There shall be an insurance commissioner of this state who shall be elected at the time and in the manner that other state officers are elected.
The commissioner in office at the effective date of this code shall continue in office for the remainder of the term for which he or she was elected and until his or her successor is duly elected and qualified.
"Commissioner," where used in this code, means the insurance commissioner of this state.
[ 2009 c 549 § 7001; 1947 c 79 § .02.01; Rem. Supp. 1947 § 45.02.01; ]
The term of office of the commissioner shall be four years, commencing on the Wednesday after the second Monday in January after his or her election.
[ 2009 c 549 § 7002; 1947 c 79 § .02.02; Rem. Supp. 1947 § 45.02.02; ]
Before entering upon his or her duties the commissioner shall execute a bond to the state in the sum of twenty-five thousand dollars, to be approved by the state treasurer and the attorney general, conditioned upon the faithful performance of the duties of his or her office.
[ 2009 c 549 § 7003; 1947 c 79 § .02.03; Rem. Supp. 1947 § 45.02.03; ]
The official seal of the commissioner shall be a vignette of George Washington, with the words "Insurance Commissioner, State of Washington" surrounding the vignette.
[ 1947 c 79 § .02.05; Rem. Supp. 1947 § 45.02.05; ]
The commissioner has the authority expressly conferred upon him or her by or reasonably implied from the provisions of this code.
The commissioner must execute his or her duties and must enforce the provisions of this code.
The commissioner may:
Make reasonable rules for effectuating any provision of this code, except those relating to his or her election, qualifications, or compensation. Rules are not effective prior to their being filed for public inspection in the commissioner's office.
Conduct investigations to determine whether any person has violated any provision of this code.
Conduct examinations, investigations, hearings, in addition to those specifically provided for, useful and proper for the efficient administration of any provision of this code.
When the governor proclaims a state of emergency under RCW 43.06.010(12), the commissioner may issue an order that addresses any or all of the following matters related to insurance policies issued in this state:
Reporting requirements for claims;
Grace periods for payment of insurance premiums and performance of other duties by insureds;
Temporary postponement of cancellations and nonrenewals; and
Medical coverage to ensure access to care.
An order by the commissioner under subsection (4) of this section may remain effective for not more than sixty days unless the commissioner extends the termination date for the order for an additional period of not more than thirty days. The commissioner may extend the order if, in the commissioner's judgment, the circumstances warrant an extension. An order of the commissioner under subsection (4) of this section is not effective after the related state of emergency is terminated by proclamation of the governor under RCW 43.06.210. The order must specify, by line of insurance:
The geographic areas in which the order applies, which must be within but may be less extensive than the geographic area specified in the governor's proclamation of a state of emergency and must be specific according to an appropriate means of delineation, such as the United States postal service zip codes or other appropriate means; and
The date on which the order becomes effective and the date on which the order terminates.
The commissioner may adopt rules that establish general criteria for orders issued under subsection (4) of this section and may adopt emergency rules applicable to a specific proclamation of a state of emergency by the governor.
The rule-making authority set forth in subsection (6) of this section does not limit or affect the rule-making authority otherwise granted to the commissioner by law.
[ 2010 c 27 § 1; 2009 c 335 § 1; 1947 c 79 § .02.06; Rem. Supp. 1947 § 45.02.06; ]
The insurance commissioner may adopt rules to implement RCW 48.21.241, 48.44.341, and 48.46.291, except that the rules do not apply to health benefit plans administered or operated under chapter 41.05 or 70.47 RCW.
[ 2005 c 6 § 10; ]
Documents, materials, or other information as described in either subsection (5) or (6), or both, of this section are confidential by law and privileged, are not subject to public disclosure under chapter 42.56 RCW, and are not subject to subpoena directed to the commissioner or any person who received documents, materials, or other information while acting under the authority of the commissioner. The commissioner is authorized to use such documents, materials, or other information in the furtherance of any regulatory or legal action brought as a part of the commissioner's official duties. The confidentiality and privilege created by this section and RCW 42.56.400(8) applies only to the commissioner, any person acting under the authority of the commissioner, the national association of insurance commissioners and its affiliates and subsidiaries, regulatory and law enforcement officials of other states and nations, the federal government, and international authorities.
Neither the commissioner nor any person who received documents, materials, or other information while acting under the authority of the commissioner is permitted or required to testify in any private civil action concerning any confidential and privileged documents, materials, or information subject to subsection (1) of this section.
The commissioner:
May share documents, materials, or other information, including the confidential and privileged documents, materials, or information subject to subsection (1) of this section, with (i) the national association of insurance commissioners and its affiliates and subsidiaries, and (ii) regulatory and law enforcement officials of other states and nations, the federal government, and international authorities, if the recipient agrees to maintain the confidentiality and privileged status of the document, material, or other information;
May receive documents, materials, or information, including otherwise either confidential or privileged, or both, documents, materials, or information, from (i) the national association of insurance commissioners and its affiliates and subsidiaries, and (ii) regulatory and law enforcement officials of other states and nations, the federal government, and international authorities and shall maintain as confidential and privileged any document, material, or information received that is either confidential or privileged, or both, under the laws of the jurisdiction that is the source of the document, material, or information; and
May enter into agreements governing the sharing and use of information consistent with this subsection.
