Washington Administrative Code

Effective January 1, 1989, with respect to medicare supplement insurance policies initially sold to residents of this state on or after that date, it is an unfair practice and an unfair method of competition for any insurer, and a prohibited practice for any health care service c…

(1) In order to assure the orderly implementation and conversion of medicare supplement insurance benefits due to changes in the federal medicare program and to eliminate provisions which may duplicate medicare:(a) No later than January 1, 1990, all insurers must substitute new p…

(1) For medicare supplement insurance policies initially sold to residents of this state on or after January 1, 1989:(a) Within ninety days of the effective date of this rule, every insurer required to file its medicare supplement insurance policy forms with the commissioner shal…

Every insurer providing group medicare supplement insurance benefits to a resident of this state shall, within thirty days of its use in this state, file with the commissioner a copy of the master policy and any certificate used in this state.[Statutory Authority: RCW 48.02.060 (…

No later than thirty days prior to the annual effective date of changes required by the Medicare Catastrophic Coverage Act of 1988, every insurer providing medicare supplement insurance policies to a resident of this state shall notify its insureds of modifications it has made to…

(COMPANY NAME)NOTICE OF CHANGES IN MEDICARE AND YOUR MEDICARE SUPPLEMENT INSURANCE — 1989Your health care benefits provided by the federal medicare program will change beginning January 1, 1989. Additional change will occur on medical benefits in following years. The major change…

(1) At least thirty days prior to use in this state, every insurer who provides medicare supplement insurance coverage to a resident of this state shall provide the commissioner with a copy of any advertisement, as defined at WAC 284-50-030, intended for use in this state, whethe…

Every insurer to whom it applies shall certify to the commissioner on the medicare supplement experience exhibit of its annual statement that it has complied with Section 4081 of the Omnibus Budget Reconciliation Act of 1987, P.L. 100-203, (1987).[Statutory Authority: RCW 48.02.0…

Nothing contained in this chapter shall be construed to limit the authority of the commissioner to regulate a medicare supplement insurance policy under other sections of Title 48 RCW.[Statutory Authority: RCW 48.02.060 (3)(a) and 48.30.010(2). WSR 88-22-061 (Order R 88-9), § 284…

The form provided at WAC 284-55-210 shall be filed with the commissioner annually not later than June 30th of each calendar year beginning June 30, 1990. The form is to be filed in addition to the NAIC experience exhibit and not in lieu thereof.The following instructions must be …

The following form of medicare supplement loss ratio experience shall be used by all insurers:MEDICARE SUPPLEMENT LOSS RATIO EXPERIENCE(SUMMARIZED BY POLICY YEAR)Experience reported for January 1 to December 31 of 19 To be filed on or before June 30of the Address (City, State, an…

The definitions in this section apply throughout this chapter.(1) "Complete filing" means a package of information containing insurance forms, supporting information, documents and exhibits submitted to the commissioner electronically using the System for Electronic Rate and Form…

This chapter contains the Washington state life, disability and credit insurance form and rate filing requirements.The purpose of this chapter is to adopt processes and procedures for insurers and filers to use when submitting life, disability and credit insurance products with t…

(1) This chapter applies to all life and disability insurers that must file forms and rates under RCW 48.18.100, 48.19.010(2) and 48.34.100.(2) Under RCW 48.18.100, the commissioner is required to act within thirty days to approve or disapprove a form. The commissioner may extend…

Insurers may not use the certification process described in RCW 48.18.100(2) to file life, disability or credit insurance forms. Insurers must file these forms under RCW 48.18.100(1) or 48.34.100.[Statutory Authority: RCW 48.02.060, 48.110.150. WSR 08-21-091 (Matter No. 2007-11),…

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 will incorporate documents posted on the SERFF website into this chapter. By reference, the comm…

(1) Each credit, life or disability insurance form or rate filing must be submitted to the commissioner electronically using SERFF.(a) Every form filed in SERFF must be attached to the form schedule.(b) Filers must send all written correspondence related to a form or rate filing …

(1) If a rate filing is required under RCW 48.19.010(2) or 48.34.100, it must be submitted:(a) Separate from any corresponding form filing; and(b) Concurrently with the corresponding form filing if new forms are being introduced.(2) Each rate filing must include, if appropriate:(…

(1) The commissioner may reject and close any filing that does not comply with WAC 284-58-030 or 284-58-033. If the commissioner rejects a filing, the insurer has not filed forms or rates with the commissioner.(2) If the commissioner rejects a filing and the filer resubmits it as…

An insurer may authorize a third-party filer to file forms or rates on its behalf. For the purposes of this section, a "third-party filer" means a person or entity in the business of providing insurance regulatory compliance services.(1) If an insurer delegates filing authority t…

An objection letter may ask the filer to revise a noncompliant form or rate filing or provide clarification or additional information. The objection letter will state the reason(s) for disapproval, including relevant case law, statutes and rules. Filers must:(1) Provide a complet…

If an insurer files a revised or replaced form, the filer must provide the supporting documentation described below:(1) If a form is revised due to an objection(s) from the commissioner, the filer must provide a detailed explanation of all material changes to the disapproved form…

