reglab/statecodes huggingface dataset:
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-34 - Credit life and credit accident and health insurance › Section 284-34-240 - What practices are insurers prohibited from doing?

Current through Register Vol. 24-14, July 15, 2024
The following practices, when engaged in by insurers in
				connection with the sale or placement of credit insurance, or as an inducement
				thereto, constitute unfair methods of competition and are subject to the
				enforcement provisions of
				RCW
				 48.30.010. An insurer must not:
(1) Offer or grant to a creditor any special
			 advantage or service that is not included in either the group insurance
			 contract or in the agency contract. This subsection does not prohibit payment
			 of agent's commissions.
(2) Agree
			 to deposit with a bank or financial institution money or securities of the
			 insurer with the design or intent that the deposit will affect or replace a
			 deposit of money or securities that otherwise would be required of the creditor
			 by the bank or financial institution as a compensating balance or offsetting
			 deposit for a loan or other advancement.
(3) Deposit money or securities without
			 interest or at a lesser rate of interest than is currently being paid by the
			 creditor, bank or financial institution to other depositors of like amounts for
			 similar durations. This subsection does not prohibit an insurer from
			 maintaining demand deposits or premium deposit accounts that the insurer needs
			 to use in the ordinary course of the insurer's business.
Statutory Authority:
				  RCW
				  48.02.060,
				  48.30.010,
				  48.34.100, and
				  48.34.110. 05-02-076 (Matter No. R
				  2002-02), §
										284-34-240, filed 1/4/05,
				  effective 4/1/05.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-34 - Credit life and credit accident and health insurance › Section 284-34-250 - What information must be disclosed to debtors?

Current through Register Vol. 24-14, July 15, 2024
(1) If a debtor buys consumer credit
			 insurance in connection with a credit transaction, the creditor must disclose
			 this information to the debtor in writing:
(a)
			 The debtor does not have to buy consumer credit insurance.
(b) The debtor may not need consumer credit
			 insurance if the debtor has other insurance that covers the risk.
(c) The debtor does not have to buy consumer
			 credit insurance to obtain credit approval.
(d) If the creditor offers more than one type
			 of consumer credit insurance to debtors, whether the debtor can buy each type
			 of insurance separately.
(e) The
			 insurer may decide to deny coverage. This statement must list all factors that
			 may cause the insurer to deny or limit coverage, including:
(i) Underwriting standards;
(ii) Exceptions to coverage;
(iii) Limitations and exclusions to
			 coverage;
(iv) Eligibility
			 criteria; and
(v) The date coverage
			 will be effective.
(f)
			 The debtor can cancel coverage within the first thirty days after receiving an
			 individual policy or group certificate. The insurer or creditor must promptly
			 refund or credit to the debtor's account all amounts charged for insurance or
			 obtaining it.
(g) The debtor may
			 cancel coverage at any time during the term of the loan if the:
(i) Debtor buys other insurance that covers
			 the risk; or
(ii) Credit agreement
			 does not require the debtor to buy consumer credit insurance.
(h) If the debtor cancels
			 coverage, the insurer or creditor must promptly pay or credit to the debtor's
			 account a refund of all unearned premium.
(i) That the debtor must provide evidence of
			 alternative insurance acceptable to the creditor at the time of cancellation
			 only if insurance is a requirement for the extension of credit.
(j) A brief description of the coverage,
			 including a description of:
(i) The amount of
			 insurance;
(ii) The term of
			 insurance;
(iii) Insured
			 events;
(iv) Any waiting or
			 elimination period;
(v) Any
			 applicable waiver of premium provision;
(vi) To whom the benefits would be paid;
			 and
(vii) The rate for each type of
			 coverage.
(k) If the
			 premium or insurance charge(s) are financed, they are subject to finance
			 charges at the rate applicable to the credit transaction.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-34 - Credit life and credit accident and health insurance › Section 284-34-260 - What is the effective date of this regulation?

Current through Register Vol. 24-14, July 15, 2024
(1) This regulation takes effect on April 1,
			 2005.
(2) Approval of all forms
			 that do not comply with this regulation is withdrawn as of October 1, 2005. No
			 form may be issued on or after October 1, 2005, unless it has been approved by
			 the commissioner and conforms to this regulation.
(3) Group insurance:
(a) Certificates and premium rates used with
			 existing policies must conform to this regulation by the first anniversary date
			 of the policy on or after October 1, 2005. This includes, but is not limited
			 to:
(i) Continuing insurance on a debtor
			 where agreement between the insurer and the group policyholder, with or without
			 notice to the debtor, is sufficient to terminate that insurance; and
(ii) Continuing insurance on a debtor where
			 the insurer has the right to change premium rates with the approval of the
			 commissioner.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-36 - Domestic fraternal mutual property insurers' agents and directors › Section 284-36-010 - Application

