BILL REQ. #: Z-0456.1
State of Washington | 59th Legislature | 2005 Regular Session |
Read first time 01/21/2005. Referred to Committee on Financial Institutions, Housing & Consumer Protection.
AN ACT Relating to insurance; amending RCW 48.02.180, 48.05.340, 48.11.100, 48.11.140, 48.14.010, 48.14.0201, 48.17.150, 48.18.100, 48.18.103, 48.18.430, 48.21.047, 48.23.010, 48.24.030, 48.29.010, 48.29.020, 48.29.120, 48.29.130, 48.29.170, 48.30.300, 48.30A.045, 48.30A.060, 48.30A.065, 48.31.100, 48.38.030, 48.44.240, 48.66.020, 48.66.045, 48.66.055, 48.66.130, 48.92.120, 48.98.015, 48.110.030, and 48.110.040; adding a new section to chapter 48.66 RCW; and repealing RCW 48.05.360, 48.29.030, 48.29.060, 48.29.070, 48.29.090, 48.29.100, 48.29.110, and 48.34.910.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:
Sec. 1 RCW 48.02.180 and 1981 c 339 s 1 are each amended to read
as follows:
(1) ((In addition to such publications as are otherwise authorized
under this code,)) The commissioner may ((from time to time))
periodically prepare and publish:
(a) ((Booklets containing the insurance code, or supplements
thereto, and such related statutes as the commissioner deems suitable
and useful for inclusion in an appendix of such booklet or
supplement.)) Title 48 RCW, Title 284 WAC, insurance bulletins and
technical assistance advisories, and other laws, rules, or regulations
relevant to the regulation of insurance;
(b) Manuals and other material ((relative)) relating to
examinations for ((licensing as provided in chapter 48.17 RCW))
licensure; and
(c) Any other publications authorized under Title 48 RCW.
(2) The commissioner may ((furnish)) provide copies of the
((insurance code, supplements thereto, and related statutes))
publications referred to in subsection (1)(a) of this section free of
charge to:
(a) Public offices and officers in this state ((concerned
therewith, to));
(b) Public officials of other states and jurisdictions ((having
supervision of)) that regulate insurance((, to));
(c) The library of congress((,)); and ((to))
(d) Officers of the armed forces of the United States of America
located at military installations in this state who are concerned with
insurance transactions at or involving ((such)) the military
installations.
(3) Except as provided in subsection (2) of this section, the
commissioner shall sell ((copies of the insurance code, supplements
thereto, examination manuals, and materials as)) the publications
referred to in subsection (1) of this section((, at)). The
commissioner may charge a reasonable price((, fixed by the
commissioner, in amount)) that is not less than the cost of
publication, handling, and distribution ((thereof)). The commissioner
shall promptly deposit all funds received ((by him pursuant to)) under
this subsection with the state treasurer to the credit of the ((general
fund)) insurance commissioner's regulatory account. For appropriation
purposes, ((such)) the funds received and deposited by the commissioner
((shall be treated as)) are a recovery of a previous expenditure.
Sec. 2 RCW 48.05.340 and 1995 c 83 s 14 are each amended to read
as follows:
(1) Subject to RCW 48.05.350 ((and 48.05.360)) to qualify for
authority to transact any one kind of insurance as defined in chapter
48.11 RCW or combination of kinds of insurance as ((shown below)) set
forth in this subsection, a foreign or alien insurer, whether stock or
mutual, or a domestic insurer ((hereafter)) formed ((shall)) after the
effective date of this section must possess unimpaired paid-in capital
stock, if a stock insurer, or unimpaired surplus if a mutual insurer,
and additional funds in surplus, as follows, and ((shall)) must
thereafter maintain unimpaired a combined total of: (a) The paid-in
capital stock if a stock insurer or surplus if a mutual insurer, plus
(b) ((such)) additional funds in surplus equal to the total of the
following initial requirements:
Kind or kinds of insurance | Paid-in
capital stock or basic surplus | Additional surplus | ||
$2,000,000 | $2,000,000 | |||
2,000,000 | 2,000,000 | |||
2,400,000 | 2,400,000 | |||
2,000,000 | 2,000,000 | |||
2,000,000 | 2,000,000 | |||
2,400,000 | 2,400,000 | |||
2,000,000 | 2,000,000 | |||
2,000,000 | 2,000,000 | |||
3,000,000 | 3,000,000 | |||
3,000,000 | 3,000,000 | |||
2,000,000 | 2,000,000 |
Sec. 3 RCW 48.11.100 and 1947 c 79 s .11.10 are each amended to
read as follows:
"Title insurance" is insurance of owners of property or others
having an interest ((therein)) in real property, against loss by
encumbrance, or defective titles, or adverse claim to title, and
associated services ((connected therewith)).
Sec. 4 RCW 48.11.140 and 1993 c 462 s 53 are each amended to read
as follows:
(1) ((No)) An insurer ((shall)) may not retain any risk on any one
subject of insurance, whether located or to be performed in this state
or elsewhere, in an amount exceeding ten percent of its surplus to
policyholders.
(2) For the purposes of this section, a "subject of insurance" as
to insurance against fire includes all properties insured by the same
insurer ((which)) that are reasonably subject to loss or damage from
the same fire.
(3) Reinsurance in an alien reinsurer not qualified under RCW
((48.05.300)) 48.12.166 may not be deducted in determining risk
retained for the purposes of this section.
(4) In the case of surety insurance, the net retention shall be
computed after deduction of reinsurances, the amount assumed by any
co-surety, the value of any security deposited, pledged, or held
subject to the consent of the surety and for the protection of the
surety.
(5) This section does not apply to life insurance, disability
insurance, title insurance, or insurance of marine risks or marine
protection and indemnity risks.
Sec. 5 RCW 48.14.010 and 1994 c 131 s 2 are each amended to read
as follows:
(1) The commissioner shall collect in advance the following fees:
(a) | For filing charter documents: | ||
(i) | Original charter documents, bylaws or record of organization of insurers, or certified copies thereof, required to be filed . . . . . . . . . . . . | $250.00 | |
(ii) | Amended charter documents, or certified copy thereof, other than amendments of bylaws . . . . . . . . . . . . | $ 10.00 | |
(iii) | No additional charge or fee shall be required for filing any of such documents in the office of the secretary of state. | ||
(b) | Certificate of authority: | ||
(i) | Issuance . . . . . . . . . . . . | $ 25.00 | |
(ii) | Renewal . . . . . . . . . . . . | $ 25.00 | |
(c) | Annual statement of insurer, filing . . . . . . . . . . . . | $ 20.00 | |
(d) | Organization or financing of domestic insurers and affiliated corporations: | ||
(i) | Application for solicitation permit, filing . . . . . . . . . . . . | $100.00 | |
(ii) | Issuance of solicitation permit . . . . . . . . . . . . | $ 25.00 | |
(e) | Agents' licenses: | ||
(i) | Agent's qualification licenses every two years . . . . . . . . . . . . | $ 50.00 | |
(ii) | Filing of appointment of each such agent, every two years . . . . . . . . . . . . | $ 20.00 | |
(iii) | Limited license issued pursuant to RCW 48.17.190, every two years . . . . . . . . . . . . | $ 20.00 | |
(f) | Reinsurance intermediary licenses: | ||
(i) | Reinsurance intermediary-broker, each year . . . . . . . . . . . . | $ 50.00 | |
(ii) | Reinsurance intermediary-manager, each year . . . . . . . . . . . . | $100.00 | |
(g) | Brokers' licenses: | ||
(i) | Broker's license, every two years . . . . . . . . . . . . | $100.00 | |
(ii) | Surplus line broker, every two years . . . . . . . . . . . . | $200.00 | |
(h) | Solicitors' license, every two years . . . . . . . . . . . . | $ 20.00 | |
(i) | Adjusters' licenses: | ||
(i) | Independent adjuster, every two years . . . . . . . . . . . . | $ 50.00 | |
(ii) | Public adjuster, every two years . . . . . . . . . . . . | $ 50.00 | |
(j) | Resident general agent's license, every two years . . . . . . . . . . . . | $ 50.00 | |
(k) | Managing general agent appointment, every two years . . . . . . . . . . . . | $200.00 | |
(l) | Examination for license, each examination: | ||
$ 20.00 | |||
(m) | Miscellaneous services: | ||
(i) | Filing other documents . . . . . . . . . . . . | $ 5.00 | |
(ii) | Commissioner's certificate under seal . . . . . . . . . . . . | $ 5.00 | |
(iii) | Copy of documents filed in the commissioner's office, reasonable charge therefor as determined by the commissioner. |
Sec. 6 RCW 48.14.0201 and 2004 c 260 s 24 are each amended to
read as follows:
(1) As used in this section, "taxpayer" means a health maintenance
organization as defined in RCW 48.46.020, a health care service
contractor as defined in RCW 48.44.010, or a self-funded multiple
employer welfare arrangement as defined in RCW 48.125.010.
