Title 48 — Title 48 INSURANCE
101 chapters · 2,134 sections in this title.
RCW 48.20.002 Scope of chapter.
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Nothing in this chapter shall apply to or affect (1) any policy of workers' compensation insurance or any policy of liability insurance with or without supplementary expense coverage therein; or (2) any policy or contract of reinsurance; or (3) any blanket or group policy of insu…
RCW 48.20.012 Format of disability policies.
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No disability policy shall be delivered or issued for delivery to any person in this state unless it otherwise complies with this code, and complies with the following:(1) It shall purport to insure only one person, except as to family expense insurance written pursuant to RCW 48…
RCW 48.20.013 Return of policy and refund of premium—Notice required—Effect of return.
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Every individual disability insurance policy issued after January 1, 1968, except single premium nonrenewable policies, shall have printed on its face or attached thereto a notice stating in substance that the person to whom the policy is issued shall be permitted to return the p…
RCW 48.20.015 Endorsements.
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If a contract is issued on any basis other than as applied for, an endorsement setting forth such modification(s) must accompany and be attached to the policy; and no endorsement shall be effective unless signed by the policyowner, and a signed copy thereof returned to the insure…
RCW 48.20.022 Policies issued by domestic insurer for delivery in another state.
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If any policy is issued by a domestic insurer for delivery to a person residing in another state, and if the insurance commissioner or corresponding public official of such other state has advised the commissioner that any such policy is not subject to approval or disapproval by …
RCW 48.20.025 Schedule of rates for individual health benefit plans—Loss ratio—Definitions.
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(1) The definitions in this subsection apply throughout this section unless the context clearly requires otherwise.(a) "Claims" means the cost to the insurer of health care services, as defined in RCW 48.43.005, provided to a policyholder or paid to or on behalf of the policyhold…
RCW 48.20.028 Calculation of premiums—Adjusted community rating method—Definitions.
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(1) Premiums for health benefit plans for individuals shall be calculated using the adjusted community rating method that spreads financial risk across the carrier's entire individual product population, except the individual product population covered under RCW 48.20.029. All su…
RCW 48.20.029 Calculation of premiums—Members of a purchasing pool—Adjusted community rating method—Definitions.
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(1) Premiums for health benefit plans for individuals who purchase the plan as a member of a purchasing pool:(a) Consisting of five hundred or more individuals affiliated with a particular industry;(b) To whom care management services are provided as a benefit of pool membership;…
RCW 48.20.032 Standard provisions required—Substitutions—Captions.
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Except as provided in RCW 48.18.130, each such policy delivered or issued for delivery to any person in this state shall contain the provisions as specified in RCW 48.20.042 to 48.20.152, inclusive, in the words in which the same appear; except, that the insurer may, at its optio…
RCW 48.20.042 Standard provision No. 1—Entire contract; changes.
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There shall be a provision as follows:ENTIRE CONTRACTS; CHANGES: This policy, including the endorsements and attached papers, if any, constitutes the entire contract of insurance. No change in this policy shall be valid until approved by an executive officer of the insurer and un…
RCW 48.20.050 Standard provision No. 2—Misstatement of age or sex.
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There shall be a provision as follows:"MISSTATEMENT OF AGE OR SEX: If the age or sex of the insured has been misstated, all amounts payable under this policy shall be such as the premium paid would have purchased at the correct age or sex."The amount of any underpayments which ma…
RCW 48.20.052 Standard provision No. 3—Time limit on certain defenses.
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There shall be a provision as follows:"TIME LIMIT ON CERTAIN DEFENSES: (a) After two years from the date of issue of this policy no misstatements except fraudulent misstatements, made by the applicant in the application for such policy shall be used to void the policy or to deny …
RCW 48.20.062 Standard provision No. 4—Grace period.
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There shall be a provision as follows:GRACE PERIOD: A grace period of . . . . (insert a number not less than "7" for weekly premium policies, "10" for monthly premium policies, and "31" for all other policies) days will be granted for the payment of each premium falling due after…
RCW 48.20.072 Standard provision No. 5—Reinstatement.
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There shall be a provision as follows:REINSTATEMENT: If any renewal premium be not paid within the time granted the insured for payment, a subsequent acceptance of premium by the insurer or by any insurance producer duly authorized by the insurer to accept such premium, without r…
RCW 48.20.082 Standard provision No. 6—Notice of claim.
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There shall be a provision as follows:NOTICE OF CLAIM: Written notice of claim must be given to the insurer within twenty days after the occurrence or commencement of any loss covered by the policy, or as soon thereafter as is reasonably possible. Notice given by or on behalf of …
RCW 48.20.092 Standard provision No. 7—Claim forms.
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There shall be a provision as follows:CLAIM FORMS: The insurer, upon receipt of a notice of claim, will furnish to the claimant such forms as are usually furnished by it for filing proofs of loss. If such forms are not furnished within fifteen days after the giving of such notice…
RCW 48.20.102 Standard provision No. 8—Proofs of loss.