No waiver of an existing privilege or claim of confidentiality in the documents, materials, or information may occur as a result of disclosure to the commissioner under this section or as a result of sharing as authorized in subsection (3) of this section.
Documents, materials, or information, which is either confidential or privileged, or both, which has been provided to the commissioner by (a) the national association of insurance commissioners and its affiliates and subsidiaries, (b) regulatory or law enforcement officials of other states and nations, the federal government, or international authorities, or (c) agencies of this state, is confidential and privileged only if the documents, materials, or information is protected from disclosure by the applicable laws of the jurisdiction that is the source of the document, material, or information.
Working papers, documents, materials, or information produced by, obtained by, or disclosed to the commissioner or any other person in the course of a financial or market conduct examination, or in the course of financial analysis or market conduct desk audit, are not required to be disclosed by the commissioner unless cited by the commissioner in connection with an agency action as defined in RCW 34.05.010(3). The commissioner shall notify a party that produced the documents, materials, or information five business days before disclosure in connection with an agency action. The notified party may seek injunctive relief in any Washington state superior court to prevent disclosure of any documents, materials, or information it believes is confidential or privileged. In civil actions between private parties or in criminal actions, disclosure to the commissioner under this section does not create any privilege or claim of confidentiality or waive any existing privilege or claim of confidentiality.
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After receipt of a public disclosure request, the commissioner shall disclose the documents, materials, or information under subsection (6) of this section that relate to a financial or market conduct examination undertaken as a result of a proposed change of control of a nonprofit or mutual health insurer governed in whole or in part by chapter 48.31B RCW.
The commissioner is not required to disclose the documents, materials, or information in (a) of this subsection if:
The documents, materials, or information are otherwise privileged or exempted from public disclosure; or
The commissioner finds that the public interest in disclosure of the documents, materials, or information is outweighed by the public interest in nondisclosure in that particular instance.
Any person may petition a Washington state superior court to allow inspection of information exempt from public disclosure under subsection (6) of this section when the information is connected to allegations of negligence or malfeasance by the commissioner related to a financial or market conduct examination. The court shall conduct an in-camera review after notifying the commissioner and every party that produced the information. The court may order the commissioner to allow the petitioner to have access to the information provided the petitioner maintains the confidentiality of the information. The petitioner must not disclose the information to any other person, except upon further order of the court. After conducting a regular hearing, the court may order that the information can be disclosed publicly if the court finds that there is a public interest in the disclosure of the information and the exemption of the information from public disclosure is clearly unnecessary to protect any individual's right of privacy or any vital governmental function.
[ 2015 c 122 § 15; 2007 c 126 § 1; 2005 c 274 § 309; 2005 c 126 § 1; 2001 c 57 § 1; ]
All nonpublic personal health information obtained by, disclosed to, or in the custody of the commissioner, regardless of the form or medium, is confidential and is not subject to public disclosure under chapter 42.56 RCW. The commissioner shall not disclose nonpublic personal health information except in the furtherance of regulatory or legal action brought as a part of the commissioner's official duties.
The following definitions apply only for the purposes of this section:
"Health information" means any information or data, except age or gender, whether oral or recorded in any form or medium, created by or derived from a health care provider or a patient, or a policyholder or enrollee, that relates to:
The past, present, or future physical, mental, or behavioral health or condition of an individual;
The provision of health care to an individual; or
Payment for the provision of health care to an individual.
"Health care" means preventive, diagnostic, therapeutic, rehabilitative, maintenance, or palliative care, services, procedures, tests, or counseling that:
Relates to the physical, mental, or behavioral condition of an individual;
Affects the structure or function of the human body or any part of the human body, including the banking of blood, sperm, organs, or any other tissue; or
Prescribes, dispenses, or furnishes to an individual drugs or biologicals, or medical devices or health care equipment and supplies.
"Nonpublic personal health information" means health information:
That identifies an individual who is the subject of the information; or
With respect to which there is a reasonable basis to believe that the information could be used to identify an individual.
"Patient" means an individual who is receiving, has received, or has sought health care. The term includes a deceased individual who has received health care.
"Policyholder" or "enrollee" means a person who is covered by, enrolled in, has applied for, or purchased, an insurance policy, a health plan as defined in RCW 48.43.005, a group plan, or any other product regulated by the insurance commissioner. "Policyholder" or "enrollee" may include, without limitation, a subscriber, member, annuitant, beneficiary, spouse, or dependent.