(2) Each taxpayer shall pay a tax on or before the first day of
March of each year to the state treasurer through the insurance
commissioner's office. The tax shall be equal to the total amount of
all premiums and prepayments for health care services received by the
taxpayer during the preceding calendar year multiplied by the rate of
two percent.
(3) Taxpayers shall prepay their tax obligations under this
section. The minimum amount of the prepayments shall be percentages of
the taxpayer's tax obligation for the preceding calendar year
recomputed using the rate in effect for the current year. For the
prepayment of taxes due during the first calendar year, the minimum
amount of the prepayments shall be percentages of the taxpayer's tax
obligation that would have been due had the tax been in effect during
the previous calendar year. The tax prepayments shall be paid to the
state treasurer through the commissioner's office by the due dates and
in the following amounts:
(a) On or before June 15, forty-five percent;
(b) On or before September 15, twenty-five percent;
(c) On or before December 15, twenty-five percent.
(4) For good cause demonstrated in writing, the commissioner may
approve an amount smaller than the preceding calendar year's tax
obligation as recomputed for calculating the health maintenance
organization's, health care service contractor's, self-funded multiple
employer welfare arrangement's, or certified health plan's prepayment
obligations for the current tax year.
(5) Moneys collected under this section shall be deposited in the
general fund through March 31, 1996, and in the health services account
under RCW 43.72.900 after March 31, 1996.
(6) The taxes imposed in this section do not apply to:
(a) Amounts received by any taxpayer from the United States or any
instrumentality thereof as prepayments for health care services
provided under Title XVIII (medicare) of the federal social security
act.
(b) Amounts received by any health care service contractor, as
defined in RCW 48.44.010, as prepayments for health care services
included within the definition of practice of dentistry under RCW
18.32.020.
(c) Participant contributions to self-funded multiple employer
welfare arrangements that are not taxable in this state.
(7) Beginning January 1, 2000, the state does hereby preempt the
field of imposing excise or privilege taxes upon taxpayers and no
county, city, town, or other municipal subdivision shall have the right
to impose any such taxes upon such taxpayers. This subsection shall be
limited to premiums and payments for health benefit plans offered by
health care service contractors under chapter 48.44 RCW, health
maintenance organizations under chapter 48.46 RCW, and self-funded
multiple employer welfare arrangements as defined in RCW 48.125.010.
The preemption authorized by this subsection shall not impair the
ability of a county, city, town, or other municipal subdivision to
impose excise or privilege taxes upon the health care services directly
delivered by the employees of a health maintenance organization under
chapter 48.46 RCW.
(8) The taxes imposed by this section apply to a self-funded
multiple employer welfare arrangement only in the event that they are
not preempted by the employee retirement income security act of 1974,
as amended, 29 U.S.C. Sec. 1001 et seq. The arrangements and the
commissioner shall initially request an advisory opinion from the
United States department of labor or obtain a declaratory ruling from
a federal court on the legality of imposing state premium taxes on
these arrangements. If there has not been a final determination by the
United States department of labor or a federal court that the taxes are
not preempted by federal law, the taxes provided for in this section
become effective on March 1, 2005, or thirty days following the
issuance of a certificate of authority, whichever is later. During the
time period between March 1, 2005, or thirty days following the
issuance of a certificate of authority, whichever is later, and the
final determination by the United States department of labor or a
federal court, any taxes shall be deposited in an interest bearing
escrow account maintained by the [self-funded] multiple employer
welfare arrangement. Upon a final determination that the taxes are not
preempted by the employee retirement income security act of 1974, as
amended, 29 U.S.C. Sec. 1001 et seq., all funds in the interest bearing
escrow account shall be transferred to the state treasurer.
(9) The effect of transferring contracts for health care services
from one taxpayer to another taxpayer is to transfer the tax prepayment
obligation with respect to the contracts.
(10) On or before June 1st of each year, the commissioner shall
notify each taxpayer required to make prepayments in that year of the
amount of each prepayment and shall provide remittance forms to be used
by the taxpayer. However, a taxpayer's responsibility to make
prepayments is not affected by failure of the commissioner to send, or
the taxpayer to receive, the notice or forms.
Sec. 7 RCW 48.17.150 and 1994 c 131 s 4 are each amended to read
as follows:
(1) To qualify for an agent's or broker's license, an applicant
must otherwise comply with this code ((therefor)) and must:
(a) Be at least eighteen years of age ((or over)), if an
individual;
(b) Be a bona fide resident of and actually reside in this state,
or if a corporation, be other than an insurer and maintain a lawfully
established place of business in this state, except as provided in RCW
48.17.330;
(c) Be empowered to be an agent or broker((, as the case may be,))
under its members' agreement, if a firm, or by its articles of
incorporation, if a corporation;
(d) Complete ((such)) the minimum educational requirements for the
issuance of an agent's license for the kinds of insurance specified in
RCW 48.17.210 as may be required by regulation issued by the
commissioner;
(e) Successfully pass any examination as required under RCW
48.17.110;
(f) Be a trustworthy person;
(g)(i) If for an agent's license, be appointed as its agent by one
or more authorized insurers, subject to issuance of the license;
((and))
(ii) The commissioner may by regulation establish requirements,
including notification formats, in addition to or in lieu of the
requirements of (g)(i) of this subsection to allow an agent to act as
a representative of and place insurance with an insurer without first
notifying the commissioner of the appointment for a period of time up
to but not exceeding thirty days from the date the first insurance
application is executed by the agent; and
(h) If for broker's license, have had at least two years experience
either as an agent, solicitor, adjuster, general agent, broker, or as
an employee of insurers or representatives of insurers, and special
education or training of sufficient duration and extent reasonably to
satisfy the commissioner that ((he)) the applicant possesses the
competence necessary to fulfill the responsibilities of broker.
(2) The commissioner shall by regulation establish minimum
continuing education requirements for the renewal or reissuance of a
license to an agent or a broker((: PROVIDED, That)).
(a) The commissioner shall require that continuing education
courses will be made available on a statewide basis in order to ensure
that persons residing in all geographical areas of this state will have
a reasonable opportunity to attend such courses.
(b) The continuing education requirements ((shall)) must be
appropriate to the license for the kinds of insurance specified in RCW
48.17.210((: PROVIDED FURTHER, That)).
(c) The continuing education requirements may be waived by the
commissioner for good cause shown.
(3) If the commissioner finds that the applicant is ((so))
qualified and that the license fee has been paid, the license shall be
issued. Otherwise, the commissioner shall refuse to issue the license.
Sec. 8 RCW 48.18.100 and 1997 c 428 s 3 are each amended to read
as follows:
(1) No insurance policy form ((other than surety bond forms, forms
exempt under RCW 48.18.103,)) or application form where written
application is required and is to be attached to the policy, or printed
life or disability rider or endorsement form ((shall)) may be issued,
delivered, or used unless it has been filed with and approved by the
commissioner. This section ((shall)) does not apply to:
(a) Surety bond forms;
(b) Forms filed under RCW 48.18.103;
(c) Forms exempted from filing requirements by the commissioner
under RCW 48.18.103; or
(d) Manuscript policies, riders, or endorsements of unique
character designed for and used with relation to insurance upon a
particular subject.
(2) Every such filing containing a certification, in a form
approved by the commissioner, by either the chief executive officer of
the insurer or by an actuary who is a member of the American academy of
actuaries, attesting that the filing complies with Title 48 RCW and
Title 284 of the Washington Administrative Code, may be used by
((such)) the insurer immediately after filing with the commissioner.
