  48.66.041,
				  48.66.050,
				  48.66.100,
				  48.66.110,
				  48.66.120,
				  48.66.130,
				  48.66.150 and
				  48.66.160. 90-07-059 (Order R
				  90-4), §
										284-66-300, filed 3/20/90,
				  effective 4/20/90.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-66 - Washington medicare supplement insurance regulation › Section 284-66-310 - Attained age rating prohibited

Current through Register Vol. 24-14, July 15, 2024
The commissioner has found and defines it to be an unfair act
				or practice and an unfair method of competition, and a prohibited practice, for
				any issuer, directly or indirectly, to use the increasing age of an insured,
				subscriber, or participant as the basis for increasing premiums or prepayment
				charges with respect to medicare supplement insurance. Accordingly, the rating
				practice commonly referred to as "attained age rating" is
				prohibited.
Statutory Authority:
				  RCW
				  48.02.060 and
				  48.66.165. 05-17-019 (Matter No. R
				  2004-08), §
										284-66-310, filed 8/4/05,
				  effective 9/4/05. Statutory Authority:
				  RCW
				   48.02.060,
				  48.20.450,
				  48.20.460,
				  48.20.470,
				  48.30.010,
				  48.44.020,
				  48.44.050,
				  48.44.070,
				  48.46.030,
				  48.46.130 and
				  48.46.200. 92-06-021 (Order R
				  92-1), §
										284-66-310, filed 2/25/92,
				  effective 3/27/92. Statutory Authority:
				  RCW
				   48.02.060,
				  48.20.450,
				  48.20.460,
				  48.20.470,
				  48.30.010,
				  48.44.020,
				  48.44.050,
				  48.44.070,
				  48.46.030,
				  48.46.130,
				  48.46.200,
				  48.66.041,
				  48.66.050,
				  48.66.100,
				  48.66.110,
				  48.66.120,
				  48.66.130,
				  48.66.150 and
				  48.66.160. 90-07-059 (Order R
				  90-4), §
										284-66-310, filed 3/20/90,
				  effective 4/20/90.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-66 - Washington medicare supplement insurance regulation › Section 284-66-320 - Reporting of multiple policies

Current through Register Vol. 24-14, July 15, 2024
(1) On or before March 1st of each year, an
			 issuer must report to the commissioner the following information for every
			 individual resident of this state for which the issuer has in force more than
			 one medicare supplement policy or certificate on a form approved by the
			 commissioner, substantially in the form provided in WAC
			 284-66-323:
(a) Policy and certificate number;
			 and
(b) Date of issuance.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-66 - Washington medicare supplement insurance regulation › Section 284-66-323 - Form for reporting multiple medicare supplement policies and certificates

Current through Register Vol. 24-14, July 15, 2024
Medicare Supplement Regulation
FORM FOR REPORTING
MEDICARE SUPPLEMENT POLICIES
Company Name:
Address:
Phone Number:
Due: March 1, annually
The purpose of this form is to report the following information
				on each resident of this state with more than one medicare supplement policy or
				certificate in force. The information is to be grouped by individual
				policyholder.
Policy and
Certificate #
Date of
Issuance
Signature
Name and Title (please type)
Date
Statutory Authority:
				  RCW
				  48.66.030(3)(a),
				  48.66.041, and
				  48.66.165. 09-24-052 (Matter No. R
				  2009-08), §
										284-66-323, filed 11/24/09,
				  effective 1/19/10. Statutory Authority:
				  RCW
				   48.02.060,
				  48.20.450,
				  48.20.460,
				  48.20.470,
				  48.30.010,
				  48.44.020,
				  48.44.050,
				  48.44.070,
				  48.46.030,
				  48.46.130 and
				  48.46.200. 92-06-021 (Order R
				  92-1), §
										284-66-323, filed 2/25/92,
				  effective 3/27/92.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-66 - Washington medicare supplement insurance regulation › Section 284-66-330 - Standards for marketing

Current through Register Vol. 24-14, July 15, 2024
(1)
			 Every issuer marketing medicare supplement insurance coverage in this state,
			 directly or through its producers, must:
(a)
			 Establish marketing procedures to assure that any comparison of policies or
			 certificates by its insurance producers will be fair and accurate.
(b) Establish marketing procedures to assure
			 excessive insurance is not sold or issued.
(c) Display prominently by type, stamp or
			 other appropriate means, on the first page of the policy or certificate the
			 following:
"NOTICE TO BUYER: THIS (POLICY, CONTRACT OR CERTIFICATE) MAY
				NOT COVER ALL OF YOUR MEDICAL EXPENSES."
(d) Inquire and otherwise make every
			 reasonable effort to identify whether a prospective applicant or enrollee for
			 medicare supplement insurance already has disability insurance and the types
			 and amounts of any such insurance.
(e) Establish auditable procedures for
			 verifying compliance with this section.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-66 - Washington medicare supplement insurance regulation › Section 284-66-340 - Appropriateness of recommended purchase and excessive insurance

