WSR 19-15-133
PROPOSED RULES
OFFICE OF THE
INSURANCE COMMISSIONER
[Insurance Commissioner Matter R 2018-09—Filed July 23, 2019, 2:08 p.m.]
Original Notice.
Preproposal statement of inquiry was filed as WSR 18-17-141.
Title of Rule and Other Identifying Information: Adverse notifications.
Hearing Location(s): On August 28, 2019, at 9:00 a.m., at the Office of the Insurance Commissioner, 5000 Capitol Boulevard S.E., Tumwater, WA 98501.
Date of Intended Adoption: September 3, 2019.
Submit Written Comments to: David Forte, P.O. Box 40260, Olympia, WA 98504-0260, email rulescoordinator@oic.wa.gov, fax 360-586-3109, by August 27, 2018.
Assistance for Persons with Disabilities: Contact Melanie Watness, phone 360-725-7013, fax 360-586-2023, TTY 360-586-0241, email MelanieW@oic.wa.gov.
Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: The commissioner will consider adopting rules to increase consumer awareness of available agency assistance and to help consumers with their insurance questions by requiring contact information for the office of the insurance commissioner on certain notifications from the company and carrier.
Reasons Supporting Proposal: When a consumer receives an adverse notice from their insurance company or health carrier, there may be confusion. The commissioner will consider rule making to provide the office of the insurance commissioner's contact information on these certain notifications in order to assist the consumer and educate them on the insurance process.
Statutory Authority for Adoption: RCW 48.02.060, 48.18.545, 48.19.035, 48.43.525, and 48.43.535.
Statute Being Implemented: None.
Rule is not necessitated by federal law, federal or state court decision.
Name of Proponent: Mike Kreidler, insurance commissioner, governmental.
Name of Agency Personnel Responsible for Drafting: David Forte, P.O. Box 40260, Olympia, WA 98504-0260, 360-725-7042; Implementation: Steve Valandra, P.O. Box 40255, Olympia, WA 98504-0255, 360-725-7000; and Enforcement: Doug Hartz, P.O. Box 40255, Olympia, WA 98504-0255, 360-725-7000.
A school district fiscal impact statement is not required under RCW 28A.305.135.
A cost-benefit analysis is required under RCW 34.05.328. A preliminary cost-benefit analysis may be obtained by contacting David Forte, P.O. Box 40260, Olympia, WA 98504-0260, phone 360-725-7042, email davidf@oic.wa.gov.
This rule proposal, or portions of the proposal, is exempt from requirements of the Regulatory Fairness Act because the proposal:
Is exempt under RCW 19.85.025(4).
Explanation of exemptions: The office of the insurance commissioner has found that none of the existing insurance companies impacted by the proposed rule may be considered small businesses under RCW 19.85.020(3).
July 23, 2019
Mike Kreidler
Insurance Commissioner
NEW SECTION
WAC 284-30-770Adverse notification requirements.
(1) This section applies to all insurers, fraternal benefit societies, health carriers including disability, health maintenance organizations (HMOs), health care service contractors (HCSCs), and limited licensed carriers, and to all insurance policies, health plans, and insurance contracts.
(2) For the purpose of this section only the term "Adverse notification" means a notice, statement, or document from an insurer, fraternal benefit societies, health carriers including disability, HMOs, HCSCs, and limited licensed carriers to their insured, or enrollee, or both, describing one or more of the following:
(a) A claim denial;
(b) A final claim payment for less than the amount of the claim submitted. This does not include a claim that is paid less than the original amount to reflect the contracted health care provider's rate;
(c) An adverse benefit determination as defined in RCW 48.43.005(2); and
(d) Rescission, cancellation, termination or nonrenewal of a policy unless initiated by an insured. This does not apply to the end of a scheduled policy term or cancellation due to nonpayment of premium.
(3) On each adverse notification provided, the notice must include the following information:
"If you have questions or concerns about the actions of your insurance company or agent, or would like information on your rights to file an appeal, contact the Washington state Office of the Insurance Commissioner's consumer protection hotline at 1-800-562-6900 or visit www.insurance.wa.gov. The insurance commissioner protects and educates insurance consumers, advances the public interest, and provides fair and efficient regulation of the insurance industry."
(4) The notice specified in subsection (3) of this section must be in the same font type and not less than the font size of the majority of the notification. This notice must appear on the first page, at the end of the adverse notification, or where this notice currently exists if adverse notices are already provided to insureds.