AN ACT Relating to
technical changes to Title 48 RCW; amending RCW 48.87.020, 48.87.040,
48.66.130, 48.07.040, and 48.43.055; and adding a new section to chapter 48.66
RCW.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF
WASHINGTON:
Sec. 1. RCW 48.87.020 and 1993 c
112 s 2 are each amended to read as follows:
Unless the context
clearly requires otherwise, the definitions in this section apply throughout
this chapter.
(1)
"Association" means the joint underwriting association established
under this chapter.
(2) "Midwifery and
birth center malpractice insurance" means insurance coverage against the
legal liability of the insured and against loss damage or expense incident to a
claim arising out of the death or injury of a person as a result of negligence
or malpractice in rendering professional service by a licensee.
(3)
"Licensee" means a person or facility licensed to provide midwifery
services under chapter 18.50, ((18.88)) 18.79, or 18.46 RCW.
Sec. 2. RCW 48.87.040 and 1993 c
112 s 4 are each amended to read as follows:
The association shall
be comprised of all insurers possessing a certificate of authority to write and
engaged in writing medical malpractice insurance within this state and general
casualty companies. Every insurer shall be a member of the association and
shall remain a member as a condition of its authority to continue to transact
business in this state. Only licensed midwives under chapter 18.50 RCW,
certified nurse midwives licensed under chapter ((18.88)) 18.79
RCW, or birth centers licensed under chapter 18.46 RCW may participate in the
joint underwriting authority.
Sec. 3. RCW 48.66.130 and 1995 c
85 s 2 are each amended to read as follows:
(1) On or after January
1, 1996, and notwithstanding any other provision of Title 48 RCW, a medicare
supplement policy or certificate shall not exclude or limit benefits for losses
incurred more than three months from the effective date of coverage because it
involved a preexisting condition.
(2) On or after January
1, 1996, a medicare supplement policy or certificate shall not define a
preexisting condition more restrictively than as a condition for which medical
advice was given or treatment was recommended by or received from a physician,
or other health care provider acting within the scope of his or her license,
within three months before the effective date of coverage.
(3) If a medicare
supplement insurance policy or certificate contains any limitations with
respect to preexisting conditions, such limitations must appear as a separate
paragraph of the policy or certificate and be labeled as "Preexisting
Condition Limitations."
(4) No exclusion or
limitation of preexisting conditions may be applied to policies or certificates
replaced in accordance with the provisions of RCW 48.66.045 if the policy or
certificate replaced had been in effect for at least three months.
NEW SECTION. Sec.
4. A new section is added
to chapter 48.66 RCW to read as follows:
(1) Under this section,
persons eligible for a medicare supplement policy or certificate are those
individuals described in subsection (3) of this section who, subject to
subsection (3)(b)(ii) of this section, apply to enroll under the policy not
later than sixty‑three days after the date of the termination of
enrollment described in subsection (3) of this section, and who submit evidence
of the date of termination or disenrollment with the application for a medicare
supplement policy.
(2) With respect to eligible
persons, an issuer may not deny or condition the issuance or effectiveness of a
medicare supplement policy described in subsection (4) of this section that is
offered and is available for issuance to new enrollees by the issuer, shall not
discriminate in the pricing of such a medicare supplement policy because of
health status, claims experience, receipt of health care, or medical condition,
and shall not impose an exclusion of benefits based on a preexisting condition
under such a medicare supplement policy.
(3) "Eligible
persons" means an individual that meets the requirements of (a), (b), (c),
(d), (e), or (f) of this subsection, as follows:
(a) The individual is
enrolled under an employee welfare benefit plan that provides health benefits
that supplement the benefits under medicare; and the plan terminates, or the
plan ceases to provide all such supplemental health benefits to the individual;
(b)(i) The individual
is enrolled with a medicare+choice organization under a medicare+choice plan
under part C of medicare, and any of the following circumstances apply, or the
individual is sixty-five years of age or older and is enrolled with a program
of all inclusive care for the elderly (PACE) provider under section 1894 of
the social security act, and there are circumstances similar to those described
in this subsection (3)(b) that would permit discontinuance of the individual's
enrollment with the provider if the individual were enrolled in a
medicare+choice plan:
(A) The certification
of the organization or plan under this subsection (3)(b) has been terminated,
or the organization or plan has notified the individual of an impending
termination of such a certification;
(B) The organization
has terminated or otherwise discontinued providing the plan in the area in
which the individual resides, or has notified the individual of an impending
termination or discontinuance of such a plan;
(C) The individual is
no longer eligible to elect the plan because of a change in the individual's
place of residence or other change in circumstances specified by the secretary
of the United States department of health and human services, but not including
termination of the individual's enrollment on the basis described in section
1851(g)(3)(B) of the federal social security act (where the individual has not
paid premiums on a timely basis or has engaged in disruptive behavior as
specified in standards under section 1856 of the federal social security act),
or the plan is terminated for all individuals within a residence area;
(D) The individual
demonstrates, in accordance with guidelines established by the secretary of the
United States department of health and human services, that:
(I) The organization
offering the plan substantially violated a material provision of the
organization's contract under this part in relation to the individual,
including the failure to provide an enrollee on a timely basis medically
necessary care for which benefits are available under the plan or the failure
to provide such covered care in accordance with applicable quality standards;
or
(II) The organization,
an agent, or other entity acting on the organization's behalf materially
misrepresented the plan's provisions in marketing the plan to the individual;
or
(E) The individual
meets other exceptional conditions as the secretary of the United States
department of health and human services may provide.
(ii)(A) An individual
described in (b)(i) of this subsection may elect to apply (a) of this
subsection by substituting, for the date of termination of enrollment, the date
on which the individual was notified by the medicare+choice organization of the
impending termination or discontinuance of the medicare+choice plan it offers
in the area in which the individual resides, but only if the individual
disenrolls from the plan as a result of such notification.
