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284-55-010  <<  284-55-020 >>   284-55-030

PDFWAC 284-55-020

Applicability and scope.

(1) This chapter applies to guaranteed renewable medicare supplemental insurance policies delivered to residents of this state prior to January 1, 1989, including every such group and individual policy of disability insurance and to every such subscriber contract of an insurer, fraternal benefit society, health care service contractor, or health maintenance organization, 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 by reason of age. Such policy or contract is referred to in this chapter as "medicare supplemental insurance" or "medicare supplement insurance policy."
(2) Except as required by federal law, this regulation shall not apply to:
(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;
(b) A policy or contract of any professional, trade, or occupational association for its members or former members, or combination thereof, if such association:
(i) Is composed of individuals all of whom are or have been actively engaged in the same profession, trade or occupation;
(ii) Has been maintained in good faith for purposes other than obtaining insurance; and
(iii) Has been in existence for at least two years prior to the date of initial offering of such policy or plan to its members;
(c) Individual policies or contracts issued pursuant to a conversion privilege under a policy or contract of group or individual insurance when such group or individual policy or contract includes provisions which are inconsistent with the requirements of this regulation;
(d) Policies issued to employees or members as additions to franchise plans in existence on the effective date of this regulation, or
(e) Health maintenance organization contracts specified in RCW 48.66.160, to the extent they may be in conflict with this regulation.
[Statutory Authority: RCW 48.02.060 and 48.66.041. WSR 90-17-038 (Order R 90-7), § 284-55-020, filed 8/10/90, effective 9/10/90. Statutory Authority: RCW 48.02.060 (3)(a) and 48.30.010(2). WSR 88-22-061 (Order R 88-9), § 284-55-020, filed 11/1/88. Statutory Authority: RCW 48.02.060, 48.44.050 and 48.46.200. WSR 82-01-016 (Order R 81-6), § 284-55-020, filed 12/9/81.]
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