RCW 48.46.450
Conversion agreement to be offered—Exceptions, conditions.
(1) Except as otherwise provided by this section, any group health maintenance agreement that provides benefits for hospital or medical care must contain a provision granting a person covered by the group agreement the right to obtain a conversion agreement from the health maintenance organization upon termination of the person's eligibility for coverage under the group agreement.
(2) A health maintenance organization need not offer a conversion agreement to:
(a) A person whose coverage under the group agreement ended when the person's employment or membership was terminated for misconduct: PROVIDED, That when a person's employment or membership is terminated for misconduct, a conversion policy shall be offered to the spouse and/or dependents of the terminated employee or member. The policy shall include in the conversion provisions the same conversion rights and conditions which are available to employees or members and their spouses and/or dependents who are terminated for reasons other than misconduct;
(b) A person who is eligible for federal medicare coverage; or
(c) A person who is covered under another group plan, policy, contract, or agreement providing benefits for hospital or medical care.
(3) To obtain the conversion agreement, a person must submit a written application and the first premium payment for the conversion agreement not later than thirty-one days after the date the person's eligibility for group coverage terminates or thirty-one days after the date the person received notice of termination of coverage, whichever is later. The conversion agreement shall become effective without lapse of coverage, immediately following termination of coverage under the group agreement.
(4) If a health maintenance organization or group agreement holder does not renew, cancels, or otherwise terminates the group agreement, the health maintenance organization must offer a conversion agreement to any person who was covered under the terminated agreement unless the person is eligible to obtain group benefits for hospital or medical care within thirty-one days after such nonrenewal, cancellation, or termination of the group agreement or thirty-one days after the date the person received notice of termination of coverage, whichever is later.
(5) The health maintenance organization shall determine the premium for the conversion agreement in accordance with the organization's table of premium rates applicable to the age and class of risk of each person to be covered under the agreement and the type and amount of benefits provided.
[ 2010 c 110 § 3; 1984 c 190 § 9.]
NOTES:
Application—2010 c 110: See note following RCW 48.21.260.
Legislative intent—Severability—1984 c 190: See notes following RCW 48.21.250.
Structure Revised Code of Washington
Chapter 48.46 - Health Maintenance Organizations.
48.46.010 - Legislative declaration—Purpose.
48.46.012 - Filings with secretary of state—Copy for commissioner.
48.46.027 - Registration, required—Issuance of securities—Penalty.
48.46.033 - Unregistered activities—Acts committed in this state—Sanctions.
48.46.045 - Catastrophic health plans permitted.
48.46.062 - Schedule of rates for individual agreements—Loss ratio—Definitions.
48.46.064 - Calculation of premiums—Adjusted community rate—Definitions.
48.46.068 - Requirements for plans offered to small employers—Definitions.
48.46.080 - Annual statement—Filings—Contents—Fee—Penalty for failure to file—Accuracy required.
48.46.090 - Standard of services provided.
48.46.100 - Grievance procedure.
48.46.135 - Fine in addition to or in lieu of suspension, revocation, or refusal.
48.46.170 - Effect of chapter as to other laws—Construction.
48.46.190 - Payroll deductions for capitation payments to health maintenance organizations.
48.46.200 - Rules and regulations.
48.46.210 - Compliance with federal funding requirements—Construction.
48.46.220 - Review of administrative action.
48.46.225 - Financial failure—Supervision of commissioner—Priority of distribution of assets.
48.46.235 - Minimum net worth—Requirement to maintain—Determination of amount.
48.46.237 - Minimum net worth—Domestic or foreign health maintenance organization.
48.46.240 - Funded reserve requirements.
48.46.243 - Contract—Participant liability.
48.46.245 - Plan for handling insolvency—Commissioner's review.
48.46.247 - