Washington Administrative Code

(1)(a) Except as provided in (b) of this subsection, this section applies to any long-term care policy or certificate issued in this state on or after January 1, 2009.(b) For certificates issued on or after January 1, 2009, under a group long-term care insurance policy as defined…

Prior to offering group long-term care insurance to a resident of this state pursuant to RCW 48.83.030, 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 regulatory lon…

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

(1) Every issuer or entity marketing 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, including any compa…

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

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

(1) The issuer must notify policyholders of the availability of a new long-term 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. The notice must be provided …

(1)(a) Every 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 benefit; or(ii) R…

(1) This section does not apply to life insurance policies or riders containing accelerated long-term care benefits.(2) To comply with the requirement to offer a nonforfeiture benefit pursuant to the provisions of RCW 48.83.120:(a) A policy or certificate offered with nonforfeitu…

(1) A 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 restrictive than requ…

(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 ten-point type.(2) The outline of coverage must contain no material of an advertising nature.(3) Text t…

(1) A long-term care insurance shopper's guide in the format developed by the National Association of Insurance Commissioners, or a guide developed or approved by the commissioner, must be provided to all prospective applicants of a long-term care insurance policy or certificate.…

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 long-term care policy.(2) No issuer or insurance …

The following form must be used by issuers to annually report rescission of long-term care policies.RESCISSION REPORTING FORM FOR LONG-TERM CARE POLICIES FOR THE STATEOF FOR THE REPORTING YEAR 20[ ] Company Name: Address: Phone Number: Due: March 1, annuallyInstructions: The purp…

The following form of personal worksheet must be used by issuers in the sale of long-term care insurance policies.Long-Term Care InsurancePersonal WorksheetPeople buy long-term care insurance for many reasons. Some don't want to use their own assets to pay for long-term care. Som…

The following form of disclosure must be used in this state.Things You Should Know Before You BuyLong-Term Care InsuranceLong-TermCareInsuranceA long-term care insurance policy may pay most of the costs for your care in a nursing home. Many policies also pay for care at home or o…

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

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

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 long-term care insurance.Long-Term Care Insurance Replacement and Lapse Reporting FormFor the State of For the Reporting Year of Company Name: Due: June 30, AnnuallyCompany Address: Company NAIC Nu…

For purposes of WAC 284-83-210 through 284-83-250:(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 calculati…

(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, commencing with reports for accounting periods beginning on or after January 1, 2009, all issuers must separate data concerning long-term care insurance policies from data concerning other insurance policies.[Statutory Authority: RCW 48.…

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

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 284-83-210 through 284-83-245 do not apply to life insurance policies that accelerate benefits for long-term care.(2) A life insurance policy that funds long-term care benefits entirely by accelerating the death benefit is considered to provide reasonable benefits in rela…

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, 48.83.070, 48.83.110, 48.83.120, 48.83.130(1), and 48.83.140 (4)(a). WSR 08-24-01…

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 48.83.090 and 48.83.170 by establishing prompt payment requirements for long-term care insurance.(2) For purposes of this section, the following definitions apply:(a) "Claim" means a request for payment of benefits under an in-…

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 284-83-400 through 284-83-420 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 disclos…

(1) WAC 284-83-400 through 284-83-420 applies to any qualified long-term care insurance partnership policy, as defined by federal law and this chapter.(2) These sections do not apply to medicare supplement policies regulated under chapters 48.66 RCW and 284-55 or 284-66 WAC; poli…

Every long-term care partnership policy must meet the standards for long-term care policies or contracts in chapters 48.83 and 48.85 RCW and this chapter, unless specifically provided otherwise.(1) As used in WAC 284-83-400 through 284-83-420, "qualified long-term care partnershi…

(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 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 under the pol…

Prior to selling, soliciting, or negotiating, or continuing to sell, solicit, or negotiate long-term care partnership policies in this state, all licensed producers must meet the education requirements in RCW 48.83.130(2).[Statutory Authority: RCW 48.02.060 and 48.85.030. WSR 11-…

(1) This chapter applies to all insurers and to every individual fixed premium universal life insurance policy form, as defined in this regulation, whether solicited on an individual or mass-marketing basis, filed for approval after August 31, 1986.(2) The approval of individual …

As used in this regulation:(1) "Universal life insurance policy" means any individual life insurance policy having provisions for separately identified interest credits (other than in connection with dividend accumulations, premium deposit funds, or other supplementary accounts) …

The minimum valuation standard for universal life insurance policies shall be the commissioners reserve valuation method, as hereinafter described for such policies, and the tables and interest rates hereinafter specified. The terminal reserve for the basic policy and any benefit…

(1) If, in any policy year, the guaranteed maturity premium on any universal life insurance policy is less than the valuation net premium for such policy, calculated by the valuation method actually used in calculating the reserve thereon but using the minimum valuation standards…

(1) Reserves, as calculated without regard to this section, may, under some circumstances, be less than the cash surrender value or the policy value. In such instances, the reserves shall be increased to be equal to the largest of the cash surrender value, the reserve for the pol…

(1) The minimum cash surrender values shall be determined separately for the basic policy and any benefits and riders for which premiums are paid separately. The following requirements pertain to a basic policy and any benefits and riders for which premiums are not paid separatel…

The policy shall, in addition to compliance with RCW 48.23.020, provide or comply with the following:(1) The policy shall provide that the policyowner will be sent, without charge, at least annually, a report which will serve to keep such policyowner advised as to the status of t…

In connection with any advertising, solicitation, negotiation, or procurement of a fixed premium universal life insurance policy:(1) Any statement of policy cost factors or benefits shall contain:(a) The corresponding guaranteed policy cost factors or benefits, clearly identified…

The policy shall provide that the policyowner will be sent, without charge, at least annually, a report which will serve to keep such policyowner advised of the status of the policy, and any riders attached, including the rights to the values and benefits. The report shall also s…

Pursuant to RCW 48.30.010, it shall be an unfair practice to:(1) Contrive to set the premiums at the time of repricing so as to reduce, postpone or avoid cash values.(2) Recoup past losses or distribute past gains when repricing the policies, when defining the current interest to…

(1) The actuarial memorandum which accompanies the policy filing shall list, among other things, the basis or modification of each table of maximum mortality charge to be used by the company; for example, male, female, and nonsmoker, smoker, etc. It shall also include sufficient …