HB 2087 — Addressing travel insurance.

(3)(a)(3) TravelEligibility insuranceand ratesunderwriting standards for travel insurance may varybe duedeveloped toand provided based on travel protection plans designed for individual or identified marketing or distribution channels.channels, provided those standards also meet the state's underwriting standards for inland marine.

(b)p. Eligibility and underwriting standards for travel insurance may be developed and provided based on travel protection plans designed for individual or identified marketing or distribution channels, provided those standards also meet the state's underwriting standards for inland marine.

(4)11 SubsectionsHB (1)2087 throughNEW (3)SECTION. of this section do not constitute a violation of RCW 48.18.480 when used for travel insurance.

NEW SECTION.

A new section is added to chapter 48.3048.43 RCW to read as follows:

p.(2)(a) A person may not act as or hold himself or herself out to be an adjuster in this state unless licensed by the commissioner or otherwise authorized to act as an adjuster under this chapter.

12 SHB 2087 (2)(a) A person may not act as or hold himself or herself out to be an adjuster in this state unless licensed by the commissioner or otherwise authorized to act as an adjuster under this chapter.

RCW 48.17.530 and 2007 c 117 s 29 are each amended to read as follows:

(1) The commissioner may place on probation, suspend, revoke, or refuse to issue or renew an adjuster's license, an insurance producer's license, a title insurance agent's license, a registration of a travel retailer, or any surplus line broker's license, or may levy a civil penalty in accordance with RCW 48.17.560 or any combination of actions, for any one or more of the following causes:

(a) Providing incorrect, misleading, incomplete, or materially untrue information in the license application;

(b) Violating any insurance laws, or violating any rule, subpoena, or order of the commissioner or of another state's insurance commissioner;

(c) Obtaining or attempting to obtain a license through misrepresentation or fraud;

(d) Improperly withholding, misappropriating, or converting any moneys or properties received in the course of doing insurance business;

(e) Intentionally misrepresenting the terms of an actual or proposed insurance contract or application for insurance;

(f) Having been convicted of a felony;

(g) Having admitted or been found to have committed any insurance unfair trade practice or fraud;

(h) Using fraudulent, coercive, or dishonest practices, or demonstrating incompetence, untrustworthiness, or financial irresponsibility in this state or elsewhere;

(i) Having an insurance producer license, or its equivalent, denied, suspended, or revoked in any other state, province, district, or territory;

p.

13 SHB 2087 (j) Forging another's name to an application for insurance or to any document related to an insurance transaction;

(k) Improperly using notes or any other reference material to complete an examination for an insurance license;

(l) Knowingly accepting insurance business from a person who is required to be licensed under this title and is not so licensed, other than orders for issuance of title insurance on property located in this state placed by a nonresident title insurance agent authorized to act as a title insurance agent in the title insurance agent's home state;

or (m) Obtaining a loan from an insurance client that is not a financial institution and who is not related to the insurance producer by birth, marriage, or adoption, except the commissioner may, by rule, define and permit reasonable arrangements.

(2) The license or registration of a business entity may be suspended, revoked, or refused if the commissioner finds that an individual licensee's or registrant's violation was known or should have been known by one or more of the partners, officers, or managers acting on behalf of the partnership or corporation, and the violation was neither reported to the commissioner nor corrective action taken.

(3) The commissioner shall retain the authority to enforce the provisions of and impose any penalty or remedy authorized by this chapter and this title against any person who is under investigation for or charged with a violation of this chapter or this title, even if the person's license or registration has been surrendered or has lapsed by operation of law.

(4) The holder of any license which has been revoked or suspended shall surrender the license certificate to the commissioner at the commissioner's request.

(5) The commissioner may probate a suspension or revocation of a license or registration under reasonable terms determined by the commissioner.

In addition, the commissioner may require a licensee or registrant who is placed on probation to:

(a) Report regularly to the commissioner on matters that are the basis of the probation;

(b) Limit practice to an area prescribed by the commissioner;

or (c) Continue or renew continuing education until the licensee attains a degree of skill satisfactory to the commissioner in the area that is the basis of the probation.

p.