The commissioner may:
Share documents, materials, or other information, including the confidential documents, materials, or information subject to subsection (1) of this section, with (i) the national association of insurance commissioners and its affiliates and subsidiaries, and (ii) regulatory and law enforcement officials of this and other states and nations, the federal government, and international authorities, if the recipient agrees to maintain the confidentiality and privileged status of the document, material, or other information;
Receive documents, materials, or information, including otherwise either confidential or privileged documents, materials, or information, from (i) the national association of insurance commissioners and its affiliates and subsidiaries, and (ii) regulatory and law enforcement officials of this and other states and nations, the federal government, and international authorities and must maintain as confidential or privileged any document, material, or information received that is either confidential or privileged, or both, under the laws of the jurisdiction that is the source of the document, material, or information; and
Enter into agreements governing the sharing and use of information consistent with this subsection.
No waiver of an existing claim of confidentiality or privilege in the documents, materials, or information may occur as a result of disclosure to the commissioner under this section or as a result of sharing as authorized in subsection (3) of this section.
The commissioner shall add language in large font to the release consumers use when filing complaints with the office, whether online or in writing, informing them that the office may share their personal health information with other entities and for the purposes authorized under subsection (3) of this section, and that the information will only be shared if it is to be held confidential by the other entity. Consumers shall be provided the opportunity to opt out at the time of filing their complaint, indicating that their personal health information may not be shared under subsection (3) of this section.
[ 2017 c 193 § 1; ]
The commissioner may prosecute an action in any court of competent jurisdiction to enforce any order made by him or her pursuant to any provision of this code.
If the commissioner has cause to believe that any person has violated any penal provision of this code or of other laws relating to insurance he or she shall certify the facts of the violation to the public prosecutor of the jurisdiction in which the offense was committed.
If the commissioner has cause to believe that any person is violating or is about to violate any provision of this code or any regulation or order of the commissioner, he or she may:
issue a cease and desist order; and/or
bring an action in any court of competent jurisdiction to enjoin the person from continuing the violation or doing any action in furtherance thereof.
The attorney general and the several prosecuting attorneys throughout the state shall prosecute or defend all proceedings brought pursuant to the provisions of this code when requested by the commissioner.
[ 2009 c 549 § 7005; 1967 c 150 § 1; 1947 c 79 § .02.08; Rem. Supp. 1947 § 45.02.08; ]
The commissioner may appoint a chief deputy commissioner, who shall have power to perform any act or duty conferred upon the commissioner. The chief deputy commissioner shall take and subscribe the same oath of office as the commissioner, which oath shall be endorsed upon the certificate of his or her appointment and filed in the office of the secretary of state.
The commissioner may appoint additional deputy commissioners for such purposes as he or she may designate.
The commissioner shall be responsible for the official acts of his or her deputies, and may revoke at will the appointment of any deputy.
The commissioner may employ examiners, and such actuarial, technical, and administrative assistants and clerks as he or she may need for proper discharge of his or her duties.
The commissioner, or any deputy or employee of the commissioner, shall not be interested, directly or indirectly, in any insurer except as a policyholder; except, that as to such matters wherein a conflict of interests does not exist on the part of any such person, the commissioner may employ insurance actuaries or other technicians who are independently practicing their professions even though such persons are similarly employed by insurers.
The commissioner may require any deputy or employee to be bonded as he or she shall deem proper but not to exceed in amount the sum of twenty-five thousand dollars. The cost of any such bond shall be borne by the state.
[ 2009 c 549 § 7006; 1949 c 190 § 1; 1947 c 79 § .02.09; Rem. Supp. 1949 § 45.02.09; ]
There is established, within the office of the insurance commissioner, the volunteer position of health care authority ombuds to assist retirees enrolled in the public employees' benefits board program. The volunteer position shall be trained as part of the existing volunteer training provided to the statewide health insurance benefit advisors. The position shall help retirees with questions and concerns, assist the public employees' benefits board program with identification of retiree concerns, and maintain access to updated program information.
[ 2013 c 23 § 101; 2012 c 150 § 1; ]
Any power or duty vested in the commissioner by any provision of this code may be exercised or discharged by any deputy, assistant, examiner, or employee of the commissioner acting in his or her name and by his or her authority.
[ 2009 c 549 § 7007; 1947 c 79 § .02.10; Rem. Supp. 1947 § 45.02.10; ]
The commissioner shall have an office at the state capital, and may maintain such offices elsewhere in this state as he or she may deem necessary.
[ 2009 c 549 § 7008; 1947 c 79 § .02.11; Rem. Supp. 1947 § 45.02.11; ]
The commissioner shall preserve in permanent form records of his or her proceedings, hearings, investigations, and examinations, and shall file such records in his or her office.
The records of the commissioner and insurance filings in his or her office shall be open to public inspection, except as otherwise provided by this code.
Except as provided in subsection (4) of this section, actuarial formulas, statistics, and assumptions submitted in support of a rate or form filing by an insurer, health care service contractor, or health maintenance organization or submitted to the commissioner upon his or her request shall be withheld from public inspection in order to preserve trade secrets or prevent unfair competition.
