ESB 5261 -
By Representative Morrell
On page 12, after line 31, insert the following:
"Sec. 7 RCW 48.84.020 and 1986 c 170 s 2 are each amended to read
as follows:
Unless the context requires otherwise, the definitions in this
section apply throughout this chapter.
(1) "Long-term care insurance" or "long-term care benefit contract"
means any insurance policy or benefit contract primarily advertised,
marketed, offered, or designed to provide coverage or services for
either institutional or community-based convalescent, custodial,
chronic, or terminally ill care. Such terms do not include and this
chapter shall not apply to policies or contracts governed by chapter
48.66 RCW and continuing care retirement communities.
(2) "Loss ratio" means the incurred claims plus or minus the
increase or decrease in reserves as a percentage of the earned
premiums, or the projected incurred claims plus or minus the increase
or decrease in projected reserves as a percentage of projected earned
premiums, as defined by the commissioner.
(3) "Preexisting condition" means a ((covered person's medical
condition that caused that person to have received medical advice or
treatment during the specified time period before the effective date of
coverage)) condition for which medical advice or treatment was
recommended by, or received from, a provider of health care services
within six months preceding the effective date of coverage of an
insured person.
(4) "Medicare" means Title XVIII of the United States social
security act, or its successor program.
(5) "Medicaid" means Title XIX of the United States social security
act, or its successor program.
(6) "Nursing home" means a nursing home as defined in RCW
18.51.010.
Sec. 8 RCW 48.84.040 and 1986 c 170 s 4 are each amended to read
as follows:
No long-term care insurance policy or benefit contract may:
(1) Use riders, waivers, endorsements, or any similar method to
limit or reduce coverage or benefits;
(2) Indemnify against losses resulting from sickness on a different
basis than losses resulting from accidents;
(3) Be canceled, nonrenewed, or segregated at the time of rerating
solely on the grounds of the age or the deterioration of the mental or
physical health of the covered person;
(4) Exclude or limit coverage for preexisting conditions for a
period of more than ((one year)) six months prior to the effective date
of the policy or contract or more than six months after the effective
date of the policy or contract;
(5) Differentiate benefit amounts on the basis of the type or level
of nursing home care provided;
(6) Contain a provision establishing any new waiting period in the
event an existing policy or contract is converted to a new or other
form within the same company."
Correct the title.
EFFECT: Provides a preexisting waiting period of six months for long-term care insurance policies.