14 SHB 2087 (6) At any time during a probation term where the licensee has violated the probation order, the commissioner may:

(a) Rescind the probation and enforce the commissioner's original order;

and (b) Impose any disciplinary action permitted under this section in addition to or in lieu of enforcing the original order.

Sec.

15.

RCW 48.17.535 and 1997 c 58 s 857 are each amended to read as follows:

The commissioner shall immediately suspend the license, registration, or certificate of a person who has been certified pursuant to RCW 74.20A.320 by the department of social and health services as a person who is not in compliance with a support order or a residential or visitation order.

If the person has continued to meet all other requirements for reinstatement during the suspension, reissuance of the license, registration, or certificate shall be automatic upon the commissioner's receipt of a release issued by the department of social and health services stating that the ((licensee)) person is in compliance with the order.

Sec.

16.

(1)p. "Adjusted community rate" means the rating method used to establish the premium for health plans adjusted to reflect actuarially demonstrated differences in utilization or cost attributable to geographic region, age, family size, and use of wellness activities.

(2)12 "AdverseHB benefit2087 determination"(1) means"Adjusted acommunity denial,rate" reduction,means orthe terminationrating of,method orused a failure to provideestablish orthe makepremium payment, in whole or in part, for ahealth benefit,plans includingadjusted a denial, reduction, termination, or failure to providereflect oractuarially makedemonstrated paymentdifferences that is based on a determination of an enrollee's or applicant's eligibility to participate in autilization plan, and including, with respect to group health plans, a denial, reduction, or terminationcost of,attributable or a failure to providegeographic orregion, makeage, payment,family insize, wholeand oruse in part, for a benefit resulting from the application of anywellness utilizationactivities. review, as well as a failure to cover an item or service for which benefits are otherwise provided p.

15(2) SHB"Adverse 2087benefit determination" means a denial, reduction, or termination of, or a failure to provide or make payment, in whole or in part, for a benefit, including a denial, reduction, termination, or failure to provide or make payment that is based on a determination of an enrollee's or applicant's eligibility to participate in a plan, and including, with respect to group health plans, a denial, reduction, or termination of, or a failure to provide or make payment, in whole or in part, for a benefit resulting from the application of any utilization review, as well as a failure to cover an item or service for which benefits are otherwise provided because it is determined to be experimental or investigational or not medically necessary or appropriate.

(9) "Basic health plan services" means that schedule of covered health services, including the description of how those benefits are top. be administered, that are required to be delivered to an enrollee under the basic health plan, as revised from time to time.

13 HB 2087 to be administered, that are required to be delivered to an enrollee under the basic health plan, as revised from time to time.

p.(e) An agency certified by the department of health under chapter 71.24 RCW to provide medically managed or medically monitored withdrawal management services;

16 SHB 2087 (e) An agency certified by the department of health under chapter 71.24 RCW to provide medically managed or medically monitored withdrawal management services;

(b)p. In July 2008, and in each July thereafter, the insurance commissioner shall adjust the minimum deductible and out-of-pocket expense required for a plan to qualify as a catastrophic plan to reflect the percentage change in the consumer price index for medical care for a preceding 12 months, as determined by the United States department of labor.

For14 aHB plan2087 year(b) beginningIn July 2008, and in 2014,each July thereafter, the out-of-insurance pocketcommissioner limitsshall mustadjust bethe adjustedminimum deductible and out-of-pocket expense required for a plan to qualify as specifieda catastrophic plan to reflect the percentage change in sectionthe 1302consumer (c)(1)price index for medical care for a preceding 12 months, as determined by the United States department of P.L.labor.

For a plan year beginning in 2014, the out-of- pocket limits must be adjusted as specified in section 1302(c)(1) of P.L.

or p.(ii) A health benefit plan offered outside the exchange marketplace that requires a calendar year deductible or out-of-pocket expenses under the plan, other than for premiums, for covered benefits, that meets or exceeds the commissioner's annual adjustment under (b) of this subsection.

