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ENGROSSED HOUSE BILL 2837
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State of Washington 54th Legislature 1996 Regular Session
By Representatives Dyer, Cody and Murray; by request of Insurance Commissioner
Read first time 01/22/96. Referred to Committee on Health Care.
AN ACT Relating to the definition of medicare supplemental insurance or medicare supplement insurance policy; amending RCW 48.66.020; and declaring an emergency.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:
Sec. 1. RCW 48.66.020 and 1995 c 85 s 1 are each amended to read as follows:
Unless the context clearly requires otherwise, the definitions in this section apply throughout this chapter.
(1) "Medicare supplemental insurance" or "medicare supplement insurance policy" refers to a group or individual policy of disability insurance or a subscriber contract of a health care service contractor, a health maintenance organization, or a fraternal benefit society, which relates its benefits to medicare, or which is advertised, marketed, or designed primarily as a supplement to reimbursements under medicare for the hospital, medical, or surgical expenses of persons eligible for medicare. Such term does not include:
(a) ((A policy or
contract of one or more employers or labor organizations, or of the trustees of
a fund established by one or more employers or labor organizations, or
combination thereof, for employees or former employees, or combination thereof,
or for members or former members, or combination thereof, of the labor
organizations; or
(b))) A policy issued pursuant to a contract under
Section 1876 ((or Section 1833)) of the federal social security act (42
U.S.C. Sec. 1395 et seq.), or an issued policy under a demonstration ((project
authorized pursuant to amendments to the federal social security act)) specified
in 42 U.S.C. Sec. 1395ss(g)(1); or
(((c))) (b)
Insurance policies or health care benefit plans, including group conversion
policies, provided to medicare eligible persons, that are not marketed or held
to be medicare supplement policies or benefit plans.
(2) "Medicare" means the "Health Insurance for the Aged Act," Title XVIII of the Social Security Amendments of 1965, as then constituted or later amended.
(3) "Medicare eligible expenses" means health care expenses of the kinds covered by medicare, to the extent recognized as reasonable and medically necessary by medicare.
(4) "Applicant" means:
(a) In the case of an individual medicare supplement insurance policy or subscriber contract, the person who seeks to contract for insurance benefits; and
(b) In the case of a group medicare supplement insurance policy or subscriber contract, the proposed certificate holder.
(5) "Certificate" means any certificate delivered or issued for delivery in this state under a group medicare supplement insurance policy.
(6) "Loss ratio" means the incurred claims as a percentage of the earned premium computed under rules adopted by the insurance commissioner.
(7) "Preexisting condition" means a covered person's medical condition that caused that person to have received medical advice or treatment during a specified time period immediately prior to the effective date of coverage.
(8) "Disclosure form" means the form designated by the insurance commissioner which discloses medicare benefits, the supplemental benefits offered by the insurer, and the remaining amount for which the insured will be responsible.
(9) "Issuer" includes insurance companies, health care service contractors, health maintenance organizations, fraternal benefit societies, and any other entity delivering or issuing for delivery medicare supplement policies or certificates to a resident of this state.
NEW SECTION. Sec. 2. This act is necessary for the immediate preservation of the public peace, health, or safety, or support of the state government and its existing public institutions, and shall take effect immediately.
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