Current through Register Vol. 24-14, July 15, 2024
This regulation, WAC 284-36-010 through
				284-36-040,
				shall apply only as to domestic fraternal mutual property insurers, as defined
				in
				RCW
				 48.36A.040 and
				48.36A.390,
				and to any domestic stock insurer w hil e it is a subsidiary of such a
				fraternal mutual property insurer.
Order R 75-5, §
										284-36-010, filed
				  10/22/75.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-36 - Domestic fraternal mutual property insurers' agents and directors › Section 284-36-020 - Agent-directors permitted

Current through Register Vol. 24-14, July 15, 2024
Pursuant to the authority vested in the commissioner under
				RCW
				 48.07.130(3) up to one-third
				(to the nearest whole number) of the members of the board of directors of such
				an insurer may also be insurance agents of the insurer, and be entitled to
				receive, and receive from the insurer payment of, commissions or other
				compensation for insurance business written or serviced by them on the same
				bases as apply to other agents of the insurer in general. Agent-directors
				qualified under this provision are excepted from the prohibition contained in
				RCW
				 48.07.130(1), to the extent
				of their activities hereby authorized.
Order R 75-5, §
										284-36-020, filed
				  10/22/75.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-36 - Domestic fraternal mutual property insurers' agents and directors › Section 284-36-030 - Election or service as director prohibited

Current through Register Vol. 24-14, July 15, 2024
No individual who is an insurance agent of such an insurer
				shall be elected or serve as a member of the insurer's board of directors if
				thereby the number of agent-directors of the insurer would exceed one-third (to
				the nearest whole number) of the total regular membership of the said board.
				Temporary vacancies on the board of directors resulting from death, disability
				or resignation of a director, shall not be deemed to reduce such total regular
				membership.
Order R 75-5, §
										284-36-030, filed
				  10/22/75.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-36 - Domestic fraternal mutual property insurers' agents and directors › Section 284-36-040 - Fiduciary responsibilities not affected

Current through Register Vol. 24-14, July 15, 2024
Nothing in this regulations shall be deemed to affect the
				responsibilities of a director as a fiduciary of the insurer, its members or
				stockholders, or other legal responsibilities of a director.
Order R 75-5, §
										284-36-040, filed
				  10/22/75.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-36A - Fraternal benefit societies › Section 284-36A-005 - Purpose and scope

Current through Register Vol. 24-14, July 15, 2024
This chapter applies to all fraternal benefit societies
				transacting the business of life and disability insurance in this state. The
				risk-based surplus standard in this chapter provide a mechanism for the
				commissioner to evaluate the ability of a fraternal benefit society to manage
				its insurance operations and to fulfill its responsibilities as tax-exempt
				benevolent and charitable organization for the benefit of members and others.
				The risk-based surplus standard of this chapter is a minimum standard. It is an
				estimate of the surplus level required of a fraternal benefit society that is
				necessary so that the entity may survive a series of catastrophic financial
				events. The risk-based surplus formula is the ratio of the fraternal benefit
				society's total adjusted surplus to its risk-based surplus.
Statutory Authority:
				  RCW
				  48.02.060,
				  48.36A.100(7),
				  48.36A.290(4),
				  48.36A.100,
				  48.36A.282,
				  48.36A.284,
				  48.36A.286,
				  48.36A.290,
				  48.36A.310 and 1996 c 236.
				  96-22-064 (Matter No. R 96-5), §
										284-36A-005, filed 11/4/96,
				  effective 12/5/96.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-36A - Fraternal benefit societies › Section 284-36A-010 - Definitions

Current through Register Vol. 24-14, July 15, 2024
(1) "Adjusted RBS
			 report" means an RBS report which has been adjusted by the commissioner in
			 accordance with WAC
			 284-36A-020(4).
(2) "AVR" means asset valuation
			 reserve.
(3) "Corrective order"
			 means an order issued by the commissioner specifying corrective actions which
			 the commissioner has determined are required.
(4) "Fraternal benefit society" is defined at
			 RCW
			  48.36A.010.
(5) "NAIC" means the National Association of
			 Insurance Commissioners.
(6)
			 "Negative trend" means, with respect to a fraternal benefit society, negative
			 trend over a period of time, as determined in accordance with the "trend test
			 calculation" included in the RBS instructions.
(7) "RBC" means risk-based capital.
(8) "RBS" means risk-based surplus.
(9) "RBS instructions" means the RBC report
			 for life insurance companies, including risk-based capital instructions
			 adopted, by the NAIC.
(10) "RBS
			 level" means a fraternal benefit society's society action level RBS, regulatory
			 action level RBS, authorized control level RBS, or mandatory control level RBS
			 where:
(a) "Society action level RBS" means,
			 with respect to a fraternal benefit society, the product of 2.0 and its
			 authorized control level RBS;
(b)
			 "Regulatory action level RBS" means the product of 1.5 and its authorized
			 control level RBS;
(c) "Authorized
			 control level RBS" means the number determined under the risk-based surplus
			 formula in accordance with the RBS instructions;
(d) "Mandatory control level RBS" means the
			 product of.70 and the authorized control level RBS.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-36A - Fraternal benefit societies › Section 284-36A-020 - Report of RBS level - Formula for determining level - Inaccurate reports adjusted by commissioner