For individual and small group health benefit plan rate filings submitted on or after July 1, 2011, subsection (3) of this section applies only to the numeric values of each small group rating factor used by a health carrier as authorized by RCW 48.21.045(3)(a), 48.44.023(3)(a), and 48.46.066(3)(a). Subsection (3) of this section may continue to apply for a period of one year from the date a new individual or small group product filing is submitted or until the next rate filing for the product, whichever occurs earlier, if the commissioner determines that the proposed rate filing is for a new product that is distinct and unique from any of the carrier's currently or previously offered health benefit plans. Carriers must make a written request for a product classification as a new product under this subsection and must receive subsequent written approval by the commissioner for this subsection to apply.
Unless the commissioner has determined that a filing is for a new product pursuant to subsection (4) of this section, for all individual or small group health benefit rate filings submitted on or after July 1, 2011, the health carrier must submit part I rate increase summary and part II written explanation of the rate increase as set forth by the department of health and human services at the time of filing, and the commissioner must:
Make each filing and the part I rate increase summary and part II written explanation of the rate increase available for public inspection on the tenth calendar day after the commissioner determines that the rate filing is complete and accepts the filing for review through the electronic rate and form filing system; and
Prepare a standardized rate summary form, to explain his or her findings after the rate review process is completed. The commissioner's summary form must be included as part of the rate filing documentation and available to the public electronically.
[ 2011 c 312 § 1; 1985 c 264 § 2; 1979 ex.s. c 130 § 1; 1947 c 79 § .02.12; Rem. Supp. 1947 § 45.02.12; ]
Whenever any documents are filed with the insurance commissioner which affect a corporate or company name, the insurance commissioner shall immediately notify the secretary of state of the filing. If any other action is taken by the insurance commissioner which affects a corporate or company name, the insurance commissioner shall immediately notify the secretary of state of the action. The insurance commissioner shall cooperate with the secretary of state to ascertain that there is no duplication of corporate or company names.
[ 1998 c 23 § 19; ]
Any certificate or license issued by the commissioner shall bear the seal of his or her office.
Copies of records or documents in his or her office certified to by the commissioner shall be received as evidence in all courts in the same manner and to the same effect as if they were the originals.
When required for evidence in court, the commissioner shall furnish his or her certificate as to the authority of an insurer or other licensee in this state on any particular date, and the court shall receive the certificate in lieu of the commissioner's testimony.
[ 2009 c 549 § 7009; 1947 c 79 § .02.13; Rem. Supp. 1947 § 45.02.13; ]
The commissioner shall to the extent he or she deems useful for the proper discharge of his or her responsibilities under the provisions of this code:
Consult and cooperate with the public officials having supervision over insurance in other states.
Share jointly with other states in the employment of actuaries, statisticians, and other insurance technicians whose services or the products thereof are made available and are useful to the participating states and to the commissioner.
Share jointly with other states in establishing and maintaining offices and clerical facilities for purposes useful to the participating states and to the commissioner.
All arrangements made jointly with other states under items (b) and (c) of subsection (1) of this section shall be in writing executed on behalf of this state by the commissioner. Any such arrangement, as to participation of this state therein, shall be subject to termination by the commissioner at any time upon reasonable notice.
For the purposes of this code "National Association of Insurance Commissioners" means that voluntary organization of the public officials having supervision of insurance in the respective states, districts, and territories of the United States, whatever other name such organization may hereafter adopt, and in the affairs of which each of such public officials is entitled to participate subject to the constitution and bylaws of such organization.
[ 2009 c 549 § 7010; 1947 c 79 § .02.14; Rem. Supp. 1947 § 45.02.14; ]
The commissioner must purchase at the expense of the state, and in the manner provided by law, printing, books, reports, furniture, equipment, and supplies as he or she deems necessary to the proper discharge of his or her duties under this code.
[ 2011 c 47 § 2; 2009 c 549 § 7011; 1947 c 79 § .02.15; Rem. Supp. 1947 § 45.02.15; ]
The commissioner shall:
Obtain and publish for the use of courts and appraisers throughout the state, tables showing the average expectancy of life and values of annuities and of life and term estates.
Disseminate information concerning the insurance laws of this state.
Provide assistance to members of the public in obtaining information about insurance products and in resolving complaints involving insurers and other licensees.
[ 1988 c 248 § 1; 1947 c 79 § .02.16; Rem. Supp. 1947 § 45.02.16; ]
The commissioner shall, as soon as accurate preparation enables, prepare a report of his or her official transactions during the preceding fiscal year, containing information relative to insurance as the commissioner deems proper.
[ 2009 c 549 § 7012; 1987 c 505 § 53; 1977 c 75 § 69; 1947 c 79 § .02.17; Rem. Supp. 1947 § 45.02.17; ]
The commissioner may periodically prepare and publish:
Title 48 RCW, Title 284 WAC, insurance bulletins and technical assistance advisories, and other laws, rules, or regulations relevant to the regulation of insurance;
Manuals and other material relating to examinations for licensure; and
Any other publications authorized under Title 48 RCW.
