Revised Code of Washington - RCW Title 48 Insurance - Chapter 48.20 Disability Insurance

48.20.002 Scope of chapter
Nothing in this chapter shall apply to or affect (1) any policy of workers' compensation insurance or any policy of liability insurance with or without ...

48.20.012 Format of disability policies
No disability policy shall be delivered or issued for delivery to any person in this state unless it otherwise complies with this code, and complies ...

48.20.013 Return of policy and refund of premium -- Notice required -- Effect of return
Every individual disability insurance policy issued after January 1, 1968, except single premium nonrenewable policies, shall have printed on its face or attached thereto a ...

48.20.015 Endorsements
If a contract is issued on any basis other than as applied for, an endorsement setting forth such modification(s) must accompany and be attached to ...

48.20.022 Policies issued by domestic insurer for delivery in another state
If any policy is issued by a domestic insurer for delivery to a person residing in another state, and if the insurance commissioner or corresponding ...

48.20.025 Schedule of rates for individual health benefit plans -- Loss ratio -- Remittance of premiums -- Definitions
(1) The definitions in this subsection apply throughout this section unless the context clearly requires otherwise. (a) "Claims" means the cost to the insurer of ...

48.20.028 Calculation of premiums -- Adjusted community rating method -- Definitions
(1) Premiums for health benefit plans for individuals shall be calculated using the adjusted community rating method that spreads financial risk across the carrier's entire ...

48.20.029 Calculation of premiums -- Members of a purchasing pool -- Adjusted community rating method -- Definitions
(1) Premiums for health benefit plans for individuals who purchase the plan as a member of a purchasing pool: (a) Consisting of five hundred or ...

48.20.032 Standard provisions required -- Substitutions -- Captions
Except as provided in RCW 48.18.130, each such policy delivered or issued for delivery to any person in this state shall contain the provisions as ...

48.20.042 Standard provision No. 1 -- Entire contract; changes
There shall be a provision as follows: ENTIRE CONTRACTS; CHANGES: This policy, including the endorsements and attached papers, if any, constitutes the entire contract of ...

48.20.050 Standard provision No. 2 -- Misstatement of age or sex
There shall be a provision as follows: "MISSTATEMENT OF AGE OR SEX: If the age or sex of the insured has been misstated, all amounts ...

48.20.052 Standard provision No. 3 -- Time limit on certain defenses
There shall be a provision as follows: "TIME LIMIT ON CERTAIN DEFENSES: (a) After two years from the date of issue of this policy no ...

48.20.062 Standard provision No. 4 -- Grace period
There shall be a provision as follows: GRACE PERIOD: A grace period of . . . . (insert a number not less than "7" for ...

48.20.072 Standard provision No. 5 -- Reinstatement
There shall be a provision as follows: REINSTATEMENT: If any renewal premium be not paid within the time granted the insured for payment, a subsequent ...

48.20.082 Standard provision No. 6 -- Notice of claim
There shall be a provision as follows: NOTICE OF CLAIM: Written notice of claim must be given to the insurer within twenty days after the ...

48.20.092 Standard provision No. 7 -- Claim forms
There shall be a provision as follows: CLAIM FORMS: The insurer, upon receipt of a notice of claim, will furnish to the claimant such forms ...

48.20.102 Standard provision No. 8 -- Proofs of loss
There shall be a provision as follows: PROOFS OF LOSS: Written proof of loss must be furnished to the insurer at its said office in ...

48.20.112 Standard provision No. 9 -- Time of payment of claims
There shall be a provision as follows: TIME OF PAYMENT OF CLAIMS: Indemnities payable under this policy for any loss other than loss for which ...

48.20.122 Standard provision No. 10 -- Payment of claims
(1) There shall be a provision as follows: PAYMENT OF CLAIMS: Indemnity for loss of life will be payable in accordance with the beneficiary designation ...

48.20.132 Standard provision No. 11 -- Physical examination and autopsy
There shall be a provision as follows: PHYSICAL EXAMINATIONS AND AUTOPSY: The insurer at its own expense shall have the right and opportunity to examine ...

48.20.142 Standard provision No. 12 -- Legal actions
There shall be a provision as follows: LEGAL ACTIONS: No action at law or in equity shall be brought to recover on this policy prior ...

48.20.152 Standard provision No. 13 -- Change of beneficiary
There shall be a provision as follows: CHANGE OF BENEFICIARY: Unless the insured makes an irrevocable designation of beneficiary, the right to change of beneficiary ...

