Washington Administrative Code

(1) The commissioner may reject and close any filing that does not comply with WAC 284-20C-020. If the commissioner rejects a filing, the provider has not filed the service contract(s) with the commissioner.(2) If the commissioner rejects a filing and the filer resubmits it as a …

(1) RCW 48.110.073(3) says contracts must be filed with the commissioner within sixty days after the provider first issues the contract to a consumer. If the commissioner rejects a filing under WAC 284-20C-030, the provider has not filed contracts with the commissioner.(2) If the…

(1) A provider may authorize a third-party filer to file contracts on its behalf. Under this section, a "third-party filer" means:(a) An administrator as defined in RCW 48.110.020(1);(b) An insurer; or(c) A person or entity in the business of providing regulatory compliance servi…

If a provider files a revised or replaced contract, the filer must provide the supporting documentation described below:(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 disappro…

(1) Filers must include a common effective date for all contracts submitted in a filing.(2) The proposed effective date must be a specific date.(a) Vague statements, such as one that says the provider will implement a filing thirty days after the commissioner's approval is not sp…

If a provider will use a previously approved Washington amendatory form with a new contract, the filer must:(1) Provide a copy of the amendatory form as supporting documentation; or(2) Provide the company tracking number from the contract filing under which the endorsement was fi…

An objection letter may ask the filer to revise noncompliant contracts or provide clarification or additional information about the contract. If the commissioner finds that a contract contains provisions that are contrary to RCW 48.110.073, the objection letter will state the rea…

Providers may issue motor vehicle service contracts written in languages other than English.(1) If a provider translates a contract from English to another language, the provider must:(a) File the translated version of the contract with the commissioner.(b) Include written disclo…

After March 1, 1968, no new policy of automobile physical damage insurance or property insurance covering property located in the state of Washington shall be endorsed with a long form loss payable or mortgagee clause, other than:(1) For automobile physical damage insurance, the …

loss payable endorsementThis form is identical to that promulgated in Washington State Insurance Commissioner's Regulation No. 335, pursuant to section 1, chapter 12, Laws of 1967, ex. sess., State of Washington.1. Loss or damage, if any, under this policy shall be payable first …

(1) Except as otherwise specifically provided, this chapter applies to all supplemental long-term care insurance policies, contracts, or riders delivered or issued for delivery in this state on or after May 1, 2026, including qualified supplemental long-term care insurance polici…

For the purpose of this chapter, the following definitions apply, unless the context clearly requires otherwise.(1) "Applicant" has the meaning set forth in RCW 48.212.020.(2) "Certificate" has the meaning set forth in RCW 48.212.020.(3) "Exceptional increase" means only those in…

A supplemental long-term care insurance policy or certificate delivered or issued for delivery in this state must not use the following terms unless the terms are defined in the policy or certificate and the definitions satisfy the following standards. This section specifies mini…

The following standards for policy provisions apply to all supplemental long-term care insurance policies delivered or issued for delivery in this state.(1) Renewability. The terms "guaranteed renewable" and "noncancellable" must not be used in any individual supplemental long-te…

As a protection against unintentional lapse, each issuer offering supplemental long-term care insurance must comply with all of the following:(1)(a) Notice before lapse or termination. No individual supplemental long-term care insurance policy or certificate may be issued until t…

(1) Renewability. Supplemental long-term care insurance policies must contain a renewability provision.(a) The renewability provision must be appropriately captioned, must appear on the first page of the policy, and must clearly state that the coverage is guaranteed renewable or …

(1) Except for policies for which no applicable premium rate or rate schedule increases can be made, the issuer must provide all of the information listed in this subsection to the applicant at the time of application or enrollment. If the method of application does not allow for…

An issuer shall not issue, deliver, or use a supplemental long-term care insurance policy, contract, rider, certificate, or application form unless it has been filed with and approved by the commissioner. The issuer must provide the following information to the commissioner for r…

(1) All applications for supplemental long-term care insurance policies or certificates except those that are guaranteed issue must contain clear and unambiguous questions designed to ascertain the health condition of the applicant.(2)(a) If an application for supplemental long-t…

(1) Supplemental long-term care insurance policies, certificates, contracts, or riders must provide benefits for home health care or community care services. Supplemental long-term care insurance policies, certificates, contracts, or riders must not limit or exclude benefits for …

(1) If an issuer makes a determination pursuant to RCW 48.212.090(2) that a policyholder's care and safety needs are not being met by the policyholder's current care setting or provider upon transition from the benefits provided under chapter 50B.04 RCW, the issuer must:(a) Notif…

The following form must be used by issuers to annually report independent third-party review appeal decisions concerning changes made by issuers for supplemental long-term care policyholders under RCW 48.212.090(2).INDEPENDENT THIRD-PARTY REVIEW APPEALS REPORTING FORM FOR SUPPLEM…

(1) No issuer may offer a supplemental long-term care insurance policy in this state unless the issuer also offers to the policyholder, in addition to any other inflation protection, the option to purchase a policy that provides for benefit levels to increase with benefit maximum…

(1) Application forms must include questions designed to elicit information as to whether, as of the date of the application, the applicant has another health, supplemental long-term care, or long-term care insurance policy or certificate in force or whether a supplemental long-t…

The following notice is required in WAC 284-212-060(3):notice to applicant regarding replacement of individual [accident and sickness] [health] [SUPPLEMENTAL LONG-TERM CARE INSURANCE] OR [LONG-TERM CARE INSURANCE][Insurance company's name and address]SAVE THIS NOTICE! IT MAY BE I…