The commissioner may provide copies of the publications referred to in subsection (1)(a) of this section free of charge to:
Public offices and officers in this state;
Public officials of other states and jurisdictions that regulate insurance;
The library of congress; and
Officers of the armed forces of the United States of America located at military installations in this state who are concerned with insurance transactions at or involving the military installations.
Except as provided in subsection (2) of this section, the commissioner shall sell the publications referred to in subsection (1) of this section. The commissioner may charge a reasonable price that is not less than the cost of publication, handling, and distribution. The commissioner shall promptly deposit all funds received under this subsection with the state treasurer to the credit of the insurance commissioner's regulatory account. For appropriation purposes, the funds received and deposited by the commissioner are a recovery of a previous expenditure.
[ 2005 c 223 § 1; 1981 c 339 § 1; 1977 c 75 § 70; 1959 c 225 § 1; ]
As used in this section:
"Insurance fraud surcharge" means the fees imposed by subsection (2)(b) of this section.
"Organization" means every insurer, as defined in RCW 48.01.050, having a certificate of authority to do business in this state, every health care service contractor, as defined in RCW 48.44.010, every health maintenance organization, as defined in RCW 48.46.020, or self-funded multiple employer welfare arrangement, as defined in RCW 48.125.010, registered to do business in this state. "Class one" organizations consist of all insurers as defined in RCW 48.01.050. "Class two" organizations consist of all organizations registered under provisions of chapters 48.44 and 48.46 RCW. "Class three" organizations consist of self-funded multiple employer welfare arrangements as defined in RCW 48.125.010.
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"Receipts" means (A) net direct premiums consisting of direct gross premiums, as defined in RCW 48.18.170, paid for insurance written or renewed upon risks or property resident, situated, or to be performed in this state, less return premiums and premiums on policies not taken, dividends paid or credited to policyholders on direct business, and premiums received from policies or contracts issued in connection with qualified plans as defined in RCW 48.14.021, and (B) prepayments to health care service contractors, as defined in RCW 48.44.010, health maintenance organizations, as defined in RCW 48.46.020, or participant contributions to self-funded multiple employer welfare arrangements, as defined in RCW 48.125.010, less experience rating credits, dividends, prepayments returned to subscribers, and payments for contracts not taken.
Participant contributions, under chapter 48.125 RCW, used to determine the receipts in this state under this section are determined in the same manner as premiums taxable in this state are determined under RCW 48.14.090.
"Regulatory surcharge" means the fees imposed by subsection (2)(a) of this section.
The annual cost of operating the office of the insurance commissioner is determined by legislative appropriation.
A pro rata share of the cost, except for the cost of the insurance fraud program, is charged to all organizations as a regulatory surcharge. Each class of organization must contribute a sufficient amount to the insurance commissioner's regulatory account to pay the reasonable costs, including overhead, of regulating that class of organization.
The annual cost of operating the insurance fraud program is charged to all organizations as an insurance fraud surcharge. Each class of organization must contribute a sufficient amount to the insurance commissioner's fraud account to pay the reasonable costs of the program, including overhead.
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The regulatory surcharge is calculated separately for each class of organization. The regulatory surcharge collected from each organization is that portion of the cost of operating the insurance commissioner's office, except for the cost of operating the insurance fraud program, for that class of organization, for the ensuing fiscal year that is represented by the organization's portion of the receipts collected or received by all organizations within that class on business in this state during the previous calendar year. However, the regulatory surcharge must not exceed one-eighth of one percent of receipts and the minimum regulatory surcharge is one thousand dollars.
The insurance fraud surcharge collected from each organization is the cost of operating the insurance fraud program for the ensuing fiscal year that is represented by the organization's portion of the receipts collected or received on business in this state during the previous calendar year. However, the insurance fraud surcharge may not exceed one one-hundredths of one percent of receipts and the minimum insurance fraud surcharge is one hundred dollars.
The commissioner must annually, on or before July 1st, calculate and bill each organization for the amount of the regulatory and insurance fraud surcharges. The surcharges are due and payable no later than July 15th of each year. However, if the necessary financial records are not available or if the amount of the legislative appropriation is not determined in time to carry out such calculations and bill the surcharges within the time specified, the commissioner may use the surcharge factors for the prior year as the basis for the surcharges and, if necessary, the commissioner may impose supplemental fees to fully and properly charge the organizations. Any organization failing to pay the surcharges by July 31st must pay the same penalties as the penalties for failure to pay taxes when due under RCW 48.14.060. The surcharges required by this section are in addition to all other taxes and fees now imposed or that may be subsequently imposed.
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All moneys collected for the regulatory surcharge must be deposited in the insurance commissioner's regulatory account in the state treasury which is hereby created.
All moneys collected for the insurance fraud surcharge must be deposited in the insurance commissioner's fraud account in the state treasury which is hereby created.
