Wash. Admin. Code § 284-66-323 - Form for reporting multiple medicare supplement policies and certificates

Current through Register Vol. 22-07, April 1, 2022

Medicare Supplement Regulation

FORM FOR REPORTING

MEDICARE SUPPLEMENT POLICIES

Company Name:

Address:

Phone Number:

Due: March 1, annually

The purpose of this form is to report the following information on each resident of this state with more than one medicare supplement policy or certificate in force. The information is to be grouped by individual policyholder.

Policy and

Certificate #

Date of

Issuance

Signature

Name and Title (please type)

Date

Notes

Wash. Admin. Code § 284-66-323

Statutory Authority: RCW 48.66.030(3)(a), 48.66.041, and 48.66.165. 09-24-052 (Matter No. R 2009-08), § 284-66-323, filed 11/24/09, effective 1/19/10. Statutory Authority: RCW 48.02.060, 48.20.450, 48.20.460, 48.20.470, 48.30.010, 48.44.020, 48.44.050, 48.44.070, 48.46.030, 48.46.130 and 48.46.200. 92-06-021 (Order R 92-1), § 284-66-323, filed 2/25/92, effective 3/27/92.

The following state regulations pages link to this page.



State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.