The commissioner may order an insurer to cease using a certified form
upon the grounds set forth in RCW 48.18.110. This subsection ((shall))
does not apply to certain types of policy forms designated by the
commissioner by rule.
(3) Except as provided in RCW 48.18.103, every filing that does not
contain a certification pursuant to subsection (2) of this section
((shall)) must be made not less than thirty days in advance of ((any
such)) issuance, delivery, or use. At the expiration of ((such)) the
thirty days, the filed form ((so filed)) shall be deemed approved
unless prior thereto it has been affirmatively approved or disapproved
by order of the commissioner. The commissioner may extend by not more
than an additional fifteen days the period within which he or she may
((so)) affirmatively approve or disapprove any ((such)) form, by giving
notice of ((such)) the extension before expiration of the initial
thirty-day period. At the expiration of ((any such)) the period ((as
so)) that has been extended, and in the absence of ((such)) prior
affirmative approval or disapproval, ((any such)) the form shall be
deemed approved. The commissioner may withdraw any ((such)) approval
at any time for cause. By approval of any ((such)) form for immediate
use, the commissioner may waive any unexpired portion of ((such)) the
initial thirty-day waiting period.
(4) The commissioner's order disapproving any ((such)) form or
withdrawing a previous approval ((shall)) must state the grounds
((therefor)) for disapproval.
(5) No ((such)) form ((shall)) may knowingly be ((so)) issued or
delivered as to which the commissioner's approval does not then exist.
(6) The commissioner may, by ((order)) rule, exempt from the
requirements of this section ((for so long as he or she deems proper,))
any class or type of insurance ((document or form or type thereof as
specified in such order, to which in his or her opinion this section
may not practicably be applied, or the)) policy forms if filing and
approval ((of which are, in his or her opinion,)) is not desirable or
necessary for the protection of the public.
(7) Every member or subscriber to a rating organization ((shall))
must adhere to the form filings made on its behalf by the organization.
Deviations from ((such)) the organization are permitted only when filed
with the commissioner in accordance with this chapter.
Sec. 9 RCW 48.18.103 and 2003 c 248 s 4 are each amended to read
as follows:
(1) It is the intent of the legislature to assist the purchasers of
commercial property casualty insurance by allowing policies to be
issued more expeditiously and provide a more competitive market for
forms.
(2) Commercial property casualty policies may be issued prior to
filing the forms.
(3) All commercial property casualty forms ((shall)) must be filed
with the commissioner within thirty days after an insurer issues any
policy using them. This subsection does not apply to:
(a) Types or classes of forms that the commissioner exempts from
filing by rule; and
(b) Manuscript policies, riders, or endorsements of unique
character designed for and used with relation to insurance upon a
particular subject.
(((3))) (4) If, within thirty days after a commercial property
casualty form has been filed, the commissioner finds that the form does
not meet the requirements of this chapter, the commissioner shall
disapprove the form and give notice to the insurer or rating
organization that made the filing, specifying how the form fails to
meet the requirements and stating when, within a reasonable period
thereafter, the form shall be deemed no longer effective. The
commissioner may extend the time for review ((another)) an additional
fifteen days by giving notice to the insurer prior to the expiration of
the original thirty-day period.
(((4))) (5) Upon a final determination of a disapproval of a policy
form under subsection (((3))) (4) of this section, the insurer
((shall)) must amend any previously issued disapproved form by
endorsement to comply with the commissioner's disapproval.
(((5))) (6) For purposes of this section, "commercial property
casualty" means insurance pertaining to a business, profession,
occupation, nonprofit organization, or public entity for the lines of
property and casualty insurance defined in RCW 48.11.040, 48.11.050,
48.11.060, or 48.11.070.
(((6))) (7) Except as provided in subsection (((4))) (5) of this
section, the disapproval shall not affect any contract made or issued
prior to the expiration of the period set forth in the notice of
disapproval.
(((7))) (8) Every member or subscriber to a rating organization
must adhere to the form filings made on its behalf by the organization.
An insurer may deviate from forms filed on its behalf by an
organization only if the insurer files the forms with the commissioner
in accordance with this chapter.
(9) In the event a hearing is held on the actions of the
commissioner under subsection (((3))) (4) of this section, the burden
of proof shall be on the commissioner.
Sec. 10 RCW 48.18.430 and 1949 c 190 s 25 are each amended to
read as follows:
(1) The benefits, rights, privileges, and options ((which)) under
any annuity contract ((heretofore or hereafter issued are due or
prospectively)) that are due the annuitant who paid the consideration
for the annuity contract((, shall not be)) are not subject to execution
((nor shall)) and the annuitant may not be compelled to exercise ((any
such)) those rights, powers, or options, ((nor shall)) and creditors
((be)) are not allowed to interfere with or terminate the contract,
except:
(a) As to amounts paid for or as premium on ((any such)) an annuity
with intent to defraud creditors, with interest thereon, and of which
the creditor has given the insurer written notice at its home office
prior to ((the)) making ((of)) the payments to the annuitant out of
which the creditor seeks to recover. ((Any such)) The notice ((shall))
must specify the amount claimed or ((such)) the facts ((as)) that will
enable the insurer to ((ascertain such)) determine the amount, and
((shall)) must set forth ((such)) the facts ((as)) that will enable the
insurer to ((ascertain)) determine the insurance or annuity contract,
the person insured or annuitant and the payments sought to be avoided
on the ((ground)) basis of fraud.
(b) The total exemption of benefits presently due and payable to
((any)) an annuitant periodically or at stated times under all annuity
contracts ((under which he is an annuitant, shall)) may not at any time
exceed two thousand five hundred ((and fifty)) dollars per month for
the length of time represented by ((such)) the installments, and ((that
such)) a periodic payment in excess of two thousand five hundred ((and
fifty)) dollars per month ((shall be)) is subject to garnishee
execution to the same extent as are wages and salaries.
(c) If the total benefits presently due and payable to ((any)) an
annuitant under all annuity contracts ((under which he is an annuitant,
shall)) at any time exceeds payment at the rate of two thousand five
hundred ((and fifty)) dollars per month, then the court may order
((such)) the annuitant to pay to a judgment creditor or apply on the
judgment, in installments, ((such)) the portion of ((such)) the excess
benefits ((as to)) that the court ((may appear)) determines to be just
and proper, after due regard for the reasonable requirements of the
judgment debtor and ((his family, if dependent upon him)) the judgment
debtor's dependent family, as well as any payments required to be made
by the annuitant to other creditors under prior court orders.
(2) The benefits, rights, privileges, or options accruing under
((such)) an annuity contract to a beneficiary or assignee ((shall not
be)) are not transferable ((nor)) or subject to commutation, and if the
benefits are payable periodically or at stated times, the same
exemptions and exceptions contained ((herein)) in this section for the
annuitant((, shall apply with respect to such)) apply to the
beneficiary or assignee.
(3) An annuity contract within the meaning of this section ((shall
be)) is any obligation to pay certain sums at stated times, during life
or lives, or for a specified term or terms, issued for a valuable
consideration, regardless of whether or not ((such)) the sums are
payable to one or more persons, jointly or otherwise, but does not
include payments under life insurance contracts at stated times during
life or lives, or for a specified term or terms.
Sec. 11 RCW 48.21.047 and 1995 c 265 s 22 are each amended to
read as follows:
(1) ((No insurer shall)) An insurer may not offer any health
benefit plan to any small employer without complying with ((the
provisions of)) RCW 48.21.045(((5))) (3).
(2) Employers purchasing health plans provided through associations
or through member-governed groups formed specifically for the purpose
of purchasing health care ((shall not be considered)) are not small
employers and ((such plans shall not be subject to the provisions of
RCW 48.21.045(5))) the plans are not subject to RCW 48.21.045(3).
(3) For purposes of this section, "health benefit plan," "health
plan," and "small employer" mean the same as defined in RCW 48.43.005.