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There shall be a provision as follows:PROOFS OF LOSS: Written proof of loss must be furnished to the insurer at its said office in case of claim for loss for which this policy provides any periodic payment contingent upon continuing loss within ninety days after the termination o…
RCW 48.20.112 Standard provision No. 9—Time of payment of claims.
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There shall be a provision as follows:TIME OF PAYMENT OF CLAIMS: Indemnities payable under this policy for any loss other than loss for which this policy provides any periodic payment will be paid immediately upon receipt of due written proof of such loss. Subject to due written …
RCW 48.20.122 Standard provision No. 10—Payment of claims.
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(1) There shall be a provision as follows:PAYMENT OF CLAIMS: Indemnity for loss of life will be payable in accordance with the beneficiary designation and the provisions respecting such payment which may be prescribed herein and effective at the time of payment. If no such design…
RCW 48.20.132 Standard provision No. 11—Physical examination and autopsy.
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There shall be a provision as follows:PHYSICAL EXAMINATIONS AND AUTOPSY: The insurer at its own expense shall have the right and opportunity to examine the person of the insured when and as often as it may reasonably require during the pendency of a claim hereunder and to make an…
RCW 48.20.142 Standard provision No. 12—Legal actions.
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There shall be a provision as follows:LEGAL ACTIONS: No action at law or in equity shall be brought to recover on this policy prior to the expiration of sixty days after written proof of loss has been furnished in accordance with the requirements of this policy. No such action sh…
RCW 48.20.152 Standard provision No. 13—Change of beneficiary.
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There shall be a provision as follows:CHANGE OF BENEFICIARY: Unless the insured makes an irrevocable designation of beneficiary, the right to change of beneficiary is reserved to the insured and the consent of the beneficiary or beneficiaries shall not be requisite to surrender o…
RCW 48.20.162 Optional standard provisions.
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Except as provided in RCW 48.18.130, no such policy delivered or issued for delivery to any person in this state shall contain provisions respecting the matters set forth in RCW 48.20.172 to *48.20.272, inclusive, unless such provisions are in the words in which the same appear i…
RCW 48.20.172 Optional standard provision No. 14—Change of occupation.
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There may be a provision as follows:CHANGE OF OCCUPATION: If the insured be injured or contract sickness after having changed his occupation to one classified by the insurer as more hazardous than that stated in this policy or while doing for compensation anything pertaining to a…
RCW 48.20.192 Optional standard provision No. 15—Other insurance in this insurer.
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There may be a provision as follows:OTHER INSURANCE IN THIS INSURER: If an accident or sickness or accident and sickness policy or policies previously issued by the insurer to the insured be in force concurrently herewith, making the aggregate indemnity for . . . . . . . . . (ins…
RCW 48.20.202 Optional standard provision No. 16—Insurance with other insurers (Provision of service or expense incurred basis).
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(1) There may be a provision as follows:INSURANCE WITH OTHER INSURERS: If there be other valid coverage, not with this insurer, providing benefits for the same loss on a provision of service basis or on an expense incurred basis and of which this insurer has not been given writte…
RCW 48.20.212 Optional standard provision No. 17—Insurance with other insurers.
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(1) There may be a provision as follows:INSURANCE WITH OTHER INSURERS: If there be other valid coverage, not with this insurer, providing benefits for the same loss on other than an expense incurred basis and of which this insurer has not been given written notice prior to the oc…
RCW 48.20.222 Optional standard provision No. 18—Relation of earnings to insurance.
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(1) There may be a provision as follows:RELATION OF EARNINGS TO INSURANCE: If the total monthly amount of loss of time benefits promised for the same loss under all valid loss of time coverage upon the insured, whether payable on a weekly or monthly basis, shall exceed the monthl…
RCW 48.20.232 Optional standard provision No. 19—Unpaid premium.
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There may be a provision as follows:UNPAID PREMIUM: Upon the payment of a claim under this policy, any premium then due and unpaid or covered by any note or written order may be deducted therefrom.[ 1951 c 229 s 24. Prior: 1947 c 79 s .20.23; Rem. Supp. 1947 s 45.20.23.]
RCW 48.20.242 Optional standard provision No. 20—Cancellation.
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There may be a provision as follows:CANCELLATION: The insurer may cancel this policy at any time by written notice delivered to the insured, or mailed to his or her last address as shown by the records of the insurer, stating when, not less than five days thereafter, such cancell…
RCW 48.20.252 Optional standard provision No. 21—Conformity with state statutes.
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There may be a provision as follows:CONFORMITY WITH STATE STATUTES: Any provision of this policy which, on its effective date, is in conflict with the statutes of the state in which the insured resides on such date is hereby amended to conform to the minimum requirements of such …
RCW 48.20.262 Optional standard provision No. 22—Illegal occupation.
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There may be a provision as follows:ILLEGAL OCCUPATION: The insurer shall not be liable for any loss to which a contributing cause was the insured's commission of or attempt to commit a felony or to which a contributing cause was the insured's being engaged in an illegal occupati…
RCW 48.20.282 Order of certain policy provisions.
