Washington Administrative Code

For purposes of WAC 284-212-210 through 284-212-250:(1) "Actual loss ratio" means a retrospective calculation and calculated as the benefits incurred divided by the "premiums earned," both measured from the beginning of the calculating period to the date of the loss ratio calcula…

(1) The actuary responsible for setting premium rates must group similar policy forms, including forms no longer being marketed, in the pricing calculations.(a) The grouping must be satisfactory to the commissioner, who may rely on the judgment of the pricing actuary.(b) Factors …

For reporting and record-keeping purposes, all issuers must separate data concerning supplemental long-term care insurance policies from data concerning other insurance policies.[Statutory Authority: RCW 48.02.060 (3)(a), 48.85.030(1), 48.212.140, 48.212.150, 48.212.170, 48.212.2…

The following standards and requirements apply to supplemental long-term care insurance forms:(1) Benefits for individual supplemental long-term care insurance forms will be deemed reasonable in relation to the premiums if the overall loss ratio is at least 60 percent over a calc…

Issuers must maintain records of earned premiums and incurred benefits for each policy year for each contract, rider, endorsement and similar form which is combined for purposes of premium calculations, including the reserves. Records must be maintained of the experience expected…

In determining the credibility and appropriateness of experience data, due consideration will be given by the commissioner to all relevant factors including:(1) Statistical credibility of premiums and benefits such as low exposure or low loss frequency;(2) Past and projected tren…

(1) WAC 284-212-210 through 284-212-245 do not apply to life insurance policies that accelerate benefits for supplemental long-term care.(2) A life insurance policy that funds supplemental long-term care benefits entirely by accelerating the death benefit is considered to provide…

Unless a supplemental long-term care benefit is funded through a life insurance policy by the acceleration of death benefit, a supplemental long-term care insurance policy rate or form must not be filed as a rider to a life insurance policy. Issuers of supplemental long-term care…

Issuers must adopt and use administrative, business, and operational practices and procedures designed to protect an insured's right to privacy granted under chapter 70.02 RCW and federal laws and regulations. For example, issuers must not disclose the insured's health informatio…

Issuers must adopt and use administrative, business, and operational practices and procedures to protect the insured's right to confidential health care services.[Statutory Authority: RCW 48.02.060 (3)(a), 48.85.030(1), 48.212.140, 48.212.150, 48.212.170, 48.212.200, and 48.85.03…

The following administrative, business, and operational standards must be used by issuers to ensure timely review of a claim denial.(1) Issuers must have a fully operational, comprehensive claims denial review process.(2) Issuers must implement procedures for registering and resp…

(1) The purpose of this section is to effectuate RCW 48.212.120 and 48.212.200 by establishing prompt payment requirements for supplemental long-term care insurance.(2) For purposes of this section, the following definitions apply:(a) "Claim" means a request for payment of benefi…

If there is a discrepancy between a description of the terms and conditions of insurance between the master policy and any certificate issued under that master policy, the description most favorable to the insured must be used by the issuer and governs the matter.[Statutory Autho…

WAC 284-212-400 through 284-212-420 is adopted pursuant to RCW 48.85.030 and 48.85.040. The purpose of these sections is to effectuate chapter 48.85 RCW, the Washington Long-Term Care Partnership Act. Pursuant to RCW 48.85.030, these sections establish minimum standards and discl…

(1) WAC 284-212-400 through 284-212-420 applies to any supplemental long-term care insurance policy that is federally tax-qualified and meets the requirements to participate in the state long-term care partnership program, as defined by federal law and this chapter.(2) These sect…

Every supplemental long-term care partnership policy must meet the standards for supplemental long-term care insurance policies or contracts in chapters 48.85 and 48.212 RCW, and this chapter, unless specifically provided otherwise.(1) As used in WAC 284-212-400 through 284-212-4…

(1) Within one year of the date that an issuer begins to advertise, market, offer, or sell policies that qualify under the Washington state long-term care partnership program, the issuer must offer to all of its current policyholders and certificate holders the opportunity to exc…

All issuers of qualified supplemental long-term care partnership policies must provide regular reports to the United States Secretary of Health and Human Services in accordance with regulations of the secretary. These reports include notification regarding when benefits provided …

Prior to selling, soliciting, or negotiating, or continuing to sell, solicit, or negotiate supplemental long-term care partnership policies in this state, all licensed producers must meet the education requirements in RCW 48.212.160.[Statutory Authority: RCW 48.02.060 (3)(a), 48.…

These rules and regulations, adopted under the authority of chapter 177, Laws of 1993, shall be entitled the Washington United States Longshore and Harbor Workers' Compensation Act assigned risk plan (hereinafter referred to as "the assigned risk plan").[Statutory Authority: RCW …

The purposes of the assigned risk plan are:(1) To promote a strong and healthy maritime industry, within Washington state, by ensuring the continued availability of workers' compensation coverage required by the United States Longshore and Harbor Workers' Act and maritime employe…

(1) The assigned risk plan shall become effective at 12:01 a.m. July 1, 1992.(2) The assigned risk plan shall not terminate until all policies under the plan have expired and outstanding obligations incurred under such policies have been satisfied.[Statutory Authority: RCW 48.02.…

(1) The assigned risk plan shall provide coverage only for employers who are unable to purchase United States Longshore and Harbor Workers' Compensation Act (USL&H) coverage and maritime employers' liability coverage incidental to such workers' compensation coverage for their ope…

(1) "Administrator" means any organization designated by the assigned risk plan and approved by the commissioner to provide administrative support for the plan. Such support shall be defined by the governing committee in its operating plan. It may include, but is not limited to, …

(1) Participation in the assigned risk plan is mandatory for all authorized insurers writing primary or excess United States Longshore and Harbor Workers' Act compensation insurance in Washington state, and for the state industrial insurance fund.(2) Any assessments and distribut…