Unexpended funds in the insurance commissioner's regulatory and fraud accounts at the close of a fiscal year are carried forward to the succeeding fiscal year and are used to reduce future regulatory and insurance fraud surcharges.
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Each insurer may annually collect regulatory and insurance fraud surcharges remitted in preceding years by means of a policyholder surcharge on premiums charged for all kinds of insurance. The recoupment is at a uniform rate reasonably calculated to collect the regulatory and insurance fraud surcharges remitted by the insurer.
If an insurer fails to collect the entire amount of the recoupment in the first year under this section, it may repeat the recoupment procedure provided for in this subsection (7) in succeeding years until the regulatory and insurance fraud surcharges are fully collected or a de minimis amount remains uncollected. Any such de minimis amount may be collected as provided in (d) of this subsection.
The amount and nature of any recoupment must be separately stated on either a billing or policy declaration sent to an insured. The amount of the recoupment must not be considered a premium for any purpose, including the premium tax or agents' commissions.
An insurer may elect not to collect the regulatory and insurance fraud surcharges from its insured. In such a case, the insurer may recoup the regulatory and insurance fraud surcharges through its rates, if the following requirements are met:
The insurer remits the amount of the surcharges not collected by election under this subsection; and
The surcharges are not considered a premium for any purpose, including the premium tax or agents' commission.
[ 2020 c 195 § 2; 2011 c 47 § 3; 2009 c 161 § 1; 2008 c 328 § 6003; 2007 c 468 § 1; 2007 c 153 § 3; 2004 c 260 § 22; 2003 1st sp.s. c 25 § 923; 2002 c 371 § 913; 1987 c 505 § 54; 1986 c 296 § 7; ]
Legal process against a person (a) for whom the commissioner has been appointed attorney for service of process, or (b) who may be served by service of process upon the commissioner, must be served upon the commissioner either by a person competent to serve a summons or by registered mail. At the time of service, the plaintiff must pay to the commissioner ten dollars, taxable as costs in the action.
As soon as practicable, the commissioner must send or make available a copy of the process to the person on whose behalf he or she has been served by mail, electronic means, or other means reasonably calculated to give notice. The copy must be sent or made available in a manner that is secure and with a receipt that is verifiable.
The commissioner must keep a record of the day and hour of service upon him or her of all legal process.
Proceedings must not be had against the person, and the person must not be required to appear, plead, or answer until the expiration of forty days after the date of service upon the commissioner.
The commissioner may adopt rules to implement this section.
[ 2010 c 18 § 5; ]
The commissioner shall accept registration of pharmacy benefit managers as established in RCW 19.340.030 and receipts shall be deposited in the insurance commissioner's regulatory account.
The commissioner shall have enforcement authority over chapter 19.340 RCW consistent with requirements established in RCW 19.340.110.
The commissioner may adopt rules to implement chapter 19.340 RCW and to establish registration and renewal fees that ensure the registration, renewal, and oversight activities are self-supporting.
[ 2016 c 210 § 5; ]
For the purposes of developing or implementing an individual health insurance market stability program, any reports, data, documents, or materials that health carriers submit to or receive from the United States department of health and human services as part of any health and human services operated risk adjustment or reinsurance program, or that the Washington state health insurance pool, established under chapter 48.41 RCW, prepares for purposes of this section that are obtained by, disclosed to, or in the custody of the commissioner, regardless of the form or medium, are confidential and are not subject to public disclosure under chapter 42.56 RCW. The commissioner shall not disclose these reports, data, documents, or materials except in the furtherance of developing and implementing an individual health insurance market stability program.
For the purposes of this section:
A health and human services operated risk adjustment or reinsurance program is any of the health insurance risk adjustment or reinsurance programs established under 42 U.S.C. Secs. 18061 and 18063. The reports, data, documents, and materials that are confidential under this section include all data and information carriers are required to provide to health and human services through the dedicated data environments required by 45 C.F.R. Sec. 153.700 et seq. for all health carriers participating in any health and human services health insurance risk adjustment or reinsurance program; and
"Health carrier" has the same meaning as in RCW 48.43.005.
The commissioner may:
Share documents, materials, or other information, including the confidential documents, materials, or information subject to subsection (1) of this section, with contractors conducting actuarial, economic, or other analyses necessary to develop or implement an individual health insurance market stability program.
Enter into agreements governing the sharing and use of information consistent with this subsection.
No waiver of an existing claim of confidentiality or privilege in the documents, materials, or information may occur as a result of disclosure to the commissioner under this section or as a result of sharing as authorized in subsection (3) of this section.
Nothing in this section may be construed to authorize the commissioner to submit a complete application to the federal government for a waiver of any provision of federal law, including the federal patient protection and affordable care act, P.L. 111-148, as amended by the federal health care and education reconciliation act, P.L. 111-152, or federal regulations or guidance issued under the affordable care act. The commissioner shall provide the joint select committee on health care oversight established by RCW 44.82.010 with a progress report prior to submitting a draft waiver application to the federal government.