Sec. 12 RCW 48.23.010 and 1979 c 130 s 2 are each amended to read
as follows:
((The provisions of this chapter apply)) This chapter applies to
contracts of life insurance and annuities other than group life
insurance, group annuities, and, except for RCW 48.23.260, 48.23.270,
and 48.23.340, ((and 48.23.350,)) other than industrial life
insurance((: PROVIDED, That the provisions of)). However, Title 48
RCW ((shall)) does not apply to charitable gift annuities issued by a
board of a state university, regional university, or a state college,
nor to the issuance thereof.
Sec. 13 RCW 48.24.030 and 1993 c 132 s 1 are each amended to read
as follows:
(1) Insurance under any group life insurance policy issued
((pursuant to)) under RCW 48.24.020, ((or)) 48.24.050, ((or))
48.24.060, ((or)) 48.24.070, or 48.24.090 may, if seventy-five percent
of the then insured employees or labor union members or public employee
association members or members of the Washington state patrol elect, be
extended to insure the spouse and dependent children, or any class or
classes thereof, of each ((such)) insured employee or member who so
elects, in amounts in accordance with a plan ((which)) that precludes
individual selection by the employees or members or by the employer or
labor union or trustee((, and which insurance on the life of any one
family member including a spouse shall not be in excess of fifty
percent of the insurance on the life of the insured employee or
member)).
Premiums for the insurance on ((such)) the family members shall be
paid by the policyholder, either from the employer's funds or funds
contributed by him, trustee's funds, or labor union funds, and/
(2) ((Such)) A spouse insured ((pursuant to)) under this section
((shall have)) has the same conversion right as to the insurance on his
or her life as is vested in the employee or member under this chapter.
Sec. 14 RCW 48.29.010 and 1997 c 14 s 1 are each amended to read
as follows:
(1) This chapter relates only to title insurers for real property.
(2) ((None of the provisions of)) This code ((shall be deemed to))
does not apply to persons engaged in the business of preparing and
issuing abstracts of title to property and certifying to ((the)) their
correctness ((thereof)) so long as ((such)) the persons do not
guarantee or insure ((such)) the titles.
(3) For purposes of this chapter, unless the context clearly
requires otherwise:
(a) "Title policy" means any written instrument, contract, or
guarantee by means of which title insurance liability is assumed.
(b) "Abstract of title" means a written representation, provided
((pursuant to)) under contract, whether written or oral, intended to be
relied upon by the person who has contracted for the receipt of
((such)) this representation, listing all recorded conveyances,
instruments, or documents ((which)) that, under the laws of the state
of Washington, impart constructive notice with respect to the chain of
title to the real property described. An abstract of title is not a
title policy as defined in this subsection.
(c) "Preliminary report," "commitment," or "binder" means reports
furnished in connection with an application for title insurance and are
offers to issue a title policy subject to the stated exceptions ((set
forth)) in the reports, the conditions and stipulations of the report
and the issued policy, and ((such)) other matters as may be
incorporated by reference. The reports are not abstracts of title, nor
are any of the rights, duties, or responsibilities applicable to the
preparation and issuance of an abstract of title applicable to the
issuance of any report. ((Any such)) The report ((shall not be
construed as, nor constitute,)) is not a representation as to the
condition of the title to real property, but ((shall constitute)) is a
statement of terms and conditions upon which the issuer is willing to
issue its title policy, if ((such)) the offer is accepted.
Sec. 15 RCW 48.29.020 and 1990 c 76 s 1 are each amended to read
as follows:
A title insurer ((shall not be)) is not entitled to have a
certificate of authority unless ((it otherwise qualifies therefor, nor
unless)):
(1) It is a stock corporation((.));
(2) It owns or leases and maintains a complete set of tract indexes
of the county in this state in which its principal office ((within this
state)) is located((.)); and
(3) ((It deposits and keeps on deposit with the commissioner a
guaranty fund in amount as set forth in RCW 48.29.030 and comprised of
cash or public obligations as specified in RCW 48.13.040.)) It has and
maintains the capital and surplus requirements set forth in RCW
48.05.340.
Sec. 16 RCW 48.29.120 and 1947 c 79 s .29.12 are each amended to
read as follows:
(((1) Each title insurer shall annually apportion to a special
reserve fund an amount determined by applying the rate of twenty-five
cents for each one thousand dollars of net increase of insurance it has
in force as at the end of such year. Such apportionment shall be
continued or resumed as needed to maintain the special reserve fund at
an amount equal to not less than the guaranty fund deposit required of
the insurer.)) In
determining the financial condition of a title insurer doing business
under this title, the general provisions of chapter 48.12 RCW requiring
the establishment of reserves sufficient to cover all known and unknown
liabilities including allocated and unallocated loss adjustment expense
apply, except that a title insurer shall establish and maintain:
(2) The special reserve fund shall be held by the insurer as an
additional guaranty fund, and shall be used only for the payment of
losses after the insurer's liquid resources available for the payment
of losses, other than such special reserve fund or the guaranty fund
deposit, have been exhausted.
(3) For the purposes of computing the special reserve fund as
provided in subsection (1) of this section, net increase of insurance
in force resulting from reinsurance of the risks of another title
insurer shall not be included to the extent that a like special reserve
fund on such insurance is maintained by the ceding insurer.
(1) A known claim reserve in an amount estimated to be sufficient
to cover all unpaid losses, claims, and allocated loss adjustment
expenses arising under title insurance policies, guaranteed
certificates of title, guaranteed searches, and guaranteed abstracts of
title, and all unpaid losses, claims, and allocated loss adjustment
expenses for which the title insurer may be liable, and for which the
insurer has received notice by or on behalf of the insured, holder of
a guarantee or escrow, or security depositor;
(2)(a) A statutory or unearned premium reserve consisting of:
(i) The amount of the special reserve fund that was required prior
to the effective date of this section, which balance must be released
in accordance with (b) of this subsection; and
(ii) Additions to the reserve after the effective date of this
section must be made out of total charges for title insurance policies
and guarantees written, as set forth in the title insurer's most recent
annual statement on file with the commissioner, equal to the sum of the
following:
(A) For each title insurance policy on a single risk written or
assumed after the effective date of this section, fifteen cents per one
thousand dollars of net retained liability for policies under five
hundred thousand dollars; and
(B) For each title insurance policy on a single risk written or
assumed after the effective date of this section, ten cents per one
thousand dollars of net retained liability for policies of five hundred
thousand or greater.
(b) The aggregate of the amounts set aside in this reserve in any
calendar year pursuant to (a) of this subsection must be released from
the reserve and restored to net profits over a period of twenty years
under the following formula:
(i) Thirty-five percent of the aggregate sum on July 1st of the
year next succeeding the year of addition;
(ii) Fifteen percent of the aggregate sum on July 1st of each of
the succeeding two years;
(iii) Ten percent of the aggregate sum on July 1st of the next
succeeding year;
(iv) Three percent of the aggregate sum on July 1st of each of the
next three succeeding years;
(v) Two percent of the aggregate sum on July 1st of each of the
next three succeeding years; and
(vi) One percent of the aggregate sum on July 1st of each of the
next succeeding ten years.
(c) The insurer shall calculate an adjusted statutory unearned
premium reserve as of the effective date of this section. The adjusted
reserve is calculated as if (a)(ii) and (b) of this subsection had been
in effect for all years beginning twenty years prior to the effective
date of this section. For purposes of this calculation, the balance of
the reserve as of that date is deemed to be zero. If the adjusted
reserve so calculated exceeds the aggregate amount set aside for
statutory or unearned premiums in the insurer's annual statement on
file with the commissioner on the effective date of this section, the
insurer shall, out of total charges for policies of title insurance,
increase its statutory or unearned premium reserve by an amount equal
to one-sixth of that excess in each of the succeeding six years,
commencing with the calendar year that includes the effective date of
this section, until the entire excess has been added.
(d) The aggregate of the amounts set aside in this reserve in any
calendar year as adjustments to the insurer's statutory or unearned
premium reserve under (c) of this subsection shall be released from the
reserve and restored to net profits, or equity if the additions
required by (c) of this subsection reduced equity directly, over a
period not exceeding ten years under to the following table:
Year of Addition | Release |
Year 11 | Equally over 10 years |
Year 2 | Equally over 9 years |
Year 3 | Equally over 8 years |
Year 4 | Equally over 7 years |
Year 5 | Equally over 6 years |
Year 6 | Equally over 5 years |
Sec. 17 RCW 48.29.130 and 1967 c 150 s 30 are each amended to
read as follows:
((The funds of a domestic title insurer, other than those
representing its guaranty fund deposit, shall be invested)) A domestic
title insurer shall invest its funds as follows:
(1) Funds in an amount not less than its reserve required ((special
reserve shall)) by RCW 48.29.120 must be kept invested in investments
eligible for domestic life insurers.