48.20.162 Optional standard provisions
Except as provided in RCW 48.18.130, no such policy delivered or issued for delivery to any person in this state shall contain provisions respecting the ...

48.20.172 Optional standard provision No. 14 -- Change of occupation
There may be a provision as follows: CHANGE OF OCCUPATION: If the insured be injured or contract sickness after having changed his occupation to one ...

48.20.192 Optional standard provision No. 15 -- Other insurance in this insurer
There may be a provision as follows: OTHER INSURANCE IN THIS INSURER: If an accident or sickness or accident and sickness policy or policies previously ...

48.20.202 Optional standard provision No. 16 -- Insurance with other insurers (Provision of service or expense incurred basis)
(1) There may be a provision as follows: INSURANCE WITH OTHER INSURERS: If there be other valid coverage, not with this insurer, providing benefits for ...

48.20.212 Optional standard provision No. 17 -- Insurance with other insurers
(1) There may be a provision as follows: INSURANCE WITH OTHER INSURERS: If there be other valid coverage, not with this insurer, providing benefits for ...

48.20.222 Optional standard provision No. 18 -- Relation of earnings to insurance
(1) There may be a provision as follows: RELATION OF EARNINGS TO INSURANCE: If the total monthly amount of loss of time benefits promised for ...

48.20.232 Optional standard provision No. 19 -- Unpaid premium
There may be a provision as follows: UNPAID PREMIUM: Upon the payment of a claim under this policy, any premium then due and unpaid or ...

48.20.242 Optional standard provision No. 20 -- Cancellation
There may be a provision as follows: CANCELLATION: The insurer may cancel this policy at any time by written notice delivered to the insured, or ...

48.20.252 Optional standard provision No. 21 -- Conformity with state statutes
There may be a provision as follows: CONFORMITY WITH STATE STATUTES: Any provision of this policy which, on its effective date, is in conflict with ...

48.20.262 Optional standard provision No. 22 -- Illegal occupation
There may be a provision as follows: ILLEGAL OCCUPATION: The insurer shall not be liable for any loss to which a contributing cause was the ...

48.20.282 Order of certain policy provisions
The provisions which are the subject of RCW 48.20.042 to *48.20.272, inclusive, or any corresponding provisions which are used in lieu thereof in accordance with ...

48.20.292 Third party ownership
The word "insured," as used in this chapter, shall not be construed as preventing a person other than the insured with a proper insurable interest ...

48.20.302 Requirements of other jurisdictions
(1) Any policy of a foreign or alien insurer, when delivered or issued for delivery to any person in this state, may contain any provision ...

48.20.312 Age limit
If any such policy contains a provision establishing, as an age limit or otherwise, a date after which the coverage provided by the policy will ...

48.20.322 Effective date of standard provision and certain other sections -- Five year period
The provisions contained in RCW 48.20.002 to 48.20.322, inclusive, shall take effect on September 1, 1951. A policy, rider or endorsement, which could have been ...

48.20.340 "Family expense disability insurance" defined
(1) Family expense disability insurance is that covering members of any one family including one or both spouses and dependents provided under a master policy ...

48.20.350 "Franchise plan" defined
(1) Disability insurance on a franchise plan is that issued to (a) five or more employees of a common employer, or to (b) ten or ...

48.20.360 Extended disability benefit
A disability insurance contract which provides a reasonable amount of disability indemnity for both accidental injuries and sickness, other than a contract of group or ...

48.20.380 Incontestability after reinstatement
The reinstatement of any policy of noncancellable disability insurance hereafter delivered or issued for delivery in this state shall be contestable only on account of ...

48.20.385 When injury caused by intoxication or use of narcotics
An insurer may not deny coverage for the treatment of an injury solely because the injury was sustained as a consequence of the insured's being ...

48.20.390 Podiatric medicine and surgery
Notwithstanding any provision of any disability insurance contract, benefits shall not be denied thereunder for any medical or surgical service performed by a holder of ...

48.20.391 Diabetes coverage
The legislature finds that diabetes imposes a significant health risk and tremendous financial burden on the citizens and government of the state of Washington, and ...

48.20.392 Prostate cancer screening
(1) Each disability insurance policy issued or renewed after December 31, 2006, that provides coverage for hospital or medical expenses shall provide coverage for prostate ...

48.20.393 Mammograms -- Insurance coverage
Each disability insurance policy issued or renewed after January 1, 1990, that provides coverage for hospital or medical expenses shall provide coverage for screening or ...