(B) In the case of an
individual making the election under (b)(ii)(A) of this subsection, the issuer
involved shall accept the application of the individual submitted before the
date of termination of enrollment, but the coverage under subsection (1) of
this section shall only become effective upon termination of coverage under the
medicare+choice plan involved;
(c)(i) The individual
is enrolled with:
(A) An eligible
organization under a contract under section 1876 (medicare risk or cost);
(B) A similar
organization operating under demonstration project authority, effective for
periods before April 1, 1999;
(C) An organization
under an agreement under section 1833(a)(1)(A) (health care prepayment plan);
or
(D) An organization
under a medicare select policy; and
(ii) The enrollment
ceases under the same circumstances that would permit discontinuance of an
individual's election of coverage under (b)(i) of this subsection;
(d) The individual is
enrolled under a medicare supplement policy and the enrollment ceases because:
(i)(A) Of the
insolvency of the issuer or bankruptcy of the nonissuer organization; or
(B) Of other
involuntary termination of coverage or enrollment under the policy;
(ii) The issuer of the
policy substantially violated a material provision of the policy; or
(iii) The issuer, an
agent, or other entity acting on the issuer's behalf materially misrepresented
the policy's provisions in marketing the policy to the individual;
(e)(i) The individual
was enrolled under a medicare supplement policy and terminates enrollment and
subsequently enrolls, for the first time, with any medicare+choice organization
under a medicare+choice plan under part C of medicare, any eligible
organization under a contract under section 1876 (medicare risk or cost), any
similar organization operating under demonstration project authority, any PACE
program under section 1894 of the social security act, an organization under an
agreement under section 1833(a)(1)(A) (health care prepayment plan), or a
medicare select policy; and
(ii) The subsequent
enrollment under (e)(i) of this subsection is terminated by the enrollee during
any period within the first twelve months of such subsequent enrollment (during
which the enrollee is permitted to terminate such subsequent enrollment under
section 1851(e) of the federal social security act); or
(f) The individual,
upon first becoming eligible for benefits under part A of medicare at age
sixty-five, enrolls in a medicare+choice plan under part C of medicare, or in a
PACE program under section 1894, and disenrolls from the plan or program by not
later than twelve months after the effective date of enrollment.
(4) An eligible person
under subsection (3) of this section is entitled to a medicare supplement
policy as follows:
(a) A person eligible
under subsection (3)(a), (b), (c), and (d) of this section is entitled to a
medicare supplement policy that has a benefit package classified as plan A
through G offered by any issuer;
(b) A person eligible
under subsection (3)(e) of this section is entitled to the same medicare
supplement policy in which the individual was most recently previously
enrolled, if available from the same issuer, or, if not so available, a policy
described in (a) of this subsection; and
(c) A person eligible
under subsection (3)(f) of this section is entitled to any medicare supplement
policy offered by any issuer.
(5)(a) At the time of
an event described in subsection (3) of this section, and because of which an
individual loses coverage or benefits due to the termination of a contract,
agreement, policy, or plan, the organization that terminates the contract or
agreement, the issuer terminating the policy, or the administrator of the plan
being terminated, respectively, must notify the individual of his or her rights
under this section, and of the obligations of issuers of medicare supplement
policies under subsection (1) of this section. The notice must be communicated
contemporaneously with the notification of termination.
(b) At the time of an
event described in subsection (3) of this section, and because of which an
individual ceases enrollment under a contract, agreement, policy, or plan, the
organization that offers the contract or agreement, regardless of the basis for
the cessation of enrollment, the issuer offering the policy, or the
administrator of the plan, respectively, must notify the individual of his or
her rights under this section, and of the obligations of issuers of medicare
supplement policies under subsection (1) of this section. The notice must be
communicated within ten working days of the issuer receiving notification of
disenrollment.
Sec. 5. RCW 48.07.040 and 1985 c
364 s 2 are each amended to read as follows:
Each incorporated
domestic insurer shall((, in the month of January, February, March, or
April,)) hold ((the)) an annual meeting of its shareholders
or members at such time and place as may be stated in or fixed in accordance
with its bylaws for the purpose of receiving reports of its affairs and to
elect directors. Each domestic insurance holding corporation shall hold an
annual meeting of its shareholders at such time and place as may be stated in
or fixed in accordance with its bylaws. Special meetings of the shareholders
of an incorporated domestic insurer or domestic insurance holding corporation
shall be called and held by such persons and in such a manner as stated in the
articles of incorporation or bylaws.
Sec. 6. RCW 48.43.055 and 1995 c
265 s 20 are each amended to read as follows:
Each
health carrier as defined under RCW 48.43.005 shall file with the commissioner
its procedures for review and adjudication of complaints initiated by ((covered
persons or)) health care providers. Procedures filed under this section
shall provide a fair review for consideration of complaints. Every health
carrier shall provide reasonable means ((whereby)) allowing any
((person)) health care provider aggrieved by actions of the
health carrier ((may)) to be heard ((in person or by their
authorized representative on their)) after submitting a written
request for review. If the health carrier fails to grant or reject ((such))
a request within thirty days after it is made, the complaining ((person))
health care provider may proceed as if the complaint had been rejected.
A complaint that has been rejected by the health carrier may be submitted to
nonbinding mediation. Mediation shall be conducted ((pursuant to)) under
mediation rules similar to those of the American arbitration association, the
center for public resources, the judicial arbitration and mediation service,
RCW 7.70.100, or any other rules of mediation agreed to by the parties. This
section is solely for resolution of provider complaints. Complaints by, or on
behalf of, a covered person are subject to the grievance processes in RCW
48.43.530.