(2) Other funds may be invested in:
(a) The insurer's plant and equipment, up to a maximum of fifty
percent of capital plus surplus.
(b) Stocks and bonds of abstract companies when approved by the
commissioner.
(c) Investments eligible for the investment of funds of any
domestic insurer.
Sec. 18 RCW 48.29.170 and 1981 c 223 s 2 are each amended to read
as follows:
Title insurance agents ((shall be)) are exempt from the provisions
of RCW ((48.17.090(2) and)) 48.17.180(1) ((which otherwise)) that
require that each individual empowered to exercise the authority of a
licensed firm or corporation must be separately licensed.
Sec. 19 RCW 48.30.300 and 1993 c 492 s 287 are each amended to
read as follows:
Notwithstanding any provision contained in Title 48 RCW to the
contrary:
(((1) No)) A person or entity engaged in the business of insurance
in this state ((shall)) may not refuse to issue any contract of
insurance or cancel or decline to renew such contract because of the
sex or marital status, or the presence of any sensory, mental, or
physical handicap of the insured or prospective insured. The amount of
benefits payable, or any term, rate, condition, or type of coverage
((shall)) may not be restricted, modified, excluded, increased, or
reduced on the basis of the sex or marital status, or be restricted,
modified, excluded, or reduced on the basis of the presence of any
sensory, mental, or physical handicap of the insured or prospective
insured. ((Subject to the provisions of subsection (2) of this section
these provisions shall)) This subsection does not prohibit fair
discrimination on the basis of sex, or marital status, or the presence
of any sensory, mental, or physical handicap when bona fide statistical
differences in risk or exposure have been substantiated.
(((2) With respect to disability policies issued or renewed on and
after July 1, 1994, that provide coverage against loss arising from
medical, surgical, hospital, or emergency care services:))
(a) Policies shall guarantee continuity of coverage. Such
provision, which shall be included in every policy, shall provide that:
(i) The policy may be canceled or nonrenewed without the prior
written approval of the commissioner only for nonpayment of premium or
as permitted under RCW 48.18.090; and
(ii) The policy may be canceled or nonrenewed because of a change
in the physical or mental condition or health of a covered person only
with the prior written approval of the commissioner. Such approval
shall be granted only when the insurer has discharged its obligation to
continue coverage for such person by obtaining coverage with another
insurer, health care service contractor, or health maintenance
organization, which coverage is comparable in terms of premiums and
benefits as defined by rule of the commissioner.
(b) It is an unfair practice for a disability insurer to modify the
coverage provided or rates applying to an in-force disability insurance
policy and to fail to make such modification in all such issued and
outstanding policies.
(c) Subject to rules adopted by the commissioner, it is an unfair
practice for a disability insurer to:
(i) Cease the sale of a policy form unless it has received prior
written authorization from the commissioner and has offered all
policyholders covered under such discontinued policy the opportunity to
purchase comparable coverage without health screening; or
(ii) Engage in a practice that subjects policyholders to rate
increases on discontinued policy forms unless such policyholders are
offered the opportunity to purchase comparable coverage without health
screening.
The insurer may limit an offer of comparable coverage without
health screening to a period not less than thirty days from the date
the offer is first made.
Sec. 20 RCW 48.30A.045 and 1997 c 92 s 1 are each amended to read
as follows:
(1) Each insurer licensed to write direct insurance in this state,
except those exempted in subsection (2) of this section, shall
institute and maintain an insurance antifraud plan. ((An insurer
licensed on July 1, 1995, shall file its antifraud plan with the
insurance commissioner no later than December 31, 1995.)) An insurer
licensed after July 1, 1995, shall file its antifraud plan within six
months of licensure. An insurer shall file any change to the antifraud
plan with the insurance commissioner within thirty days after the plan
has been modified.
(2) This section does not apply to:
(a) Health carriers, as defined in RCW 48.43.005((,));
(b) Life insurers((, or));
(c) Title insurers; ((or))
(d) Property or casualty insurers with annual gross written medical
malpractice insurance premiums in this state that exceed fifty percent
of their total annual gross written premiums in this state; ((or all))
(e) Credit-related insurance written in connection with a credit
transaction in which the creditor is named as a beneficiary or loss
payee under the policy, except vendor single-interest or collateral
protection coverage as defined in RCW 48.22.110(4); or
(f) Insurers with gross written premiums of less than one thousand
dollars in Washington during the reporting year.
Sec. 21 RCW 48.30A.060 and 1995 c 285 s 12 are each amended to
read as follows:
By March 31st of each year, each insurer shall ((annually)) provide
to the insurance commissioner a summary report on actions taken under
its antifraud plan to prevent and combat insurance fraud. The report
must also include, but not be limited to, measures taken to protect and
ensure the integrity of electronic data processing-generated data and
manually compiled data, statistical data on the amount of resources
committed to combatting fraud, and the amount of fraud identified and
recovered during the reporting period. The antifraud plans and summary
of the insurer's antifraud activities are not public records and are
exempt from chapter 42.17 RCW, are proprietary, are not subject to
public examination, and are not discoverable or admissible in civil
litigation.
Sec. 22 RCW 48.30A.065 and 1995 c 285 s 13 are each amended to
read as follows:
An insurer that fails to file a timely antifraud plan or ((who does
not)) summary report or that fails to make a good faith attempt to file
an antifraud plan that complies with RCW 48.30A.050 or a summary report
that complies with RCW 48.30A.060, is subject to the penalty provisions
of RCW 48.01.080, but no penalty may be imposed for the first filing
made by an insurer under this chapter. An insurer that fails to follow
the antifraud plan is subject to a civil penalty not to exceed ten
thousand dollars for each violation, at the discretion of the
commissioner after consideration of all relevant factors, including the
willfulness of the violation.
Sec. 23 RCW 48.31.100 and 1947 c 79 s .31.10 are each amended to
read as follows:
(1) An order to conserve the assets of a foreign or alien insurer
((shall)) must direct the commissioner ((forthwith)) immediately to
take possession of the property of the insurer within this state and to
conserve it, subject to the further direction of the court.
(2) Whenever a domiciliary receiver is appointed for ((any such))
a foreign or alien insurer in its domiciliary state ((which)) that is
also a reciprocal state, as defined in RCW ((48.31.110)) 48.99.010, the
court shall on application of the commissioner appoint the commissioner
as the ancillary receiver in this state, subject to the provisions of
the uniform insurers liquidation act.
Sec. 24 RCW 48.38.030 and 1979 c 130 s 8 are each amended to read
as follows:
Each charitable annuity contract or policy form ((shall)) must
include the following information:
(1) The value of the property to be transferred;
(2) The amount of the annuity to be paid to the transferor or the
transferor's nominee;
(3) The manner in which and the intervals at which payment is to be
made;
(4) The age of the person during whose life payment is to be made;
and
(5) The reasonable value as of the date of the agreement of the
benefits ((thereby)) created. This value ((shall)) may not exceed by
more than fifteen percent the net single premium for the benefits,
determined ((in accordance with)) according to the standard of
valuation set forth in RCW 48.38.020(((1))) (3).
Sec. 25 RCW 48.44.240 and 1990 1st ex.s. c 3 s 12 are each
amended to read as follows:
Each group contract for health care services ((which)) that is
delivered or issued for delivery or renewed, on or after January 1,
1988, ((shall)) must contain provisions providing benefits for the
treatment of chemical dependency rendered to covered persons by a
provider ((which)) that is an "approved treatment ((facility or))
program" under RCW 70.96A.020(3).