(1) The governing committee shall be responsible for the administration of the assigned risk plan.(2) The committee shall meet at least once each calendar quarter. Seven members shall constitute a quorum, provided that the department of labor and industries and each of the define…

(1) The commissioner shall approve the assigned risk plan's operating procedures if they provide for the fair, reasonable, and equitable administration of the assigned risk plan for all concerned.(2) The commissioner shall approve rate and form filings made by the servicing carri…

Any applicant, person insured under the plan, or participating insurer, aggrieved by a ruling or decision of the plan shall have a right to appeal such decision to the commissioner. Appeals to the commissioner under this program shall in all other respects not set forth herein, b…

(1) This regulation, WAC 284-23-010 through 284-23-130, shall be known and may be cited as the "Washington life insurance advertising regulation."(2) The purpose of this regulation is to set forth minimum standards and guidelines to assure a full and truthful disclosure to the pu…

(1) For the purpose of this regulation:(a) "Policy" shall include any policy, plan, certificate, contract, agreement, statement of coverage, rider, or endorsement which provides for life insurance or annuity benefits.(b) "Insurer" shall include any organization or person which is…

(1) This regulation shall apply to any life insurance or annuity advertisement intended for dissemination in this state.(2) Every insurer shall establish and at all times maintain a system of control over the content, form and method of dissemination of all advertisements of its …

(1) Advertisements shall be truthful and not misleading in fact or by implication. The form and content of an advertisement of a policy shall be sufficiently complete and clear so as to avoid deception. It shall not have the capacity or tendency to mislead or deceive.(2) Whether …

(1) The information required to be disclosed by these rules shall not be minimized, rendered obscure or presented in an ambiguous fashion or intermingled with the text of the advertisement so as to be confusing or misleading.(2) No advertisement shall omit material information or…

(1) The full name and home office of the insurer shall be clearly identified, and if any specific individual policy is advertised it shall be identified either by form number or other appropriate description. An advertisement shall not use a trade name, an insurance group designa…

(1) An advertisement which reasonably is expected to be seen or heard beyond the limits of the jurisdiction in which the insurer is licensed shall not imply licensing beyond such limits.(2) An advertisement may state that an insurer is licensed in the state where the advertisemen…

An advertisement shall not contain statements, pictures or illustrations which are false or misleading, in fact or by implication, with respect to the assets, liabilities, insurance in force, corporate structure, financial condition, age or relative position of the insurer in the…

Each insurer shall maintain at its home or principal office a complete file containing a specimen copy of every printed, published or prepared advertisement of its individual policies and specimen copies of typical printed, published or prepared advertisements of its blanket, fra…

It is not intended that these rules conflict with or supersede any rules currently in force or subsequently adopted in this state governing specific aspects of the sale or replacement of life insurance including, but not limited to, rules dealing with life insurance cost comparis…

A violation of this regulation, WAC 284-23-010 through 284-23-130, is hereby defined to be an unfair method of competition and an unfair or deceptive act or practice in the conduct of the business of insurance, pursuant to RCW 48.30.010.[Order R-75-3, § 284-23-110, filed 8/22/75,…

(1) The purpose of this regulation is to require insurers to deliver to purchasers of life insurance, information which will improve the buyer's ability to select the most appropriate plan of life insurance for the buyer's needs, improve the buyer's understanding of the basic fea…

(1) Except for the exemptions specified in subsection (2) of this section, this regulation shall apply to any solicitation, negotiation or procurement of life insurance occurring within this state. This regulation shall apply to any issuer of life insurance contracts including fr…

For the purposes of this regulation, the following definitions shall apply:(1) "Buyer's Guide" is a document that contains, and is limited to, the current buyer's guide, which has been recommended for use by the National Association of Insurance Commissioners. A company must use …

(1) The insurer shall provide a Buyer's Guide and a policy summary to any prospective purchaser upon request.(2) The insurer shall provide, to all prospective purchasers, a Buyer's Guide prior to accepting the applicant's initial application, premium, or premium deposit.(3) A pol…

(1) In the case of a solicitation by direct response methods, the insurer shall provide a Buyer's Guide and a policy summary prior to accepting the application. However, if the policy contains an unconditional refund provision of at least ten days, the Buyer's Guide and a policy …

(1) Each insurer must maintain at its home office or principal office, a complete file containing one copy of each document authorized by the insurer for use under this regulation. The file must contain one copy of each authorized form for a period of three years following the da…

Failure of an insurer or an agent to provide or deliver a Buyer's Guide, a policy summary, or policy data as provided under WAC 284-23-230 and 284-23-235 shall constitute an unfair method of competition and an unfair act or practice, under RCW 48.30.010.[Statutory Authority: RCW …

This regulation, WAC 284-23-300 through 284-23-380, is based upon the model Annuity and Deposit Fund Disclosure Regulation adopted by the National Association of Insurance Commissioners on June 16, 1978.[Statutory Authority: RCW 48.02.060, 48.30.010, and 48.30.090. WSR 79-07-052 …

(1) The purpose of this regulation is to require insurers to deliver to prospects for annuity contracts, or for deposit funds accepted in conjunction with life insurance policies or annuity contracts, information which helps the prospect select an annuity or deposit fund, or both…

(1) To the extent hereinafter provided, this regulation shall apply to any solicitation, negotiation or procurement of annuity contracts, or deposit funds accepted in conjunction with individual life insurance policies or with annuity contracts which are subject to this regulatio…

For the purposes of this regulation, contract summary means a written statement describing the elements of the annuity contract and deposit fund, including but not limited to:(1) A prominently placed title as follows: Statement of benefit information. (This shall be followed by a…