Current through Register Vol. 24-14, July 15, 2024
(1) On
			 or prior to the annual filing date, which is hereby established as March 1,
			 every fraternal benefit society authorized to transact insurance business in
			 this state, shall prepare and submit to the commissioner a report of its RBS
			 level as of the end of the calendar year just ended, in a form and containing
			 all information required by the RBS instructions.
(2) The RBS of a fraternal benefit society
			 shall be determined in accordance with the formula set forth in the RBS
			 instructions. The formula shall take into account and may adjust for the
			 covariance between:
(a) The risk with respect
			 to the assets of the fraternal benefit society;
(b) The risk of adverse insurance experience
			 with respect to the liabilities and obligations of the fraternal benefit
			 society;
(c) The interest rate risk
			 with respect to the business of the fraternal benefit society; and
(d) All other business risks and other
			 relevant risks as are set forth in the RBS instructions, determined in each
			 case by applying the factors in the manner set forth in the RBS
			 instructions.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-36A - Fraternal benefit societies › Section 284-36A-040 - Society action level event

Current through Register Vol. 24-14, July 15, 2024
(1) "Society action level event" means any of
			 the following events:
(a) The filing of an
			 RBS report by a fraternal benefit society which indicates that the fraternal
			 benefit society's has total adjusted surplus which is greater than or equal to
			 its society action level RBS but less than the product of its authorized
			 control level RBS and 3.0 and has a negative trend;
(b) The notification by the commissioner to
			 the fraternal benefit society of an adjusted RBS report that indicates an event
			 in (a) of this subsection, provided the insurer does not challenge the adjusted
			 RBS report under WAC
			 284-36A-060; or
(c) If, pursuant to WAC
			 284-36A-060, a fraternal benefit
			 society challenges an adjusted RBS report that indicates the event in (a) of
			 this subsection, the notification by the commissioner to the fraternal benefit
			 society that the commissioner has, after a hearing, rejected the fraternal
			 benefit society's challenge.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-36A - Fraternal benefit societies › Section 284-36A-050 - Authorized control level event

Current through Register Vol. 24-14, July 15, 2024
(1) "Authorized control level event" means
			 any of the following events:
(a) The filing
			 of an RBS report by the fraternal benefit society which indicates that the
			 fraternal benefit society's total adjusted capital is greater than or equal to
			 its mandatory control level RBS but less than its authorized control level
			 RBS;
(b) The notification by the
			 commissioner to the fraternal benefit society of an adjusted RBS report that
			 indicates the event in (a) of this subsection, provided the fraternal benefit
			 society does not challenge the adjusted RBS report under WAC
			 284-36A-060;
(c) If, pursuant to WAC
			 284-36A-060, the fraternal
			 benefit society challenges an adjusted RBS report that indicates the event in
			 (a) of this subsection, notification by the commissioner to the fraternal
			 benefit society that the commissioner has, after a hearing, rejected the
			 fraternal benefit society's challenge;
(d) The failure of the fraternal benefit
			 society to respond, in a manner satisfactory to the commissioner, to a
			 corrective order (provided the fraternal benefit society has not challenged the
			 corrective order under WAC
			 284-36A-060); or
(e) If the fraternal benefit society has
			 challenged a corrective order under WAC
			 284-36A-060 and the commissioner
			 has, after a hearing, rejected the challenge or modified the corrective order,
			 the failure of the fraternal benefit society to respond, in a manner
			 satisfactory to the commissioner, to the corrective order subsequent to
			 rejection or modification by the commissioner.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-36A - Fraternal benefit societies › Section 284-36A-055 - Mandatory control level event

Current through Register Vol. 24-14, July 15, 2024
(1) "Mandatory control level event" means any
			 of the following events:
(a) The filing of an
			 RBS report which indicates that the fraternal benefit society's total adjusted
			 surplus is less than its mandatory control level RBS;
(b) Notification by the commissioner to the
			 fraternal benefit society of an adjusted RBS report that indicates the event in
			 (a) of this subsection, provided the fraternal benefit society does not
			 challenge the adjusted RBS report under WAC
			 284-36A-060; or
(c) If, pursuant to WAC
			 284-36A-060, the fraternal
			 benefit society challenges an adjusted RBS report that indicates the event in
			 (a) of this subsection, notification by the commissioner to the fraternal
			 benefit society that the commissioner has, after a hearing, rejected the
			 fraternal benefit society's challenge.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-36A - Fraternal benefit societies › Section 284-36A-060 - Fraternal benefit society's right to a hearing