17 SHB 2087 (ii) A health benefit plan offered outside the exchange marketplace that requires a calendar year deductible or out-of-pocket expenses under the plan, other than for premiums, for covered benefits, that meets or exceeds the commissioner's annual adjustment under (b) of this subsection.

(17) "Emergency medical condition" means a medical, mental health, or substance use disorder condition manifesting itself by acute symptoms of sufficient severity including, but not limited to, severe pain or emotional distress, such that a prudent layperson, who possesses an average knowledge of health and medicine, could reasonably expect the absence of immediate medical, mental health, or substancep. use disorder treatment attention to result in a condition (a) placing the health of the individual, or with respect to a pregnant woman, the health of the woman or her unborn child, in serious jeopardy, (b) serious impairment to bodily functions, or (c) serious dysfunction of any bodily organ or part.

15 HB 2087 substance use disorder treatment attention to result in a condition (a) placing the health of the individual, or with respect to a pregnant woman, the health of the woman or her unborn child, in serious jeopardy, (b) serious impairment to bodily functions, or (c) serious dysfunction of any bodily organ or part.

(ii) Medical examination and treatment, to the extent they are within the capabilities of the staff and facilities available at the hospital, as are required under section 1867 of the social security p.act (42 U.S.C.

18 SHB 2087 act (42 U.S.C.

Stabilize, with respect to an emergency medical condition, has the meaning given in section 1867(e)(3)1867 (e)(3) of the social security act (42 U.S.C.

Stabilize, with respect to an emergency medical condition, has the meaningp. given in section 1867(e)(3) of the social security act (42 U.S.C.

16 HB 2087 meaning given in section 1867(e)(3) of the social security act (42 U.S.C.

p.(19) "Employee" has the same meaning given to the term, as of January 1, 2008, under section 3(6) of the federal employee retirement income security act of 1974.

19 SHB 2087 (19) "Employee" has the same meaning given to the term, as of January 1, 2008, under section 3(6) of the federal employee retirement income security act of 1974.

(24) "Final internal adverse benefit determination" means an adverse benefit determination that has been upheld by a health plan orp. carrier at the completion of the internal appeals process, or an adverse benefit determination with respect to which the internal appeals process has been exhausted under the exhaustion rules described in RCW 48.43.530 and 48.43.535.

17 HB 2087 or carrier at the completion of the internal appeals process, or an adverse benefit determination with respect to which the internal appeals process has been exhausted under the exhaustion rules described in RCW 48.43.530 and 48.43.535.

(26) "Grievance" means a written complaint submitted by or on behalf of a covered person regarding service delivery issues other than denial of payment for medical services or nonprovision of p.medical services, including dissatisfaction with medical care, waiting time for medical services, provider or staff attitude or demeanor, or dissatisfaction with service provided by the health carrier.

20 SHB 2087 medical services, including dissatisfaction with medical care, waiting time for medical services, provider or staff attitude or demeanor, or dissatisfaction with service provided by the health carrier.

(29) "Health care facility" or "facility" means hospices licensed under chapter 70.127 RCW, hospitals licensed under chapter 70.41 RCW, rural health care facilities as defined in RCW 70.175.020, ((psychiatric)) behavioral health hospitals licensed under chapter 71.12 RCW, nursing homes licensed under chapter 18.51 RCW, community mental health centers licensed under chapter 71.05 or 71.24 RCW, kidneyp. disease treatment centers licensed under chapter 70.41 RCW, ambulatory diagnostic, treatment, or surgical facilities licensed under chapter 70.41 or 70.230 RCW, drug and alcohol treatment facilities licensed under chapter 70.96A RCW, and home health agencies licensed under chapter 70.127 RCW, and includes such facilities if owned and operated by a political subdivision or instrumentality of the state and such other facilities as required by federal law and implementing regulations.

18 HB 2087 kidney disease treatment centers licensed under chapter 70.41 RCW, ambulatory diagnostic, treatment, or surgical facilities licensed under chapter 70.41 or 70.230 RCW, drug and alcohol treatment facilities licensed under chapter 70.96A RCW, and home health agencies licensed under chapter 70.127 RCW, and includes such facilities if owned and operated by a political subdivision or instrumentality of the state and such other facilities as required by federal law and implementing regulations.

or p.(b) An employee or agent of a person described in (a) of this subsection, acting in the course and scope of his or her employment.