NEW SECTION. Sec. 26 A new section is added to chapter 48.66 RCW
to read as follows:
(1) An issuer may not deny or condition the issuance or
effectiveness of any medicare supplement policy or certificate
available for sale in this state, or discriminate in the pricing of a
policy or certificate, because of the health status, claims experience,
receipt of health care, or medical condition of an applicant in the
case of an application for a policy or certificate that is submitted
prior to or during the six-month period beginning with the first day of
the first month in which an individual is both sixty-five years of age
or older and is enrolled for benefits under medicare part B. Each
medicare supplement policy and certificate currently available from an
insurer must be made available to all applicants who qualify under this
subsection without regard to age.
(2) If an applicant qualifies under this section and submits an
application during the time period referenced in subsection (1) of this
section and, as of the date of application, has had a continuous period
of creditable coverage of at least three months, the issuer may not
exclude benefits based on a preexisting condition.
(3) If an applicant qualified under this section submits an
application during the time period referenced in subsection (1) of this
section and, as of the date of application, has had a continuous period
of creditable coverage that is less than three months, the issuer must
reduce the period of any preexisting condition exclusion by the
aggregate of the period of creditable coverage applicable to the
applicant as of the enrollment date.
Sec. 27 RCW 48.66.020 and 1996 c 269 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)) The 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 of
the federal social security act (42 U.S.C. Sec. 1395 et seq.), or an
issued policy under a demonstration specified in 42 U.S.C. Sec.
1395(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)) Medicare advantage plans established under medicare part C;
(d) Outpatient prescription drug plans established under medicare
part D; or
(e) Any health care prepayment plan that provides benefits pursuant
to an agreement under section 1833(a)(1)(A) of the federal social
security act.
(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 advantage plan" means a plan of coverage for health
benefits under medicare part C as defined in 42 U.S.C. Sec. 1395w-28(b), and includes:
(a) Coordinated care plans that provide health care services,
including but not limited to health maintenance organization plans,
with or without a point-of-service option, plans offered by provider-sponsored organizations, and preferred provider organization plans;
(b) Medical savings account plans coupled with a contribution into
a medicare advantage plan medical savings account; and
(c) Medicare advantage private fee-for-service plans.
(4) "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))) (5) "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))) (6) "Certificate" means any certificate delivered or issued
for delivery in this state under a group medicare supplement insurance
policy.
(((6))) (7) "Loss ratio" means the incurred claims as a percentage
of the earned premium computed under rules adopted by the insurance
commissioner.
(((7))) (8) "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))) (9) "Disclosure form" means the form designated by the
insurance commissioner ((which)) that discloses medicare benefits, the
supplemental benefits offered by the insurer, and the remaining amount
for which the insured will be responsible.
(((9))) (10) "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.
(11) "Bankruptcy" means when a medicare advantage organization that
is not an issuer has filed, or has had filed against it, a petition for
declaration of bankruptcy and has ceased doing business in the state.
(12) "Continuous period of creditable coverage" means the period
during which an individual was covered by creditable coverage, if
during the period of the coverage the individual had no breaks in
coverage greater than sixty-three days.
(13)(a) "Creditable coverage" means, with respect to an individual,
coverage of the individual provided under any of the following:
(i) A group health plan;
(ii) Health insurance coverage;
(iii) Part A or part B of Title XVIII of the social security act
(medicare);
(iv) Title XIX of the social security act (medicaid), other than
coverage consisting solely of benefits under section 1928 of that act;
(v) Chapter 55 of Title 10 U.S.C. (CHAMPUS);
(vi) A medical care program of the Indian health service or of a
tribal organization;
(vii) A state health benefits risk pool;
(viii) A health plan offered under chapter 89 of Title 5 U.S.C.
(federal employees health benefits program);
(ix) A public health plan as defined in federal regulation; or
(x) A health benefit plan under section 5(e) of the peace corps act
(22 U.S.C. Sec. 2504(e)).
(b) "Creditable coverage" does not include one or more, or any
combination, of the following:
(i) Coverage only for accident or disability income insurance, or
any combination thereof;
(ii) Coverage issued as a supplement to liability insurance;
(iii) Liability insurance, including general liability insurance
and automobile liability insurance;
(iv) Worker's compensation or similar insurance;
(v) Automobile medical payment insurance;
(vi) Credit only insurance;
(vii) Coverage for on-site medical clinics; or
(viii) Other similar insurance coverage, specified in federal
regulations, under which benefits for medical care are secondary or
incidental to other insurance benefits.
(c) "Creditable coverage" does not include the following benefits
if they are provided under a separate policy, certificate, or contract
of insurance or are otherwise not an integral part of the plan:
(i) Limited scope dental or vision benefits;
(ii) Benefits for long-term care, nursing home care, home health
care, community-based care, or any combination thereof; or
(iii) Other similar, limited benefits as are specified in federal
regulations.
(d) "Creditable coverage" does not include the following benefits
if offered as independent, noncoordinated benefits:
(i) Coverage only for a specified disease or illness; or
(ii) Hospital indemnity or other fixed indemnity insurance.
(e) "Creditable coverage" does not include the following if it is
offered as a separate policy, certificate, or contract of insurance:
(i) Medicare supplemental health insurance as defined under section
1882(g)(1) of the social security act;
(ii) Coverage supplemental to the coverage provided under chapter
55 of Title 10 U.S.C.; or
(iii) Similar supplemental coverage provided to coverage under a
group health plan.
(14) "Employee welfare benefit plan" means a plan, fund, or program
of employee benefits as defined in 29 U.S.C. Sec. 1002 (employee
retirement income security act).
(15) "Insolvency" means when an issuer, licensed to transact the
business of insurance in this state, has had a final order of
liquidation entered against it with a finding of insolvency by a court
of competent jurisdiction in the issuer's state of domicile.
Sec. 28 RCW 48.66.045 and 2004 c 83 s 1 are each amended to read
as follows:
Every issuer of a medicare supplement insurance policy or
certificate providing coverage to a resident of this state issued on or
after January 1, 1996, shall:
(1) Unless otherwise provided for in RCW 48.66.055, issue coverage
under its standardized benefit plans B, C, D, E, F, ((and)) G, K, or L
without evidence of insurability to any resident of this state who is
eligible for both medicare hospital and physician services by reason of
age or by reason of disability or end-stage renal disease, if the
medicare supplement policy replaces another medicare supplement
standardized benefit plan policy or certificate B, C, D, E, F, ((or))
G, K, or L or other more comprehensive coverage than the replacing
policy;
(2) Unless otherwise provided for in RCW 48.66.055, issue coverage
under its standardized plans A, H, I, and J without evidence of
insurability to any resident of this state who is eligible for both
medicare hospital and physician services by reason of age or by reason
of disability or end-stage renal disease, if the medicare supplement
policy replaces another medicare supplement policy or certificate which
is the same standardized plan as the replaced policy. After December
31, 2005, plans H, I, and J may be replaced only by the same plan if
that plan has been modified to remove outpatient prescription drug
coverage; and
(3) Set rates only on a community-rated basis. Premiums shall be
equal for all policyholders and certificate holders under a
standardized medicare supplement benefit plan form, except that an
issuer may vary premiums based on spousal discounts, frequency of
payment, and method of payment including automatic deposit of premiums
and may develop no more than two rating pools that distinguish between
an insured's eligibility for medicare by reason of:
(a) Age; or
(b) Disability or end-stage renal disease.
Sec. 29 RCW 48.66.055 and 2002 c 300 s 4 are each amended 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, or medicare part D enrollment, 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))
medicare advantage organization under a ((medicare+choice)) medicare
advantage 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)) medicare advantage 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)) medicare advantage organization of
the impending termination or discontinuance of the ((medicare+choice))
medicare advantage 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)) is only ((become)) effective upon termination of coverage
under the ((medicare+choice)) medicare advantage 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)) medicare advantage
organization under a ((medicare+choice)) medicare advantage 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))
medicare advantage 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; or
(g) The individual enrolls in a medicare part D plan during the
initial enrollment period and, at the time of enrollment in part D, was
enrolled under a medicare supplement policy that covers outpatient
prescription drugs, and the individual terminates enrollment in the
medicare supplement policy and submits evidence of enrollment in
medicare part D along with the application for a policy described in
subsection (4)(d) of this section.