Current through Register Vol. 24-14, July 15, 2024
(1) Upon notification to a fraternal benefit
			 society by the commissioner of any of the following, the fraternal benefit
			 society shall have the right to a hearing, in accordance with chapters 48.04
			 and 34.05 RCW, at
			 which the fraternal benefit society may challenge any determination or action
			 by the commissioner:
(a) Of an adjusted RBS
			 report; or
(b)
(i) That the fraternal benefit society's RBS
			 plan or revised RBS plan is unsatisfactory; and
(ii) The notification constitutes a
			 regulatory action level event with respect to such fraternal benefit society;
			 or
(c) That the
			 fraternal benefit society has failed to adhere to its RBS plan or revised RBS
			 plan and that such failure has a substantial adverse effect on the ability of
			 the fraternal benefit society to eliminate the society action level event with
			 respect to the fraternal benefit society in accordance with its RBS plan or
			 revised RBS plan; or
(d) Of a
			 corrective order with respect to the fraternal benefit society.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-36A - Fraternal benefit societies › Section 284-36A-065 - RBS report from foreign fraternal benefit society

Current through Register Vol. 24-14, July 15, 2024
(1) In the event of a company action level
			 event, regulatory action level event or authorized control level event with
			 respect to any foreign fraternal benefit society as determined under the RBS
			 statute applicable in the state of domicile of the fraternal benefit society
			 (or, if no RBS statute is in force in that state, under the provisions of this
			 regulation), if the insurance commissioner of the state of domicile of the
			 foreign fraternal benefit society fails to require the foreign fraternal
			 benefit society to file an RBS plan in the manner specified under that state's
			 RBS statute (or, if no RBS statute is in force in that state, under WAC
			 284-36A-040), the commissioner
			 may require the foreign or fraternal benefit society to file an RBS plan with
			 the commissioner. In such event, the failure of the foreign fraternal benefit
			 society to file an RBS plan with the commissioner shall be grounds to order the
			 fraternal benefit society to cease and desist from writing new insurance
			 business in this state.
(2) In the
			 event of a mandatory control level event with respect to any foreign fraternal
			 benefit society, if no domiciliary receiver has been appointed with respect to
			 the foreign fraternal benefit society under the rehabilitation and liquidation
			 statute applicable in the state of domicile of the foreign fraternal benefit
			 society, the commissioner may apply for an order pursuant to
			 RCW
			  48.31.080 to conserve the assets within this
			 state of foreign fraternal benefit society, and the occurrence of the mandatory
			 control level event shall be considered adequate grounds for the
			 application.
Statutory Authority:
				  RCW
				  48.02.060,
				  48.36A.100 and
				  48.36A.290. 98-09-016 (Matter R
				  98-03), §
										284-36A-065, filed 4/6/98,
				  effective 5/7/98.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-37 - Market conduct oversight program › Section 284-37-010 - Definitions

Current through Register Vol. 24-14, July 15, 2024
The following definitions apply throughout this chapter unless
				the context requires otherwise:
(1)
			 "Insurer" shall have the same meaning as set forth in chapter 82, section 5(4),
			 Laws of 2007, and specifically includes health care service contractors, health
			 maintenance organizations, fraternal benefit societies, and self-funded
			 multiple employer welfare arrangements.
(2) "Insurance" shall have the same meaning
			 as set forth in
			 RCW
			  48.01.040, and includes all policies and
			 contracts offered by any insurer, as defined in subsection (1) of this
			 section.
(3) "Complaint" means any
			 written or documented oral communication primarily expressing a grievance,
			 meaning an expression of dissatisfaction.
(4) "NAIC" means the National Association of
			 Insurance Commissioners, and has the same meaning as in
			 RCW
			  48.02.140.
(5) "Records" means any information from data
			 available to the commissioner, surveys, required reports, information collected
			 by the NAIC and other sources in both public and private sectors, and
			 information from within and outside the insurance industry.
Statutory Authority:
				  RCW
				  48.02.060 and 2007 c 82. 07-16-146 (Matter
				  No. R 2007-02), §
										284-37-010, filed 8/1/07,
				  effective 9/1/07.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-37 - Market conduct oversight program › Section 284-37-020 - Procedures manuals

Current through Register Vol. 24-14, July 15, 2024
To foster nationwide consistency in market conduct oversight,
				and as authorized by chapter 82, sections 6, 7 and 8, Laws of 2007 the
				commissioner adopts the following procedures and handbooks published by the
				NAIC and in effect on July 31, 2007, or as later amended. The applicable
				version of the procedure or handbook will be the version in effect when the
				relevant market conduct activity was initiated.
(1)
The NAIC Market Regulation
			 Handbook
for all market conduct oversight activities, as defined at
			 chapter 82, section 5(9), Laws of 2007.
(2)
The NAIC Market Conduct Uniform
			 Examination Procedures
for all market conduct examinations, as defined
			 at chapter 82, section 5(10), Laws of 2007.
(3)
The NAIC Standard Data
			 Request
for all requests to insurers for market data, as defined at
			 chapter 82, section 5(11), Laws of 2007.
Statutory Authority:
				  RCW
				  48.02.060 and 2007 c 82. 07-16-146 (Matter
				  No. R 2007-02), §
										284-37-020, filed 8/1/07,
				  effective 9/1/07.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-37 - Market conduct oversight program › Section 284-37-030 - Access to records