21 SHB 2087 (b) An employee or agent of a person described in (a) of this subsection, acting in the course and scope of his or her employment.

(h)p. Accident only coverage;

19 HB 2087 (h) Accident only coverage;

(l) Plans deemed by the insurance commissioner to have a short- term limited purpose or duration, or to be a student-only plan that is guaranteed renewable while the covered person is enrolled as a regular full-time undergraduate or graduate student at an accredited higher education institution, after a written request for such p.classification by the carrier and subsequent written approval by the insurance commissioner;

22 SHB 2087 classification by the carrier and subsequent written approval by the insurance commissioner;

423.458423.458(c); (c);

(38)p. "Nonemergency health care services performed by nonparticipating providers at certain participating facilities" means covered items or services other than emergency services with respect to a visit at a participating health care facility, as provided in section 2799A-1 (b) of the public health service act (42 U.S.C.

20 HB 2087 (38) "Nonemergency health care services performed by nonparticipating providers at certain participating facilities" means covered items or services other than emergency services with respect to a visit at a participating health care facility, as provided in section 2799A-1(b) of the public health service act (42 U.S.C.

p.(40) "Out-of-network" or "nonparticipating" means a provider or facility that has not contracted with a carrier or a carrier's contractor or subcontractor to provide health care services to enrollees.

23 SHB 2087 (40) "Out-of-network" or "nonparticipating" means a provider or facility that has not contracted with a carrier or a carrier's contractor or subcontractor to provide health care services to enrollees.

(45)p. "Review organization" means a disability insurer regulated under chapter 48.20 or 48.21 RCW, health care service contractor as defined in RCW 48.44.010, or health maintenance organization as defined in RCW 48.46.020, and entities affiliated with, under contract with, or acting on behalf of a health carrier to perform a utilization review.

21 HB 2087 (45) "Review organization" means a disability insurer regulated under chapter 48.20 or 48.21 RCW, health care service contractor as defined in RCW 48.44.010, or health maintenance organization as defined in RCW 48.46.020, and entities affiliated with, under contract with, or acting on behalf of a health carrier to perform a utilization review.

(47) "Small employer" or "small group" means any person, firm, corporation, partnership, association, political subdivision, sole p.proprietor, or self-employed individual that is actively engaged in business that employed an average of at least one but no more than 50 employees, during the previous calendar year and employed at least one employee on the first day of the plan year, is not formed primarily for purposes of buying health insurance, and in which a bona fide employer-employee relationship exists.

24 SHB 2087 proprietor, or self-employed individual that is actively engaged in business that employed an average of at least one but no more than 50 employees, during the previous calendar year and employed at least one employee on the first day of the plan year, is not formed primarily for purposes of buying health insurance, and in which a bona fide employer-employee relationship exists.

(a) Have been employed by the same small employer or small group for at least twelve months prior to application for small group coverage, and (b) verify that he or she derived at least 75 percent of his or her income from a trade or business through which the individual or sole proprietor has attempted to earn taxable income and for which he or she has filed the appropriate internal revenue service form 1040, schedule C or F, for the previous taxable year, except a self- employed individual or sole proprietor in an agricultural trade or business, must have derived at least 51 percent of his or her income from the trade or business through which the individual or sole proprietor has attempted to earn taxable income and for which he or shep. has filed the appropriate internal revenue service form 1040, for the previous taxable year.

22 HB 2087 she has filed the appropriate internal revenue service form 1040, for the previous taxable year.

(50) "Utilization review" means the prospective, concurrent, or retrospective assessment of the necessity and appropriateness of the allocation of health care resources and services of a provider or p.facility, given or proposed to be given to an enrollee or group of enrollees.

25 SHB 2087 facility, given or proposed to be given to an enrollee or group of enrollees.

17.15.

Sections 1 through 1513 of this act take effect January 1, 2027.

2623 SHBHB 2087