(1) Filers must include a common approval date for all forms or rates submitted in a filing.(2) Filers may submit a request to change the approval date of a filing as a note to reviewer.[Statutory Authority: RCW 48.02.060, 48.110.150. WSR 08-21-091 (Matter No. 2007-11), § 284-58-…

If an insurer will use a previously approved Washington amendatory endorsement with a new form, the filer must:(1) Provide a copy of the amendatory endorsement attached as supporting documentation; or(2) Include the SERFF tracking number under which the endorsement was filed and …

Insurers may issue insurance policy forms written in languages other than English. (1) If an insurer translates an insurance policy form from English to another language, the insurer must:(a) File the translated version of the form.(b) Include written disclosure statements on the…

(1) This regulation, WAC 284-60-010 through 284-60-100, applies to all insurers and to every disability insurance policy form filed for approval in this state after August 31, 1983, except:(a) Additional indemnity and premium waiver forms for use only in conjunction with life ins…

The purpose of this regulation is to:(1) Establish loss ratio standards for the purpose of implementing the authority of the commissioner to disapprove and to withdraw approval of disability policy forms which are not returning or are not expected to return a reasonable proportio…

(1) The "expected loss ratio" is a prospective calculation and shall be calculated as the projected "benefits incurred" divided by the projected "premiums earned" and shall be based on the actuary's best projections of the future experience within the "calculating period."(2) The…

(1) The actuary responsible for setting premium rates shall group similar policy forms, including forms no longer being marketed, in the pricing calculations. Such grouping shall rely on the judgment of the pricing actuary and be satisfactory to the commissioner. Among the factor…

The following standards and requirements apply to individual disability insurance forms:(1) Benefits shall be deemed reasonable in relation to the premiums if the overall loss ratio is at least sixty percent over a calculating period chosen by the insurer and satisfactory to the …

The following standards and requirements apply to group and blanket disability insurance policy forms and manual rates:(1) Specified disease group insurance shall generate at least a seventy-five percent loss ratio regardless of the size of the group.(2) Group disability insuranc…

Insurers shall maintain records of earned premiums and incurred benefits for each policy year for each policy, rider, endorsement and similar form which were combined for purposes of premium calculations, including the reserves. Records shall also be maintained of the experience …

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

Loss ratios other than those indicated in WAC 284-60-050 and 284-60-060 may be approved with satisfactory actuarial demonstrations. Examples of coverages where the commissioner may grant special considerations are:(1) Short term nonrenewable policy forms such as airline trip or s…

This regulation shall become effective on September 1, 1983, and shall apply to all policy, rider, endorsement, and similar forms and rate schedule filings subject to this regulation submitted on or after said date.[Statutory Authority: RCW 48.02.060. WSR 83-14-002 (Order R 83-1)…

The purpose of this chapter is to supplement the requirements of chapter 48.66 RCW, the Medicare Supplemental Health Insurance Act; to assure the orderly implementation and conversion of medicare supplement insurance benefits and premiums due to changes in the federal medicare pr…

(1) Subject to subsection (2) of this section, except as provided by federal law, chapter 48.66 RCW, or as otherwise specifically provided by this chapter, this chapter applies to every group and individual policy of disability insurance and to every subscriber contract of an iss…

For purposes of this chapter:(1) "Applicant" means:(a) In the case of an individual medicare supplement insurance policy, the person who seeks to contract for insurance benefits; and(b) In the case of a group medicare supplement insurance policy, the proposed certificate holder.(…

No policy or certificate may be advertised, solicited, issued for delivery in this state as a medicare supplement insurance policy or certificate unless the policy or certificate contains definitions or terms that conform to the requirements of this section.(1) "Accident," "accid…

(1) No policy may be advertised, solicited, or issued for delivery in this state as a medicare supplement insurance policy unless it meets or exceeds the requirements imposed by chapter 48.66 RCW.(2) A medicare supplement policy or certificate in force in this state may not conta…

The requirements of this section apply to medicare supplement policies and certificates issued or issued for delivery in this state during the period beginning January 1, 1990, and ending June 30, 1992, as well as all guaranteed renewable medicare supplement policies delivered to…

No policy or certificate may be advertised, solicited, delivered, or issued for delivery in this state as a medicare supplement policy or certificate unless it complies with these benefit standards.(1) General standards. The following standards apply to medicare supplement polici…

No policy or certificate may be advertised, solicited, delivered, or issued for delivery in this state as a medicare supplement policy or certificate unless it complies with these benefit standards. Benefit standards applicable to medicare supplement policies or certificates issu…

Standard medicare supplement benefit plans issued for delivery prior to June 1, 2010, must comply with this section.(1) An issuer must make available to each prospective policyholder and certificate holder a policy form or certificate form containing only the basic "core" benefit…

No policy or certificate delivered or issued for delivery in this state on or after June 1, 2010, as a medicare supplement policy or certificate may be advertised, solicited, delivered or issued for delivery in this state as a medicare supplement policy or certificate unless it c…

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, 2…

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 th…

(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 amedicare select policy or certificate unless it meets the requirements of this section.(2) For the purposes of this section:(a) …

(1) Issuers must provide an outline of coverage to all applicants at the time an application is presented to the prospective applicant and, except for direct response policies and certificates, must obtain an acknowledgment of receipt of the outline from the applicant.(2) The "ou…

(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 Me…