Current through Register Vol. 24-14, July 15, 2024
During the market analysis process, the commissioner may
				require access to identifiable records in the possession of, or subject to
				control or access by the insurer. This section sets forth the process that the
				commissioner will follow when requesting records. Whenever possible and
				appropriate, the commissioner will make these requests electronically.
(1) The commissioner will contact the insurer
			 in writing listing the records to be provided by the insurer for review.
(a) The list will specify the records
			 required by the market conduct oversight personnel and will set forth the
			 preferred method for transmission of records to the market conduct oversight
			 team.
(b) The request will include
			 the reason for the request and summarize how the records are intended to be
			 used.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-37 - Market conduct oversight program › Section 284-37-040 - Market conduct annual statement

Current through Register Vol. 24-14, July 15, 2024
(1) Every insurer shall file with the
			 commissioner its market conduct annual statement, as required by chapter 82,
			 section 6, Laws of 2007, in accordance with filing instructions published by
			 the NAIC.
(2) For purposes of this
			 chapter, the market conduct annual statement filing is not complete until it
			 has been received by the commissioner, in either hard copy or electronic form,
			 as designated by the commissioner.
Statutory Authority:
				  RCW
				  48.02.060 and 2007 c 82. 07-16-146 (Matter
				  No. R 2007-02), §
										284-37-040, filed 8/1/07,
				  effective 9/1/07.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-37 - Market conduct oversight program › Section 284-37-050 - Complaint verification

Current through Register Vol. 24-14, July 15, 2024
If a complaint is filed against an insurer, the commissioner
				will notify the insurer following this process. Whenever possible and
				appropriate, the commissioner will provide the notices detailed below to the
				insurer electronically.
(1) Initial
			 notice to the insurer. The commissioner will send an initial notice to the
			 insurer that identifies the name of the insurer against whom the complaint was
			 filed using the insurer's name and NAIC number, and any other available
			 identifying information as provided to the commissioner by the complainant.
(a) If the insurer disagrees with the name of
			 the insurer as identified in the complaint, it must file an objection in
			 writing no later than fifteen working days after the date the commissioner
			 sends the notice to the insurer and attach appropriate supporting information
			 or documentation.
(b) Failure of
			 the insurer to object to the legal name and NAIC number provided in the initial
			 notice of the complaint within the allotted time, will be considered to be the
			 insurer's verification that the proper insurer is identified in the
			 complaint.
(c) No extension of time
			 to respond to the initial notice will be permitted except for good cause
			 shown.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-37 - Market conduct oversight program › Section 284-37-060 - Dispute resolution

Current through Register Vol. 24-14, July 15, 2024
As required at chapter 82, section 14(3), Laws of 2007, after
				the deputy insurance commissioner responsible for market conduct oversight has
				responded to an insurer's issues, the insurer may request mediation of the
				issues. The following process governs mediation of insurer market conduct
				oversight issues.
(1) A request for
			 mediation of the issues must be made within five working days after receipt by
			 the insurer of a final decision on any issue.
(2) The commissioner will maintain a list of
			 approved mediators to mediate disputed issues. All approved mediators will be
			 qualified by training and experience.
(a) The
			 commissioner will publish a copy of the current resume and fee schedule of each
			 panel mediator on the commissioner's web site (
www.insurance.wa.gov
).
(b) At the start of a market analysis process
			 or the start of a market conduct examination, the insurer must select a
			 mediator and alternate mediator from the approved list.
(c) The party requesting mediation is
			 required to pay the costs of the mediator.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-38 - Charitable gift annuities › FILING CHARITABLE GIFT ANNUITY CONTRACTS FORMS › Section 284-38-010 - Definitions

Current through Register Vol. 24-14, July 15, 2024
The definitions in this section apply throughout this
				  chapter:
"Certificate holder" means any insurer or educational,
				  religious, charitable, or scientific institution that has been issued a
				  certificate of exemption by the commissioner to conduct a charitable gift
				  annuity business.
"Complete filing" means a package of information containing
				  charitable gift annuity contracts, supporting information, documents and
				  exhibits submitted to the commissioner electronically using the system for
				  electronic rate and form filing (SERFF).
"Contract" means a charitable gift annuity contract as
				  described in chapter 48.38 RCW.
"Date filed" means the date a complete charitable gift
				  annuity contract filing has been received and accepted by the commissioner.
				  "Filer" means a person, organization, or other entity that files charitable
				  gift annuity contracts with the commissioner.
"Objection letter" means correspondence sent by the
				  commissioner to the filer that:
(a)
				Requests clarification, documentation or other information;
(b) Explains errors or omissions in the
				filing; or
(c) Disapproves a
				charitable gift annuity contract under
				RCW
				 48.38.010(9),
				48.18.110,
				48.38.030,
				or
				48.38.042.
"SERFF" means the system for electronic rate and form filing.
				  SERFF is a proprietary National Association of Insurance Commissioners (NAIC)
				  computer-based application that allows filers to create and submit rate, rule,
				  and form filings electronically to the commissioner.
"Unrestricted net assets" also means "net assets without
				  donor restrictions."
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-38 - Charitable gift annuities › FILING CHARITABLE GIFT ANNUITY CONTRACTS FORMS › Section 284-38-100 - Filing instructions that are incorporated into this chapter