Reports, data, documents, and materials subject to this section are those obtained by the commissioner as of December 31, 2019.
The study conducted under this section to examine individual market stability options must be conducted one time only, and the data requested for purposes of the study must be mutually agreed on between the commissioner and the carriers.
A work group to study and make recommendations on natural disaster and resiliency activities is hereby created. The work group membership shall be composed of:
The insurance commissioner or his or her designee, who shall serve as the chair of the work group;
One member from each of the two largest caucuses of the house of representatives, appointed by the speaker of the house of representatives;
One member from each of the two largest caucuses of the senate, appointed by the president of the senate;
A representative from the governor's resilient Washington work group;
A representative from the Washington state association of counties;
A representative from the association of Washington cities;
A representative from the state building code council;
The commissioner of the department of natural resources or his or her designee;
The director of the Washington state military department or his or her designee;
The superintendent of public instruction or his or her designee;
The secretary of the state department of transportation or his or her designee;
The director of the department of ecology or his or her designee;
The director of the department of commerce or his or her designee;
A representative from the Washington association of building officials;
A representative from the building industry association of Washington;
Two representatives from the property and casualty insurance industry, to be selected by the insurance commissioner or his or her designee, through an application process;
A representative of emergency and transitional housing providers, to be appointed by the office of the insurance commissioner;
A representative from public utility districts to be selected by a state association of public utility districts;
A representative of water and sewer districts to be selected by a state association of water and sewer districts;
A representative selected by the Washington state commission on African American affairs, the Washington state commission on Hispanic affairs, the governor's office of Indian affairs, and the Washington state commission on Asian Pacific American affairs to represent the entities on the work group;
A representative from the state department of agriculture;
A representative from the state conservation commission as defined in RCW 89.08.030;
A representative of a federally recognized Indian tribe with a reservation located east of the crest of the Cascade mountains, to be appointed by the governor;
A representative of a federally recognized Indian tribe with a reservation located west of the crest of the Cascade mountains, to be appointed by the governor; and
Other state agency representatives or stakeholder group representatives, at the discretion of the work group, for the purpose of participating in specific topic discussions or subcommittees.
The work group shall engage in the following activities:
Review disaster mitigation and resiliency activities being done in this state by public and private entities;
Review disaster mitigation and resiliency activities being done in other states and at the federal level;
Review information on uptake in this state for disaster related insurance, such as flood and earthquake insurance;
Review information on how other states are coordinating disaster mitigation and resiliency work including, but not limited to, the work of entities such as the California earthquake authority;
Review how other states and the federal government fund their disaster mitigation and resiliency activities and programs; and
Make recommendations to the legislature and office of the insurance commissioner regarding:
Whether this state should create an ongoing disaster resiliency program;
What activities the program should engage in;
How the program should coordinate with state agencies and other entities engaged in disaster mitigation and resiliency work;
Where the program should be housed; and
How the program should be funded.
The work group shall submit, in compliance with RCW 43.01.036, a preliminary report of recommendations to the legislature, the office of the insurance commissioner, the governor, the office of the superintendent of public instruction, and the commissioner of public lands by November 1, 2019, and a final report by December 1, 2020.
[ 2019 c 388 § 2; ]
Notwithstanding any other provision of law, all insurers, fraternal benefit societies, health carriers including disability insurers, health maintenance organizations, and health care service contractors, and limited health care service contractors may not:
Decline or limit coverage of a person under a policy or contract solely due to the status of the person as a living organ donor;
Preclude a person from donating all or part of an organ as a condition of receiving or continuing to receive a policy or contract; or
Otherwise discriminate in the offering, issuance, cancellation, amount of coverage, price, or any other condition of a policy or contract for a person based solely and without any additional actuarial risks upon the status of the person as a living organ donor. Except as provided in RCW 48.43.0128, 48.44.220, or 48.46.370, this subsection does not prohibit fair discrimination on the basis of sex, or marital status, or the presence of any sensory, mental, or physical handicap when bona fide statistical differences in risk or exposure have been substantiated.
The commissioner shall make educational materials available to the health plans and the public on the access of living organ donors to insurance.
The commissioner may adopt rules to implement this section.
For purposes of this section, "living organ donor" means an individual who has donated all or part of an organ and is not deceased.
[ 2021 c 172 § 1; ]
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Beginning March 1, 2022, and annually thereafter, each health carrier, medicaid managed care organization, and third-party administrator must file with the commissioner a statement of covered lives using the form or forms prescribed and furnished by the commissioner.
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For assessments collected in fiscal year 2022, the commissioner shall assess health carriers, medicaid managed care organizations, and third-party administrators for a per member per month assessment of up to $1.54, for a total assessment not to exceed $100,000,000.
For assessments collected in fiscal year 2023, the commissioner shall assess health carriers, medicaid managed care organizations, and third-party administrators for a per member per month assessment of up to $1.92, for a total assessment not to exceed $125,000,000.