Current through Register Vol. 24-14, July 15, 2024
(1) In recommending
			 the purchase or replacement of any medicare supplement policy or certificate an
			 insurance producer must make reasonable efforts to determine the
			 appropriateness of a recommended purchase or replacement.
(2) Any sale of a medicare supplement policy
			 or certificate that will provide an individual more than one medicare
			 supplement policy or certificate is prohibited.
(3) An issuer may not issue a medicare
			 supplement policy or certificate to an individual enrolled in medicare Part C
			 unless the effective date of the coverage is after the termination date of the
			 individual's Part C coverage.
Statutory Authority:
				  RCW
				  48.02.060(3)(a) and
				  48.17.010(5).
				  11-01-159 (Matter No. R 2010-09), §
										284-66-340, filed 12/22/10,
				  effective 1/22/11. Statutory Authority:
				  RCW
				   48.02.060 and
				  48.66.165. 05-17-019 (Matter No. R
				  2004-08), §
										284-66-340, filed 8/4/05,
				  effective 9/4/05. Statutory Authority:
				  RCW
				   48.02.060,
				  48.20.450,
				  48.20.460,
				  48.20.470,
				  48.30.010,
				  48.44.020,
				  48.44.050,
				  48.44.070,
				  48.46.030,
				  48.46.130 and
				  48.46.200. 92-06-021 (Order R
				  92-1), §
										284-66-340, filed 2/25/92,
				  effective 3/27/92. Statutory Authority:
				  RCW
				   48.02.060,
				  48.20.450,
				  48.20.460,
				  48.20.470,
				  48.30.010,
				  48.44.020,
				  48.44.050,
				  48.44.070,
				  48.46.030,
				  48.46.130,
				  48.46.200,
				  48.66.041,
				  48.66.050,
				  48.66.100,
				  48.66.110,
				  48.66.120,
				  48.66.130,
				  48.66.150 and
				  48.66.160. 90-07-059 (Order R
				  90-4), §
										284-66-340, filed 3/20/90,
				  effective 4/20/90.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-66 - Washington medicare supplement insurance regulation › Section 284-66-350 - Permitted compensation arrangements

Current through Register Vol. 24-14, July 15, 2024
(1)
(a) The
			 commissioner has found and hereby defines it to be an unfair act or practice
			 and an unfair method of competition, and a prohibited practice, for any issuer,
			 directly or indirectly, to provide commission to an insurance producer or other
			 representative for the solicitation, sale, servicing, or renewal of a medicare
			 supplement policy or certificate that is delivered or issued for delivery to a
			 resident within this state unless the commission is identical as to percentage
			 of premium for every policy year as long as the coverage under the policy or
			 certificate remains in force with premiums being paid, or waived by the issuer,
			 for the coverage.
(b) Each
			 commission payment must be made by the issuer no later than sixty days
			 following the date on which the applicable premiums, that are the basis of the
			 commission calculation, were paid. Each payment must be paid to either the
			 producing insurance producer who originally sold the policy or to a successor
			 insurance producer designated by the issuer to replace the producing insurance
			 producer, or shared between them on some basis. The distribution of the
			 commission payments must be designated by the issuer in its various insurance
			 producers' commission agreements and it may not terminate, reduce or keep the
			 commission payment as long as the policy or certificate remains in force with
			 premiums being paid, or waived by the issuer, for the coverage
			 thereunder.
(c) Where an issuer
			 provides a portion of the total commission for the solicitation, sale,
			 servicing, or renewal of a medicare supplement policy or certificate to an
			 insurance producer, sales manager, district representative or other supervisor
			 who has marketing responsibilities (other than a producing or successor
			 insurance producer), while such portion of total commissions continues to be
			 paid it must be identical as to percentage of premium for every policy year as
			 long as coverage under the policy or certificate remains in force with premiums
			 being paid, or waived by the issuer, for the coverage.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-66 - Washington medicare supplement insurance regulation › Section 284-66-400 - Chapter not exclusive