Current through Register Vol. 24-14, July 15, 2024
SERFF is a dynamic application that the NAIC will revise and
				  enhance over time. To be consistent with NAIC filing standards and provide
				  timely instructions to filers, the commissioner must incorporate documents
				  posted on the SERFF web site into this chapter. By reference, the commissioner
				  incorporates these documents into this chapter:
(1) The
SERFF Industry Manual
available within the SERFF application; and
(2) State specific rate and form filing
				instructions posted on the commissioner's web site (
www.insurance.wa.gov
), including the:
Washington State SERFF Life and Disability Form
				  Filing General Instructions.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-38 - Charitable gift annuities › FILING CHARITABLE GIFT ANNUITY CONTRACTS FORMS › Section 284-38-110 - General charitable gift annuity contract filing rules

Current through Register Vol. 24-14, July 15, 2024
Filers and certificate holders must submit complete filings
				  that comply with these rules:
(1)
				Filers must submit complete filings that comply with the
SERFF Industry Manual
available within the
				  SERFF application as well as state specific instructions applicable to the
				  particular filing, as posted on the commissioner's web site (
www.insurance.wa.gov
), including the:
Washington State SERFF Life and Disability Form
				  Filing General Instructions.
(2) Filers must submit every charitable gift
				annuity contract to the commissioner electronically using SERFF.
(a) Every charitable gift annuity contract
				filed in SERFF must be attached to the form schedule.
(b) All written correspondence related to a
				charitable gift annuity contract filing must be sent in SERFF.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-38 - Charitable gift annuities › FILING CHARITABLE GIFT ANNUITY CONTRACTS FORMS › Section 284-38-120 - Filing revised or replaced charitable gift annuity contracts forms

Current through Register Vol. 24-14, July 15, 2024
If a revised or replaced charitable gift annuity contract
				  form is being filed, in addition to the requirements of WAC
				  284-38-110, the filer must
				  provide the following supporting documentation:
(1) If a contract is revised due to an
				objection(s) from the commissioner, the filer must provide a detailed
				explanation of all material changes to the disapproved contract.
(2) If a previously approved contract is
				replaced with a new version, the filer must submit an exhibit that marks and
				identifies each change or revision to the replaced contract using one of these
				methods:
(a) A draft contract that strikes
				through deletions and underlines additions or changes in the
				contract;
(b) A draft contract that
				includes comments in the margins explaining the changes in the contract;
				or
(c) A side-by-side comparison of
				current and proposed contract language.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-38 - Charitable gift annuities › FILING CHARITABLE GIFT ANNUITY CONTRACTS FORMS › Section 284-38-130 - Filing authorization rules

Current through Register Vol. 24-14, July 15, 2024
(1) A certificate holder may authorize a
				third party to file charitable gift annuity contracts on its behalf.
(2) If a certificate holder delegates filing
				authority to a third party, each filing must include a letter signed by an
				employee of the certificate holder authorizing the third party to make filings
				on behalf of the certificate holder. This subsection does not apply to a third
				party that is an affiliate or wholly owned subsidiary of the certificate
				holder.
(3) The certificate holder
				may not delegate responsibility for the content of a filing to a third party.
				The commissioner considers errors and omissions by the third party to be errors
				and omissions of the certificate holder.
(4) If a third party has a pattern of making
				filings that do not comply with this subpart, the commissioner may reject a
				delegation of filing authority from the certificate holder.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-38 - Charitable gift annuities › FILING CHARITABLE GIFT ANNUITY CONTRACTS FORMS › Section 284-38-140 - The commissioner may reject annuity contract filings

Current through Register Vol. 24-14, July 15, 2024
(1) The
				commissioner may reject and close any filing that does not comply with WAC
				284-38-100. If the commissioner
				rejects a filing, the certificate holder has not filed the charitable gift
				annuity contract with the commissioner.
(2) If the commissioner rejects a filing and
				the filer resubmits it as a new filing, the date filed will be the date the
				commissioner receives and accepts the new filing.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-38 - Charitable gift annuities › FILING CHARITABLE GIFT ANNUITY CONTRACTS FORMS › Section 284-38-150 - Responding to objection letters

Current through Register Vol. 24-14, July 15, 2024
If the commissioner disapproves a filing under
				  RCW
				   48.38.010(9),
				  48.18.110,
				  48.38.030, or
				  48.38.042, the objection letter
				  will state the reason(s) for disapproval, including relevant law and
				  administrative rules. Filers must:
(1)
				Provide a complete response to an objection letter. A complete response
				includes:
(a) A separate response to each
				objection; and
(b) If appropriate,
				revised exhibits and supporting documentation.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-38 - Charitable gift annuities › ANNUAL REPORTING REQUIREMENTS › Section 284-38-200 - Annual reporting requirements

