§ 48.46.460 — Conversion agreement—Restrictions and requirements—Rules.

Washington § 48.46.460

• Jurisdiction: Washington
• Title 48: INSURANCE
• Ch. 48.46: HEALTH MAINTENANCE ORGANIZATIONS

Text

(1) A health maintenance organization must offer a conversion agreement for comprehensive health care services and shall not require proof of insurability as a condition for issuance of the conversion agreement.

(2) A conversion agreement may not contain an exclusion for preexisting conditions for an applicant.

(3) A conversion agreement need not provide benefits identical to those provided under the group agreement. The conversion agreement may contain provisions requiring the person covered by the conversion agreement to pay reasonable deductibles and copayments, except for preventive service benefits as defined in 45 C.F.R. 147.130 (2010), implementing sections 2701 through 2763, 2791, and 2792 of the public health service act (42 U.S.C. 300gg through 300gg-63, 300gg-91, and 300gg-92), as amended.

(4) The insurance commissioner shall adopt rules to establish minimum benefit standards for conversion agreements.

(5) The commissioner shall adopt rules to establish specific standards for conversion agreement provisions. These rules may include but are not limited to:

(a) Terms of renewability;

(b) Nonduplication of coverage;

(c) Benefit limitations, exceptions, and reductions; and

(d) Definitions of terms.

Effective date — 2019 c 33: See note following RCW 48.43.005 .

Legislative intent — Severability — 1984 c 190: See notes following RCW 48.21.250 .

Legislative History

[2019 c 33 s 6;2011 c 314 s 9;1984 c 190 s 10.]