§ 48.85.030. Insurance policy criteria -- Rules
(1) The insurance commissioner shall adopt rules defining the criteria that long-term care insurance policies must meet to satisfy the requirements of this chapter. The rules shall provide that all long-term care insurance policies purchased for the purposes of this chapter:
(a) Be guaranteed renewable;
(b) Provide coverage for nursing home care and provide coverage for an alternative plan of care benefit as defined by the commissioner;
(c) Provide optional coverage for home and community-based services. Such home and community-based services shall be included in the coverage unless rejected in writing by the applicant;
(d) Provide automatic inflation protection or similar coverage for any policyholder through the age of seventy-nine and made optional at age eighty to protect the policyholder from future increases in the cost of long-term care;
(e) Not require prior hospitalization or confinement in a nursing home as a prerequisite to receiving long-term care benefits; and
(f) Contain at least a six-month grace period that permits reinstatement of the policy or contract retroactive to the date of termination if the policy or contract holder's nonpayment of premiums arose as a result of a cognitive impairment suffered by the policy or contract holder as certified by a physician.
(2) Insurers offering long-term care policies for the purposes of this chapter shall demonstrate to the satisfaction of the insurance commissioner that they:
(a) Have procedures to provide notice to each purchaser of the long-term care consumer education program;
(b) Offer case management services;
(c) Have procedures that provide for the keeping of individual policy records and procedures for the explanation of coverage and benefits identifying those payments or services available under the policy that meet the purposes of this chapter;
(d) Agree to provide the insurance commissioner, on or before September 1 of each year, an annual report containing information derived from the long-term care partnership long-term care insurance uniform data set as specified by the office of the insurance commissioner.
[1995 1st sp.s. c 18 § 78; 1993 c 492 § 460.]
Notes:
Conflict with federal requirements -- Severability -- Effective date -- 1995 1st sp.s. c 18: See notes following RCW 74.39A.030.
Findings -- Intent -- 1993 c 492: See notes following RCW 43.20.050.
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Last modified: April 7, 2009