Current through Register Vol. 24-14, July 15, 2024
(1) Every certificate holder must
				electronically file with the commissioner a completed annual report within 60
				days of its fiscal year end. A copy of the annual report form and instructions
				for completing and filing the annual report are available on the commissioner's
				website at
www.insurance.wa.gov
(2) As an ongoing statement of financial
				condition, required under RCW  48.38.010(10), the certificate holder must
				annually electronically file the following financial reports:
(a)
(i) An
				audited financial statement specific to the certificate holder prepared in
				accordance with generally accepted accounting principles for the fiscal year
				immediately preceding; or
(ii) A
				consolidated audited financial statement prepared in accordance with generally
				accepted accounting principles for the fiscal year immediately preceding, which
				includes a supplemental schedule specific to the certificate holder.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-43 - Health carriers and health plans › Subchapter A - GENERAL PROVISIONS › Section 284-43-0110 - Purpose

Current through Register Vol. 24-14, July 15, 2024
The purpose of this chapter is to establish uniform
				  regulatory standards for health carriers and to create minimum standards for
				  health plans that ensure consumer access to the health care services promised
				  in these health plans.
Statutory Authority: RCW  48.02.060, 48.20.450, 48.20.460,
					 48.30.010, 48.44.020, 48.44.050, 48.44.080, 48.46.030, 48.46.060(2), 48.46.200 and 48.46.243. WSR 98-04-005 (Matter No. R 97-3), § 284-43-110, filed
					 1/22/98, effective 2/22/98.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-43 - Health carriers and health plans › Subchapter A - GENERAL PROVISIONS › Section 284-43-0120 - Applicability and scope

Current through Register Vol. 24-14, July 15, 2024
This chapter shall apply to all health plans and all health
				  carriers subject to the jurisdiction of the state of Washington except as
				  otherwise expressly provided in this chapter. Health carriers are responsible
				  for compliance with the provisions of this chapter and are responsible for the
				  compliance of any person or organization acting on behalf of or at the
				  direction of the carrier, or acting pursuant to carrier standards or
				  requirements concerning the coverage of, payment for, or provision of health
				  care services. A carrier may not offer as a defense to a violation of any
				  provision of this chapter that the violation arose from the act or omission of
				  a participating provider or facility, network administrator, claims
				  administrator, or other person acting on behalf of or at the direction of the
				  carrier, or acting pursuant to carrier standards or requirements under a
				  contract with the carrier rather than from the direct act or omission of the
				  carrier. Nothing in this chapter shall be construed to permit the direct
				  regulation of health care providers or facilities by the office of the
				  insurance commissioner.
Statutory Authority: RCW  48.02.060, 48.18.120, 48.20.450,
					 48.20.460, 48.30.010, 48.44.050, 48.46.030, 48.46.200. WSR 00-04-034 (Matter
					 No. R 99-2), § 284-43-120, filed 1/24/00, effective 2/24/00. Statutory
					 Authority: RCW  48.02.060, 48.20.450, 48.20.460, 48.30.010, 48.44.020,
					 48.44.050, 48.44.080, 48.46.030, 48.46.060(2), 48.46.200 and 48.46.243. WSR
					 98-04-005 (Matter No. R 97-3), § 284-43-120, filed 1/22/98, effective
					 2/22/98.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-43 - Health carriers and health plans › Subchapter A - GENERAL PROVISIONS › Section 284-43-0140 - Compliance with state and federal laws

Current through Register Vol. 24-14, July 15, 2024
Health carriers shall comply with all Washington state and
				  federal laws relating to the acts and practices of carriers and laws relating
				  to health plan benefits.
Statutory Authority: RCW  48.02.060, 48.18.120, 48.20.450,
					 48.20.460, 48.30.010, 48.44.050, 48.46.030, 48.46.200. WSR 00-04-034 (Matter
					 No. R 99-2), § 284-43-125, filed 1/24/00, effective
					 2/24/00.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-43 - Health carriers and health plans › Subchapter A - GENERAL PROVISIONS › Section 284-43-0160 - Definitions

Current through Register Vol. 24-14, July 15, 2024
Except as defined in other subchapters and unless the context
				  requires otherwise, the following definitions shall apply throughout this
				  chapter.
(1) "Adverse determination"
				has the same meaning as the definition of adverse benefit determination in
				RCW
				 48.43.005, and includes:
(a) The determination includes any decision
				by a health carrier's designee utilization review organization that a request
				for a benefit under the health carrier's health benefit plan does not meet the
				health carrier's requirements for medical necessity, appropriateness, health
				care setting, level of care, or effectiveness or is determined to be
				experimental or investigational and the requested benefit is therefore denied,
				reduced, or terminated or payment is not provided or made, in whole or in part
				for the benefit;
(b) The denial,
				reduction, termination, or failure to provide or make payment, in whole or in
				part, for a benefit based on a determination by a health carrier or its
				designee utilization review organization of a covered person's eligibility to
				participate in the health carrier's health benefit plan;
(c) Any prospective review or retrospective
				review determination that denies, reduces, or terminates or fails to provide or
				make payment in whole or in part for a benefit;
(d) A rescission of coverage determination;
				or
(e) A carrier's denial of an
				application for coverage.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-43 - Health carriers and health plans › Subchapter B - PLAN MANAGEMENT › Section 284-43-0200 - Deadline for filing individual health plans, small group health plans, and stand-alone dental plans

