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ENGROSSED
HOUSE BILL 2837
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AS AMENDED BY
THE SENATE
Passed Legislature -
1996 Regular Session
State of Washington 54th
Legislature 1996 Regular Session
By
Read first time 01/22/96.
Referred to Committee on Health Care.
Modifying the
definition of medicare supplemental insurance or medicare supplement insurance
policy.
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) 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.