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The provisions which are the subject of RCW 48.20.042 to *48.20.272, inclusive, or any corresponding provisions which are used in lieu thereof in accordance with such sections, shall be printed in the consecutive order of the provisions in such sections or, at the insurer's optio…
RCW 48.20.292 Third party ownership.
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The word "insured," as used in this chapter, shall not be construed as preventing a person other than the insured with a proper insurable interest from making application for and owning a policy covering the insured or from being entitled under such a policy to any indemnities, b…
RCW 48.20.302 Requirements of other jurisdictions.
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(1) Any policy of a foreign or alien insurer, when delivered or issued for delivery to any person in this state, may contain any provision which is not less favorable to the insured or to the beneficiary than the provisions of this chapter and which is prescribed or required by t…
RCW 48.20.312 Age limit.
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If any such policy contains a provision establishing, as an age limit or otherwise, a date after which the coverage provided by the policy will not be effective, and if such date falls within a period for which premium is accepted by the insurer or if the insurer accepts a premiu…
RCW 48.20.340 "Family expense disability insurance" defined.
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(1) Family expense disability insurance is that covering members of any one family including one or both spouses and dependents provided under a master policy issued to the head of the family.(2) Any authorized disability insurer may issue family expense disability insurance.(3) …
RCW 48.20.350 "Franchise plan" defined.
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(1) Disability insurance on a franchise plan is that issued to(a) five or more employees of a common employer, or to(b) ten or more members of any bona fide trade or professional association or labor union, which association or union was formed and exists for purposes other than …
RCW 48.20.360 Extended disability benefit.
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A disability insurance contract which provides a reasonable amount of disability indemnity for both accidental injuries and sickness, other than a contract of group or blanket insurance, may provide a benefit in amount not exceeding two hundred dollars payable in event of death f…
RCW 48.20.380 Incontestability after reinstatement.
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The reinstatement of any policy of noncancellable disability insurance hereafter delivered or issued for delivery in this state shall be contestable only on account of fraud or misrepresentation of facts material to the reinstatement and only for the same period following reinsta…
RCW 48.20.385 When injury caused by intoxication or use of narcotics.
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An insurer may not deny coverage for the treatment of an injury solely because the injury was sustained as a consequence of the insured's being intoxicated or under the influence of a narcotic.[ 2004 c 112 s 2.]Notes:Finding—2004 c 112: "The legislature finds that an alcohol or d…
RCW 48.20.389 Prescribed, self-administered anticancer medication.
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(1) Each health plan issued or renewed on or after January 1, 2012, that provides coverage for cancer chemotherapy treatment must provide coverage for prescribed, self-administered anticancer medication that is used to kill or slow the growth of cancerous cells on a basis at leas…
RCW 48.20.390 Podiatric medicine and surgery.
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Notwithstanding any provision of any disability insurance contract, benefits shall not be denied thereunder for any medical or surgical service performed by a holder of a license issued pursuant to chapter 18.22 RCW provided that (1) the service performed was within the lawful sc…
RCW 48.20.391 Diabetes coverage.
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The legislature finds that diabetes imposes a significant health risk and tremendous financial burden on the citizens and government of the state of Washington, and that access to the medically accepted standards of care for diabetes, its treatment and supplies, and self-manageme…
RCW 48.20.392 Prostate cancer screening.
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(1) Each disability insurance policy issued or renewed after December 31, 2006, that provides coverage for hospital or medical expenses shall provide coverage for prostate cancer screening, provided that the screening is delivered upon the recommendation of the patient's physicia…
RCW 48.20.393 Mammograms—Insurance coverage.
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Each disability insurance policy issued or renewed after January 1, 1990, that provides coverage for hospital or medical expenses shall provide coverage for screening or diagnostic mammography services, provided that such services are delivered upon the recommendation of the pati…
RCW 48.20.395 Reconstructive breast surgery.
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(1) Any disability insurance contract providing hospital and medical expenses and health care services delivered or issued in this state after July 24, 1983, shall provide coverage for reconstructive breast surgery resulting from a mastectomy which resulted from disease, illness,…
RCW 48.20.397 Mastectomy, lumpectomy.
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No person engaged in the business of insurance under this chapter may refuse to issue any contract of insurance or cancel or decline to renew the contract solely because of a mastectomy or lumpectomy performed on the insured or prospective insured more than five years previously.…
RCW 48.20.410 Optometry.
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Notwithstanding any provision of any disability insurance contract, benefits shall not be denied thereunder for any eye care service rendered by a holder of a license issued pursuant to chapter 18.53 RCW, provided, that (1) the service rendered was within the lawful scope of such…
RCW 48.20.411 Registered nurses or advanced registered nurses.
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Notwithstanding any provision of any disability insurance contract as provided for in this chapter, benefits shall not be denied thereunder for any health care service performed by a holder of a license for registered nursing practice or *advanced registered nursing practice issu…