BILL REQ. #:  Z-0231.1 


State of Washington63rd Legislature2013 Regular Session

By Representatives Van De Wege, Morrell, Jinkins, Cody, and Bergquist; by request of Insurance Commissioner

Read first time 01/28/13.   Referred to Committee on Health Care & Wellness.

     AN ACT Relating to long-term care insurance; and amending RCW 48.83.090 and 48.83.170.


Sec. 1   RCW 48.83.090 and 2008 c 145 s 10 are each amended to read as follows:
     All long-term care denials must be made within ((sixty)) thirty days after receipt of a written request made by a policyholder or certificate holder, or his or her representative. All denials of long-term care claims by the issuer must provide a written explanation of the reasons for the denial and make available to the policyholder or certificate holder all information directly related to the denial.

Sec. 2   RCW 48.83.170 and 2008 c 145 s 18 are each amended to read as follows:
     (1) The commissioner must adopt rules that include standards for full and fair disclosure setting forth the manner, content, and required disclosures for the sale of long-term care insurance policies, terms of renewability, initial and subsequent conditions of eligibility, nonduplication of coverage provisions, coverage of dependents, preexisting conditions, termination of insurance, continuation or conversion, probationary periods, limitations, exceptions, reductions, elimination periods, requirements for replacement, recurrent conditions, and definitions of terms. The commissioner must adopt rules establishing loss ratio standards for long-term care insurance policies. The commissioner must adopt rules to promote premium adequacy and to protect policyholders in the event of proposed substantial rate increases, and to establish minimum standards for producer education, marketing practices, producer compensation, producer testing, penalties, and reporting practices for long-term care insurance.
     (2) The commissioner ((shall)) must adopt rules establishing standards protecting patient privacy rights, rights to receive confidential health care services, and standards for an issuer's timely review of a claim denial upon request of a covered person.
     (3) The commissioner must adopt by rule prompt payment requirements for long-term care insurance. The rules must include a definition of a "claim" and a definition of "clean claim." In adopting the rules the commissioner must consider the prompt payment requirements in long-term care insurance model acts developed by the national association of insurance commissioners.
The commissioner may adopt reasonable rules to effectuate any provision of this chapter in accordance with the requirements of chapter 34.05 RCW.

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