(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)) F, including F with
a high deductible, K, or L, offered by any issuer;
(b)(i) Subject to (b)(ii) of this subsection, 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))
(ii) After December 31, 2005, if the individual was most recently
enrolled in a medicare supplement policy with an outpatient
prescription drug benefit, a medicare supplement policy described in
this subsection (4)(b)(ii) is:
(A) The policy available from the same issuer but modified to
remove outpatient prescription drug coverage; or
(B) At the election of the policyholder, an A, B, C, F, including
F with a high deductible, K, or L policy, that is offered by any
issuer;
(c) A person eligible under subsection (3)(f) of this section is
entitled to any medicare supplement policy offered by any issuer; and
(d) A person eligible under subsection (3)(g) of this section is
entitled to a medicare supplement policy that has a benefit package
classified as plan A, B, C, F, including F with a high deductible, K,
or L and that is offered and is available for issuance to new enrollees
by the same issuer that issued the individual's medicare supplement
policy with outpatient prescription drug coverage.
(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.
(6) Guaranteed issue time periods are as follows:
(a) In the case of an individual described in subsection (3)(a) of
this section, the guaranteed issue period begins on the later of: (i)
The date the individual receives a notice of termination or cessation
of all supplemental health benefits or, if a notice is not received,
notice that a claim has been denied because of a termination or
cessation, or (ii) the date that the applicable coverage terminates or
ceases, and ends sixty-three days thereafter;
(b) In the case of an individual described in subsection (3)(b),
(c), (e), or (f) of this section whose enrollment is terminated
involuntarily, the guaranteed issue period begins on the date that the
individual receives a notice of termination and ends sixty-three days
after the date the applicable coverage is terminated;
(c) In the case of an individual described in subsection (3)(d)(i)
of this section, the guaranteed issue period begins on the earlier of:
(i) The date that the individual receives a notice of termination, a
notice of the issuer's bankruptcy or insolvency, or other such similar
notice if any, and (ii) the date that the applicable coverage is
terminated, and ends on the date that is sixty-three days after the
date the coverage is terminated;
(d) In the case of an individual described in subsection (3)(b),
(d)(ii) and (iii), (e), or (f) of this section, who disenrolls
voluntarily, the guaranteed issue period begins on the date that is
sixty days before the effective date of the disenrollment and ends on
the date that is sixty-three days after the effective date;
(e) In the case of an individual described in subsection (3)(g) of
this section, the guaranteed issue period begins on the date the
individual receives notice pursuant to section 1882(v)(2)(B) of the
federal social security act from the medicare supplement issuer during
the sixty-day period immediately preceding the initial part D
enrollment period and ends on the date that is sixty-three days after
the effective date of the individual's coverage under medicare part D;
and
(f) In the case of an individual described in subsection (3) of
this section but not described in the preceding provisions of this
subsection, the guaranteed issue period begins on the effective date of
disenrollment and ends on the date that is sixty-three days after the
effective date.
(7) In the case of an individual described in subsection (3)(e) of
this section whose enrollment with an organization or provider
described in subsection (3)(e)(i) of this section is involuntarily
terminated within the first twelve months of enrollment, and who,
without an intervening enrollment, enrolls with another organization or
provider, the subsequent enrollment is an initial enrollment as
described in subsection (3)(e) of this section.
(8) In the case of an individual described in subsection (3)(f) of
this section whose enrollment with a plan or in a program described in
subsection (3)(f) of this section is involuntarily terminated within
the first twelve months of enrollment, and who, without an intervening
enrollment, enrolls in another plan or program, the subsequent
enrollment is an initial enrollment as described in subsection (3)(f)
of this section.
(9) For purposes of subsection (3)(e) and (f) of this section, an
enrollment of an individual with an organization or provider described
in subsection (3)(e)(i) of this section, or with a plan or in a program
described in subsection (3)(f) of this section is not an initial
enrollment under this subsection after the two-year period beginning on
the date on which the individual first enrolled with such an
organization, provider, plan, or program.
Sec. 30 RCW 48.66.130 and 2002 c 300 s 3 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.
(5) If a medicare supplement policy or certificate replaces another
medicare supplement policy or certificate, the replacing issuer shall
waive any time periods applicable to preexisting conditions, waiting
periods, elimination periods, and probationary periods in the new
medicare supplement policy or certificate for similar benefits to the
extent that time was spent under the original policy.
(6) If a medicare supplement policy or certificate replaces another
medicare supplement policy or certificate that has been in effect for
at least three months, the replacing policy must not provide any time
period applicable to preexisting conditions, waiting periods,
elimination periods, and probationary periods for benefits similar to
those contained in the original policy or certificate.
Sec. 31 RCW 48.92.120 and 1993 c 462 s 101 are each amended to
read as follows:
(1) ((No)) A person may not act or aid in any manner in soliciting,
negotiating, or procuring liability insurance in this state from a risk
retention group unless the person is licensed as an insurance agent or
broker for casualty insurance in accordance with chapter 48.17 RCW and
pays the fees designated for the license under RCW 48.14.010.
(2)(a) ((No)) A person may not act or aid in any manner in
soliciting, negotiating, or procuring liability insurance in this state
for a purchasing group from an authorized insurer or a risk retention
group chartered in a state unless the person is licensed as an
insurance agent or broker for casualty insurance in accordance with
chapter 48.17 RCW and pays the fees designated for the license under
RCW 48.14.010.
(b) ((No)) A person may not act or aid in any manner in soliciting,
negotiating, or procuring liability insurance coverage in this state
for a member of a purchasing group under a purchasing group's policy
unless the person is licensed as an insurance agent or broker for
casualty insurance in accordance with chapter 48.17 RCW and pays the
fees designated for the license under RCW 48.14.010.
(c) ((No)) A person may not act or aid in any manner in soliciting,
negotiating, or procuring liability insurance from an insurer not
authorized to do business in this state on behalf of a purchasing group
located in this state unless the person is licensed as a surplus lines
broker in accordance with chapter 48.15 RCW and pays the fees
designated for the license under RCW 48.14.010.
(3) For purposes of acting as an agent or broker for a risk
retention group or purchasing group under subsections (1) and (2) of
this section, the requirement of residence in this state does not
apply.
(4) Every person licensed under chapters 48.15 and 48.17 RCW, on
business placed with risk retention groups or written through a
purchasing group, ((shall)) must inform each prospective insured of the
provisions of the notice required under RCW 48.92.040(7) in the case of
a risk retention group and RCW 48.92.090(((3))) (2) in the case of a
purchasing group.
Sec. 32 RCW 48.98.015 and 1993 c 462 s 37 are each amended to
read as follows:
((No)) A managing general agent may not place business with an
insurer unless there is in force a written contract between the
managing general agent and the insurer that sets forth the
responsibilities of each party and, where both parties share
responsibility for a particular function, that specifies the division
of the responsibilities, and that contains the following minimum
provisions:
(1) The insurer may terminate the contract for cause upon written
notice to the managing general agent. The insurer may suspend the
underwriting authority of the managing general agent during the
pendency of a dispute regarding the cause for termination.
(2) The managing general agent shall render accounts to the insurer
detailing all transactions and remit all funds due under the contract
to the insurer on not less than a monthly basis.
(3) The managing general agent shall hold funds collected for the
account of an insurer in a fiduciary capacity in ((a)) an FDIC insured
financial institution ((located in this state that is a member of the
federal reserve system)). This account must be used for all payments
on behalf of the insurer. The managing general agent may retain no
more than three months' estimated claims payments and allocated loss
adjustment expenses.
(4) The managing general agent shall maintain separate records of
business written for each insurer. The insurer has access to and the
right to copy all accounts and records related to its business in a
form usable by the insurer, and the commissioner has access to all
books, bank accounts, and records of the managing general agent in a
form usable to the commissioner. Those records ((shall)) must be
retained according to the requirements of this title and rules adopted
under it.
(5) The managing general agent may not assign the contract in whole
or part.
(6)(a) Appropriate underwriting guidelines must include at least
the following: The maximum annual premium volume; the basis of the
rates to be charged; the types of risks that may be written; maximum
limits of liability; applicable exclusions; territorial limitations;
policy cancellation provisions; and the maximum policy period.
(b) The insurer has the right to cancel or not renew any policy of
insurance, subject to the applicable laws and rules, including those in
chapter 48.18 RCW.