For assessments collected in fiscal year 2024, the commissioner shall assess health carriers, medicaid managed care organizations, and third-party administrators for a per member per month assessment of up to $2.30, for a total assessment not to exceed $150,000,000.
For assessments collected in fiscal year 2025, the commissioner shall assess health carriers, medicaid managed care organizations, and third-party administrators for a per member per month assessment of up to $2.69, for a total assessment not to exceed $175,000,000.
For assessments collected in fiscal year 2026 and beyond, the commissioner shall assess health carriers, medicaid managed care organizations, and third-party administrators for a per member per month assessment of up to $3.07, for a total assessment not to exceed $200,000,000.
The covered lives assessment collected from each health carrier, medicaid managed care organization, and third-party administrator is that proportion of the total assessment amount for the ensuing fiscal year that is represented by the health carrier's, medicaid managed care organization's, or third-party administrator's proportion of covered lives in this state during the previous fiscal year.
The commissioner must annually, on or before June 1st, calculate and bill each health carrier, medicaid managed care organization, and third-party administrator for the amount of the covered lives assessment. The assessment is due and payable by July 1st of each year. However, if the necessary financial records are not available in time to carry out such calculations and bill such assessments within the time specified, the commissioner may use the assessment factors from the prior year as the basis for the assessment and, if necessary, the commissioner may impose supplemental assessments to fully and properly charge the health carriers, medicaid managed care organizations, and third-party administrators. Any health carrier, medicaid managed care organization, or third-party administrator failing to pay the assessment by July 31st must pay the same penalties as the penalties for failure to pay taxes when due under RCW 48.14.060. The assessment required by this section is in addition to all other taxes and fees now imposed or that may be subsequently imposed.
Assessments and penalties collected under this section must be deposited in the foundational public health services account and spent according to RCW 43.70.515.
A health carrier, medicaid managed care organization, or third-party administrator is not subject to an assessment under this section if it has 50 or fewer covered lives in Washington.
If an assessment against a health carrier, medicaid managed care organization, or third-party administrator is prohibited by court order, the assessment for the remaining health carriers, medicaid managed care organizations, and third-party administrators may be adjusted in a manner consistent with subsection (3) of this section to ensure that the net assessment amount calculated in subsection (2) of this section will be collected.
Premiums paid by enrollees for plans offered on the individual and small group markets should not reflect assessment rates.
The definitions in this subsection apply throughout this section unless the context clearly requires otherwise.
"Covered lives" means all persons residing in Washington state who are:
Covered under an individual or group health plan that is issued or delivered in Washington state or an individual or group health plan that otherwise provides health benefits to Washington residents;
Covered under a self-funded multiple employer welfare arrangement as defined in RCW 48.125.010; or
Enrolled in a group health plan administered by a third-party administrator.
"Covered lives assessment" means the fees imposed by this section.
"Health carrier" means every health care service contractor, as defined in RCW 48.44.010, every health maintenance organization, as defined in RCW 48.46.020, or self-funded multiple employer welfare arrangement, as defined in RCW 48.125.010, registered to do business in this state.
"Health plan" has the same meaning as defined in RCW 48.43.005.
"Medicaid managed care organization" means a managed health care system under contract with the state of Washington to provide services to medicaid enrollees under RCW 74.09.522.
"Third-party administrator" means any person or entity who, on behalf of an employer, an affiliated employer under common management and control, a multiple employer welfare arrangement, a Taft-Hartley benefit trust, or other health care purchaser, receives or collects charges, contributions, or premiums for, or adjusts or settles health services claims on or for, residents of Washington state. Third-party administrator does not include health care benefit managers as defined in RCW 48.200.020. An administrator who is contracted with the state of Washington to administer a self-funded health benefits plan under chapter 41.05 RCW is a third-party administrator for purposes of this act.
[ 2021 c XXX § 2; ]**
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Every third-party administrator must register with the commissioner by December 31, 2021, and must annually renew their registration. Third-party administrators that begin administering health benefits in Washington state on or after December 31, 2021, must register with the commissioner within 30 days of when they begin administering such benefits and must annually renew their registration. Registrants shall report a change of legal name, business name, business address, or business telephone number to the commissioner within 10 days after the change.
The commissioner shall define the data elements and procedures necessary to implement this section. To minimize administrative burdens on third-party administrators, in developing the data elements and procedures for registration and renewal, the commissioner may adopt the data elements and procedures adopted by the Washington vaccine association under RCW 70.290.075.
Subject to chapter 48.04 RCW, if the commissioner finds that a third-party administrator has failed to register or to renew their registration, or has provided incorrect, misleading, incomplete, or materially untrue information to the commissioner, the commissioner may fine the third-party administrator up to $5,000 per violation and issue an order requiring the third-party administrator to remedy the violation of this section.
"Third-party administrator" has the same meaning provided in section 2 of this act.
[ 2021 c XXX § 3; ]**