48.20.395 Reconstructive breast surgery
(1) Any disability insurance contract providing hospital and medical expenses and health care services delivered or issued in this state after July 24, 1983, shall ...

48.20.397 Mastectomy, lumpectomy
No person engaged in the business of insurance under this chapter may refuse to issue any contract of insurance or cancel or decline to renew ...

48.20.410 Optometry
Notwithstanding any provision of any disability insurance contract, benefits shall not be denied thereunder for any eye care service rendered by a holder of a ...

48.20.411 Registered nurses or advanced registered nurses
Notwithstanding any provision of any disability insurance contract as provided for in this chapter, benefits shall not be denied thereunder for any health care service ...

48.20.412 Chiropractic
Notwithstanding any provision of any disability insurance contract as provided for in this chapter, benefits shall not be denied thereunder for any health care service ...

48.20.414 Psychological services
Notwithstanding any provision of any disability insurance contract, benefits shall not be denied thereunder for any psychological service rendered by a holder of a license ...

48.20.416 Dentistry
Notwithstanding any provision of any disability insurance contract as provided for in this chapter, benefits shall not be denied thereunder for any health care service ...

48.20.418 Denturist services
Notwithstanding any provision of any disability insurance contract covering dental care as provided for in this chapter, effective January 1, 1995, benefits shall not be ...

48.20.420 Dependent child coverage -- Continuation for incapacity
Any disability insurance contract providing health care services, delivered or issued for delivery in this state more than one hundred twenty days after August 11, ...

48.20.430 Dependent child coverage -- From moment of birth -- Congenital anomalies -- Notification of birth
(1) Any disability insurance contract providing hospital and medical expenses and health care services, delivered or issued for delivery in this state more than one ...

48.20.435 Option to cover dependents under age twenty-five
Any disability insurance contract that provides coverage for a subscriber's dependent must offer the option of covering any unmarried dependent under the age of twenty-five.[2007 ...

48.20.450 Standardization and simplification of terms and coverages -- Disclosure requirements
The commissioner shall issue regulations to establish specific standards, including standards of full and fair disclosure, that set forth the manner, content, and required disclosure ...

48.20.460 Standardization and simplification -- Minimum standards for benefits and coverages
(1) The commissioner shall issue regulations to establish minimum standards for benefits under each of the following categories of coverage in individual policies, other than ...

48.20.470 Standardization and simplification -- Outline of coverage -- Format and contents
(1) No policy of individual disability insurance shall be delivered or issued for delivery in this state unless an outline of coverage described in subsection ...

48.20.480 Standardization and simplification -- Simplified application form -- Coverage of loss from preexisting health condition
Notwithstanding the provisions of RCW 48.20.052, if an insurer elects to use a simplified application form, with or without a question as to the applicant's ...

48.20.490 Continuation of coverage by former spouse and dependents
Every policy of disability insurance issued, amended, or renewed after June 12, 1980, for an individual and his/her dependents shall contain provisions to assure that ...

48.20.500 Coverage for adopted children
(1) Any disability insurance contract providing hospital and medical expenses and health care services, delivered or issued for delivery in this state, which provides coverage ...

48.20.510 Cancellation of rider
Upon application by an insured, a rider shall be canceled if at least five years after its issuance, no health care services have been received ...

48.20.520 Phenylketonuria
(1) The legislature finds that: (a) Phenylketonuria is a rare inherited genetic disorder. (b) Children with phenylketonuria are unable to metabolize an essential amino acid, ...

48.20.525 Prescriptions -- Preapproval of individual claims -- Subsequent rejection prohibited -- Written record required
Disability insurance companies who through an authorized representative have first approved, by any means, an individual prescription claim as eligible may not reject that claim ...

48.20.530 Nonresident pharmacies
For the purposes of this chapter, a nonresident pharmacy is defined as any pharmacy located outside this state that ships, mails, or delivers, in any ...

48.20.550 Fixed payment insurance -- Standard disclosure form
The commissioner shall adopt rules setting forth the content of a standard disclosure form to be provided to all applicants for individual, illness-triggered fixed payment ...

48.20.555 Fixed payment insurance -- Benefit restrictions
Illness-triggered fixed payment insurance, hospital confinement fixed payment insurance, or other fixed payment insurance policies are not considered to provide coverage for hospital or medical ...

48.20.580 Mental health services -- Definition -- Coverage required, when
(1) For the purposes of this section, "mental health services" means medically necessary outpatient and inpatient services provided to treat mental disorders covered by the ...