Current through Register Vol. 24-14, July 15, 2024
Nothing contained in this chapter may be construed to limit the
				authority of the commissioner to regulate medicare supplement insurance
				policies or certificates under other sections of
				Title
				48 RCW.
Statutory Authority:
				  RCW
				  48.02.060 and
				  48.66.165. 05-17-019 (Matter No. R
				  2004-08), §
										284-66-400, filed 8/4/05,
				  effective 9/4/05. Statutory Authority:
				  RCW
				   48.02.060,
				  48.20.450,
				  48.20.460,
				  48.20.470,
				  48.30.010,
				  48.44.020,
				  48.44.050,
				  48.44.070,
				  48.46.030,
				  48.46.130 and
				  48.46.200. 92-06-021 (Order R
				  92-1), §
										284-66-400, filed 2/25/92,
				  effective 3/27/92. Statutory Authority:
				  RCW
				   48.02.060,
				  48.20.450,
				  48.20.460,
				  48.20.470,
				  48.30.010,
				  48.44.020,
				  48.44.050,
				  48.44.070,
				  48.46.030,
				  48.46.130,
				  48.46.200,
				  48.66.041,
				  48.66.050,
				  48.66.100,
				  48.66.110,
				  48.66.120,
				  48.66.130,
				  48.66.150 and
				  48.66.160. 90-07-059 (Order R
				  90-4), §
										284-66-400, filed 3/20/90,
				  effective 4/20/90.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-74 - Approved insurance tables › Section 284-74-010 - 1983 Annuity tables

Current through Register Vol. 24-14, July 15, 2024
The purpose of this section is to recognize new mortality
				tables, the 1983 table "a" and the 1983 GAM table, for use in determining the
				minimum standard of valuation for annuity and pure endowment contracts, except
				as otherwise provided in WAC
				284-74-020.
(1) The 1983 table "a" mortality table, which
			 was developed by the society of actuaries committee to recommend a new
			 mortality basis for individual annuity valuation and adopted as a recognized
			 mortality table for annuities in June 1982 by the National Association of
			 Insurance Commissioners (NAIC), and which is set forth in NAIC Proceedings,
			 1982 Vol. II, p. 454, is recognized and approved as an individual annuity
			 mortality table for valuation and, at the option of the company, may be used
			 for determining the minimum standard of valuation for any individual annuity or
			 pure endowment contract issued on or after July 10, 1982.
(2) The 1983 table "a" referred to in
			 subsection (1) of this section is to be used for determining the minimum
			 standard of valuation for any individual annuity or pure endowment contract
			 issued on or after January 1, 1988.
(3) The 1983 GAM mortality table, which was
			 developed by the society of actuaries committee on annuities and adopted as a
			 recognized mortality table for annuities in December 1983 by the NAIC, and
			 which is set forth in NAIC Proceedings, 1984 Vol. I, pp. 414-415, and the 1983
			 table "a" mortality table referred to in subsection (1) of this section, are
			 recognized and approved as group annuity mortality tables for valuation and, at
			 the option of the company, either table may be used for purposes of valuation
			 for any annuity or pure endowment purchased on or after July 10, 1982, under a
			 group annuity or pure endowment contract.
(4) The 1983 GAM table referred to in
			 subsection (3) of this section is to be used for determining the minimum
			 standard of valuation for any annuity or pure endowment purchased on or after
			 January 1, 1988 under a group annuity or pure endowment contract.
Statutory Authority:
				  RCW
				  48.02.060. 98-05-069 (Matter No. R 97-5),
				  §
										284-74-010, filed 2/17/98,
				  effective 3/20/98; 87-05-046 (Order R 87-3), §
										284-74-010, filed
				  2/18/87.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-74 - Approved insurance tables › Section 284-74-020 - Annuity 2000 and 1994 GAR tables

Current through Register Vol. 24-14, July 15, 2024
The purpose of this section is to recognize the following
				mortality tables for use in determining the minimum standard of valuation for
				annuity and pure endowment contracts: The annuity 2000 mortality table, the
				2012 individual annuity reserving (2012 IAR) table, and the 1994 group annuity
				reserving (1994 GAR) table.
(1) The
			 following definitions apply to this section:
(a) "Period table" means a table of mortality
			 rates applicable to a given year (the period).
(b) "Generational mortality table" means a
			 mortality table containing a set of mortality rates that decreases for a given
			 age from one year to the next based on a combination of a period table and a
			 projection scale containing rates of mortality improvement.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-74 - Approved insurance tables › Section 284-74-300 - Purpose

Current through Register Vol. 24-14, July 15, 2024
(1) The purpose of
			 this regulation, WAC
			 284-74-300 through
			 284-74-380 is to provide:
(a) Tables of select mortality factors and
			 rules for their use;
(b) Rules
			 concerning a minimum standard for the valuation of plans with nonlevel premiums
			 or benefits; and
(c) Rules
			 concerning a minimum standard for the valuation of plans with secondary
			 guarantees.