The following notice is required by WAC 284-212-060(4):NOTICE TO APPLICANT REGARDING REPLACEMENT OF [ACCIDENT AND SICKNESS] [HEALTH] [SUPPLEMENTAL LONG-TERM CARE INSURANCE] OR [LONG-TERM CARE INSURANCE][Insurance company's name and address]save this notice! it may be important to…

(1) Every issuer must maintain records for each insurance producer of that producer's amount of replacement sales as a percent of the insurance producer's total annual sales and the amount of lapses of supplemental long-term care insurance policies sold by the insurance producer …

Upon written request and after an administrative hearing, the commissioner may enter an order to modify or suspend a specific provision or provisions of this chapter with respect to a specific supplemental long-term care insurance policy or certificate upon a written finding that…

(1) If supplemental long-term care benefits are provided through the acceleration of benefits under group or individual life policies or riders to such policies, policy reserves for the benefits must be determined in accordance with RCW 48.74.030 (1)(g). Claim reserves must also …

(1) The issuer shall not provide notice of a pending premium rate schedule increase, including an exceptional increase, unless it has been filed with and approved by the commissioner, prior to giving the notice to the policyholders and must include:(a) Information required by WAC…

Prior to offering group supplemental long-term care insurance to a resident of this state pursuant to RCW 48.212.040 the issuer or similar organization must file with the commissioner evidence that the group policy or certificate has been approved by a state having statutory or r…

(1) Every issuer or other entity issuing supplemental long-term care insurance in this state must provide a copy of any supplemental long-term care insurance advertisement intended for use in this state whether through written, radio, or television medium for review by the commis…

(1) Every issuer or entity marketing supplemental long-term care insurance coverage in this state, directly or through its insurance producers, must:(a) Establish marketing procedures and insurance producer training requirements to ensure that:(i) Any marketing activities, includ…

(1) This section does not apply to life insurance policies that accelerate benefits for supplemental long-term care.(2) Every issuer or other entity marketing supplemental long-term care insurance must:(a) Develop and use suitability standards to determine whether the purchase or…

If a supplemental long-term care insurance policy or certificate replaces another supplemental long-term care or long-term care policy or certificate, the replacing issuer must waive any time periods applicable to preexisting conditions and probationary periods in the new supplem…

(1) The issuer must notify policyholders of the availability of a new supplemental long-term care insurance policy series that provides coverage for new long-term care services or providers material in nature and not previously available through the issuer to the general public. …

(1)(a) Every supplemental long-term care insurance policy and certificate must include a provision that allows the policyholder or certificate holder to reduce coverage and lower the policy or certificate premium in at least one of the following ways:(i) Reducing the maximum bene…

(1) This section does not apply to life insurance policies or riders containing accelerated supplemental long-term care benefits.(2) To comply with the requirement to offer a nonforfeiture benefit pursuant to the provisions of RCW 48.212.150;(a) A policy or certificate offered wi…

(1) A supplemental long-term care insurance policy must condition the payment of benefits on a determination of the insured's ability to perform activities of daily living or on cognitive impairment of the insured. Eligibility for the payment of benefits must not be more restrict…

(1) For purposes of this section the following definitions apply:(a) "Qualified long-term care services" means services that meet the requirements of Section 7702B (c)(1) of the Internal Revenue Code of 1986, as amended, including: Necessary diagnostic, preventive, therapeutic, c…

The following standards apply to the format and outline of coverage to be used in this state.(1) The outline of coverage must be a free-standing document, using no smaller than 12-point type.(2) The outline of coverage must contain no material of an advertising nature.(3) Text th…

(1) A supplemental long-term care insurance consumer's guide in the format developed or approved by the commissioner, must be provided to all prospective applicants of a supplemental long-term care insurance policy or certificate.(a) In the case of solicitations by an insurance p…

The following practices are prohibited:(1) No insurance producer or other representative of the issuer may complete the medical history portion of any form or application, including an electronic application, for the purchase of a supplemental long-term care insurance policy.(2) …

The following form must be used by issuers to annually report rescission of supplemental long-term care insurance policies.RESCISSION REPORTING FORM FOR SUPPLEMENTAL LONG-TERM CARE INSURANCE POLICIES FOR THE STATEOF FOR THE REPORTING YEAR 20[ ] Company Name: Address: Phone Number…

The following form of personal worksheet must be used by issuers in the sale of supplemental long-term care insurance policies.Supplemental Long-Term Care InsurancePersonal WorksheetSupplemental long-term care policies may only be used once benefits under the WA Cares Fund have b…

The following form of disclosure must be used in this state.Things You Should Know Before You BuySupplemental Long-Term Care InsuranceSupplemental Long-TermCare InsuranceA supplemental long-term care insurance policy may pay most of the costs for your care in a nursing home, at h…

The following form of response letter must be used in this state.Supplemental Long-Term Care Insurance Suitability LetterDear [Applicant]:Your recent application for supplemental long-term care insurance included a "personal worksheet," which asked questions about your finances a…

The following form for reporting claims denials must be used in this state.Claims Denial Reporting FormSupplemental Long-Term Care InsuranceFor the State of For the Reporting Year of Company Name: Due: June 30, annuallyCompany Address: Company NAIC Number: Contact Person: Phone N…

The following form must be used in this state to disclose a potential rate increase.Instructions:This form provides information to the applicant regarding premium rate schedules, rate schedule adjustments, potential rate revisions, and policyholder options in the event of a rate …

The following form must be used in this state to report replacements and lapses of supplemental long-term care insurance.Supplemental Long-Term Care Insurance Replacement and Lapse Reporting FormFor the State of For the Reporting Year of Company Name: Due: June 30, AnnuallyCompan…