S-3479

AN ACT Relating to long-term care insurance; amending RCW 48.84.020 and 48.84.040; and adding a new section to chapter 48.84 RCW.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:

Sec. 1. RCW 48.84.020 and 1986 c 170 s 2 are each amended to read as follows:

Unless the context requires otherwise, the definitions in this section apply throughout this chapter.

(1) "Long-term care insurance" or "long-term care benefit contract" means any insurance policy or benefit contract primarily advertised, marketed, offered, or designed to provide coverage or services for either institutional or community-based convalescent, custodial, chronic, or terminally ill care. Such terms do not include and this chapter shall not apply to policies or contracts governed by chapter 48.66 RCW and continuing care retirement communities.

(2) "Loss ratio" means the incurred claims plus or minus the increase or decrease in reserves as a percentage of the earned premiums, or the projected incurred claims plus or minus the increase or decrease in projected reserves as a percentage of projected earned premiums, as defined by the commissioner.

(3) "Preexisting condition" means a covered person's medical condition that caused that person to have received medical advice or treatment during the specified time period before the effective date of coverage.

(4) "Medicare" means Title XVIII of the United States social security act, or its successor program.

(5) "Medicaid" means Title XIX of the United States social security act, or its successor program.

(6) "Nursing home" means a nursing home as defined in RCW 18.51.010.

(7) "Home" means the residence of any person covered by an insurance policy regulated by this chapter, except a hospital or a nursing home.

(8) "Home care" means health services or assistance with at least three activities of daily living as defined by the insurance commissioner and delivered in the home of a person insured under a policy regulated by this chapter.

Sec. 2. RCW 48.84.040 and 1986 c 170 s 4 are each amended to read as follows:

No long-term care insurance policy or benefit contract may:

(1) Use riders, waivers, endorsements, or any similar method to limit or reduce coverage or benefits;

(2) Indemnify against losses resulting from sickness on a different basis than losses resulting from accidents;

(3) Be canceled, nonrenewed, or segregated at the time of rerating solely on the grounds of the age or the deterioration of the mental or physical health of the covered person;

(4) Exclude or limit coverage for preexisting conditions for a period of more than one year prior to the effective date of the policy or contract or more than six months after the effective date of the policy or contract;

(5) ((~~Differentiate benefit amounts on the basis of the type or level of nursing home care provided;~~

~~(6)~~)) Notwithstanding the provisions of RCW 48.20.052, deny a claim or cancel coverage for reasons of material misrepresentation for an ailment not disclosed on the application form if the ailment took place more than ten years prior to the effective date of the coverage;

(6) Exclude coverage for home care; or

(7) Contain a provision establishing any new waiting period in the event an existing policy or contract is converted to a new or other form within the same company.

NEW SECTION. Sec. 3. A new section is added to chapter 48.84 RCW to read as follows:

If a commercial insurer, health care service contractor, or health maintenance organization, offers coverage to individual consumers under this chapter, they shall also offer such coverage to all groups defined in RCW 48.21.010. Insurance agents shall inform all present and potential consumers that such coverage may also be purchased on a group basis.