Current through Register Vol. 24-14, July 15, 2024
This section applies to all individual health plans, small
				  group health plans, and stand-alone dental plans that provide pediatric dental
				  benefits as one of the essential health benefits. Each year, issuers must file
				  with the commissioner a complete rate and form filing for the next calendar
				  year on or before the deadline set by the commissioner. The commissioner must
				  announce and post the filing deadline no later than March 31st of each year.
				  Issuers will be permitted to amend filings only at the direction of the
				  commissioner. Filings not timely submitted will be rejected without
				  review.
Statutory Authority: RCW  48.02.060, 48.18.100, 48.43.340,
					 48.43.715, 48.44.050, and 48.46.200. WSR 14-07-047 (Matter No. R 2013-27),
					 §
											284-170-870, filed 3/13/14, effective
					 4/13/14.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-43 - Health carriers and health plans › Subchapter B - PLAN MANAGEMENT › Section 284-43-0201 - Alternate access delivery request

Current through Register Vol. 24-14, July 15, 2024
(1) Where an issuer's network meets one or
				more of the criteria in WAC
				284-43-200(15)(a) through
				(d), the issuer may submit an alternate
				access delivery request for the commissioner's review and approval. The
				alternate access delivery request must be made using the Alternate Access
				Delivery Request Form C, as provided in WAC
				284-43-220(3)(d).
(a) An alternate access delivery system must
				provide enrollees with access to medically necessary care on a reasonable basis
				without detriment to their health.
(b) The issuer must ensure that the enrollee
				obtains all covered services in the alternate access delivery system at no
				greater cost to the enrollee than if the service was obtained from network
				providers or facilities or must make other arrangements acceptable to the
				commissioner.
(i) Copayments and deductible
				requirements must apply to alternate access delivery systems at the same level
				they are applied to in-network services.
(ii) The alternate access delivery system may
				result in issuer payment of billed charges to ensure network access.
(c) An issuer must demonstrate in
				its alternate access delivery request a reasonable basis for not meeting a
				standard as part of its filing for approval of an alternate access delivery
				system, and include an explanation of why the alternate access delivery system
				provides a sufficient number or type of the provider or facility to which the
				standard applies to enrollees.
(d)
				An issuer must demonstrate a plan and practice to assist enrollees to locate
				providers and facilities in neighboring service areas in a manner that assures
				both availability and accessibility. Enrollees must be able to obtain health
				care services from a provider or facility within the closest reasonable
				proximity of the enrollee in a timely manner appropriate for the enrollee's
				health needs.
Alternate access delivery systems include, but are not
				  limited to, such provider network strategies as use of out-of-state and out of
				  county or service area providers, and exceptions to network standards based on
				  rural locations in the service area.
Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-43 - Health carriers and health plans › Subchapter B - PLAN MANAGEMENT › Section 284-43-0202 - Maintenance of sufficient provider networks

Current through Register Vol. 24-14, July 15, 2024
(1) An issuer must maintain and monitor its
				provider networks on an ongoing basis for compliance with the network access
				standards set forth in WAC
				284-43-200. This includes an
				issuer of a stand-alone dental plan offered through the exchange or a
				stand-alone dental plan offered outside the exchange for the purpose of
				providing the essential health benefit category of pediatric oral benefits,
				which must maintain and monitor its networks for compliance with WAC
				284-43-200(14).
				An issuer must report to the commissioner, within the time frames stated in
				this section, any changes affecting the ability of its network providers and
				facilities to furnish covered services to enrollees.
(2)An issuer must notify the OIC in writing
				within five business days of either receiving or issuing a written notice of
				potential contract termination that would affect the network's ability to meet
				the standards set forth in WAC
				284-43-200. Notice of potential
				termination must include an issuer's preliminary determination of whether an
				alternate access delivery request must be filed and the documentation
				supporting that determination. The issuer's notice must be submitted
				electronically following the submission instructions on the commissioner's web
				site.
(a)If the issuer determines that an
				alternate access delivery request must be submitted to comply with WAC
				284-43-200(15),
				the issuer has ten business days to submit the request and supporting
				documentation for the alternate access delivery request in accordance with WAC
				284-43-220(3)(d).
(b)If, after reviewing the issuer's
				preliminary determination that an alternate access delivery request is not
				necessary, the OIC determines that an alternate access delivery request is
				required to comply with WAC
				284-43-200(15),
				the issuer has five business days to submit the request and supporting
				documentation for the alternate access delivery request in accordance with WAC
				284-43-220(3)(d).
(c)If the OIC determines that a network is
				out of compliance with WAC
				284-43-200 and the issuer has
				failed to report this change to the OIC, the issuer must, within one business
				day of notification by the OIC, submit an alternate access delivery request in
				accordance with WAC
				284-43-200(15)
				and supporting documentation for the alternate access delivery request in
				accordance with WAC
				284-43-220(3)(d).