(7) If the contract permits the managing general agent to settle
claims on behalf of the insurer:
(a) All claims must be reported to the insurer in a timely
manner((.));
(b) A copy of the claim file must be sent to the insurer at its
request or as soon as it becomes known that the claim:
(i) Has the potential to exceed an amount determined by the
commissioner, or exceeds the limit set by the insurer, whichever is
less;
(ii) Involves a coverage dispute;
(iii) May exceed the managing general agent's claims settlement
authority;
(iv) Is open for more than six months; or
(v) Is closed by payment in excess of an amount set by the
commissioner or an amount set by the insurer, whichever is less((.));
(c) All claim files are the joint property of the insurer and the
managing general agent. However, upon an order of liquidation of the
insurer, those files become the sole property of the insurer or its
liquidator or successor. The managing general agent has reasonable
access to and the right to copy the files on a timely basis((.)); and
(d) Settlement authority granted to the managing general agent may
be terminated for cause upon the insurer's written notice to the
managing general agent or upon the termination of the contract. The
insurer may suspend the managing general agent's settlement authority
during the pendency of a dispute regarding the cause for termination.
(8) ((Where)) When electronic claims files are in existence, the
contract must address the timely transmission of the data.
(9) If the contract provides for a sharing of interim profits by
the managing general agent, and the managing general agent has the
authority to determine the amount of the interim profits by
establishing loss reserves or controlling claim payments or in any
other manner, interim profits ((shall)) may not be paid to the managing
general agent until one year after they are earned for property
insurance business and five years after they are earned on casualty
business and not until the profits have been verified under RCW
48.98.020.
(10) The managing general agent may not:
(a) Bind reinsurance or retrocessions on behalf of the insurer,
except that the managing general agent may bind automatic reinsurance
contracts under obligatory automatic agreements if the contract with
the insurer contains reinsurance underwriting guidelines including, for
both reinsurance assumed and ceded, a list of reinsurers with which the
automatic agreements are in effect, the coverages and amounts or
percentages that may be reinsured, and commission schedules;
(b) Commit the insurer to participate in insurance or reinsurance
syndicates;
(c) Use an agent that is not appointed to represent the insurer in
accordance with the requirements of chapter 48.17 RCW;
(d) Without prior approval of the insurer, pay or commit the
insurer to pay a claim over a specified amount, net of reinsurance,
that ((shall)) may not exceed one percent of the insurer's policyholder
surplus as of December 31st of the last-completed calendar year;
(e) Collect a payment from a reinsurer or commit the insurer to a
claim settlement with a reinsurer, without prior approval of the
insurer. If prior approval is given, a report ((shall)) must be
promptly forwarded to the insurer;
(f) Permit an agent appointed by it to serve on the insurer's board
of directors;
(g) Jointly employ an individual who is employed by the insurer; or
(h) Appoint a submanaging general agent.
Sec. 33 RCW 48.110.030 and 1999 c 112 s 4 are each amended to
read as follows:
(1) A person ((shall)) may not act as, or offer to act as, or hold
himself or herself out to be a service contract provider in this state,
nor may a service contract be sold to a consumer in this state, unless
the service contract provider has a valid registration as a service
contract provider issued by the commissioner.
(2) Applicants to be a service contract provider ((shall)) must
make an application to the commissioner upon a form to be furnished by
the commissioner. The application ((shall)) must include or be
accompanied by the following information and documents:
(a) All basic organizational documents of the service contract
provider, including any articles of incorporation, articles of
association, partnership agreement, trade name certificate, trust
agreement, shareholder agreement, bylaws, and other applicable
documents, and all amendments to those documents;
(b) The identities of the service contract provider's executive
officer or officers directly responsible for the service contract
provider's service contract business, and, if more than fifty percent
of the service contract provider's gross revenue is derived from the
sale of service contracts, the identities of the service contract
provider's directors and stockholders having beneficial ownership of
ten percent or more of any class of securities;
(c) Audited annual financial statements or other financial reports
acceptable to the commissioner for the two most recent years which
prove that the applicant is solvent and any information the
commissioner may require in order to review the current financial
condition of the applicant. If the service contract provider is
relying on RCW 48.110.050(2) (a) or (c) to assure the faithful
performance of its obligations to service contract holders, then the
audited financial statements of the service contract provider's parent
company may be substituted for the audited financial statements of the
service contract provider;
(d) An application fee of two hundred fifty dollars, which shall be
deposited into the ((insurance commissioner's regulatory account under
RCW 48.02.190)) general fund; and
(e) Any other pertinent information required by the commissioner.
(3) The applicant shall appoint the commissioner as its attorney to
receive service of legal process in any action, suit, or proceeding in
any court. This appointment is irrevocable and shall bind the service
contract provider or any successor in interest, shall remain in effect
as long as there is in force in this state any contract or any
obligation arising therefrom related to residents of this state, and
shall be processed in accordance with RCW 48.05.210.
(4) The commissioner may refuse to issue a registration if the
commissioner determines that the service contract provider, or any
individual responsible for the conduct of the affairs of the service
contract provider under subsection (2)(b) of this section, is not
competent, trustworthy, financially responsible, or has had a license
as a service contract provider or similar license denied or revoked for
cause by any state.
(5) A registration issued under this section is valid, unless
surrendered, suspended, or revoked by the commissioner, or not renewed
for so long as the service contract provider continues in business in
this state and remains in compliance with this chapter. A registration
is subject to renewal annually on the first day of July upon
application of the service contract provider and payment of a fee of
two hundred dollars, which shall be deposited into the ((insurance
commissioner's regulatory account under RCW 48.02.190)) general fund.
If not so renewed, the registration expires on the June 30th next
preceding.
(6) A service contract provider shall keep current the information
required to be disclosed in its registration under this section by
reporting all material changes or additions within thirty days after
the end of the month in which the change or addition occurs.
Sec. 34 RCW 48.110.040 and 1999 c 112 s 5 are each amended to
read as follows:
(1) Every registered service contract provider that is assuring its
faithful performance of its obligations to its service contract holders
by complying with RCW 48.110.050(2)(b) ((shall)) must file an annual
report for the preceding calendar year with the commissioner on or
before March 1st of each year, or within any extension of time the
commissioner for good cause may grant. The report ((shall)) must be in
the form and contain those matters as the commissioner prescribes and
shall be verified by at least two officers of the service contract
provider.
(2) At the time of filing the report, the service contract provider
((shall)) must pay a filing fee of twenty dollars which shall be
deposited into the ((insurance commissioner's regulatory account under
RCW 48.02.190)) general fund.
(3) As part of any investigation by the commissioner, the
commissioner may require a service contract provider to file monthly
financial reports whenever, in the commissioner's discretion, there is
a need to more closely monitor the financial activities of the service
contract provider. Monthly financial statements ((shall)) must be
filed in the commissioner's office no later than the twenty-fifth day
of the month following the month for which the financial report is
being filed. These monthly financial reports ((shall be)) are the
internal financial statements of the service contract provider. The
monthly financial reports that are filed with the commissioner
constitute information that might be damaging to the service contract
provider if made available to its competitors, and therefore shall be
kept confidential by the commissioner. This information ((shall)) may
not be made public or be subject to subpoena, other than by the
commissioner and then only for the purpose of enforcement actions taken
by the commissioner.
NEW SECTION. Sec. 35 The following acts or parts of acts are
each repealed:
(1) RCW 48.05.360 (Special surplus requirements for certain
combinations) and 1963 c 195 s 9;
(2) RCW 48.29.030 (Amount of deposit) and 1957 c 193 s 16 & 1947 c
79 s .29.03;
(3) RCW 48.29.060 (Impairment of deposit) and 1947 c 79 s .29.06;
(4) RCW 48.29.070 (Levy of execution against deposit) and 1955 c 86
s 14 & 1947 c 79 s .29.07;
(5) RCW 48.29.090 (Purpose of deposit) and 1955 c 86 s 16 & 1947 c
79 s .29.09;
(6) RCW 48.29.100 (Termination of deposit) and 1947 c 79 s .29.10;
(7) RCW 48.29.110 (Release of securities) and 1955 c 86 s 17 & 1947
c 79 s .29.11; and
(8) RCW 48.34.910 (Small loan act [Consumer finance act] not
affected) and 1961 c 219 s 14.