Current through Register Vol. 22-07, April 1, 2022
For purposes of this chapter:
(1) "Applicant" means:
(a) In the case of an individual medicare
supplement insurance policy, the person who seeks to contract for insurance
benefits; and
(b) In the case of a
group medicare supplement insurance policy, the proposed certificate
holder.
(2)
"Certificate" means any certificate delivered or issued for delivery in this
state under a group medicare supplement insurance policy regardless of the
situs of the group master policy.
(3) "Certificate form" means the form on
which the certificate is delivered or issued for delivery by the
issuer.
(4) "Issuer" includes
insurance companies, fraternal benefit societies, health care service
contractors, health maintenance organizations, and any other entity delivering
or issuing for delivery medicare supplement policies or certificates.
(5) "Direct response issuer" means an issuer
who, as to a particular transaction, is transacting insurance directly with a
potential insured without solicitation by, or the intervention of, a licensed
insurance producer.
(6) "Disability
insurance" is insurance against bodily injury, disablement or death by
accident, against disablement resulting from sickness, and every insurance
relating to disability insurance. For purposes of this chapter, disability
insurance includes policies or contracts offered by any issuer.
(7) "Health care expense costs," for purposes
of WAC
284-66-200(4),
means expenses of a health maintenance organization or health care service
contractor associated with the delivery of health care services that are
analogous to incurred losses of insurers.
(8) "Policy" includes agreements or contracts
issued by any issuer.
(9) "Policy
form" means the form on which the policy is delivered or issued for delivery by
the issuer.
(10) "Premium" means
all sums charged, received, or deposited as consideration for a medicare
supplement insurance policy or the continuance thereof. An assessment or a
membership, contract, survey, inspection, service, or other similar fee or
charge made by the issuer in consideration for the policy is deemed part of the
premium. "Earned premium" means the "premium" applicable to an accounting
period whether received before, during or after that period.
(11) "Prestandardized medicare supplement
benefit plan," "prestandardized benefit plan" or "prestandardized plan" means a
group or individual policy of medicare supplement insurance issued prior to
January 1, 1990.
(12) "Replacement"
means any transaction where new medicare supplement coverage is to be
purchased, and it is known or should be known to the proposing insurance
producer or other representative of the issuer, or to the proposing issuer if
there is no insurance producer, that by reason of the transaction, existing
medicare supplement coverage has been or is to be lapsed, surrendered or
otherwise terminated.
(13)
"Secretary" means the Secretary of the United States Department of Health and
Human Services.
(14) "1990
standardized medicare supplement benefit plan" means a group or individual
policy of medicare supplement insurance issued on or after January 1, 1990, and
prior to June 1, 2010, and includes medicare supplement insurance policies and
certificates renewed on or after that date which are not replaced by the issuer
at the request of the insured.
(15)
"2010 standardized medicare supplement benefit plan" or "2010 plan" means a
group or individual policy of medicare supplement insurance with an effective
date for coverage on or after June 1, 2010.
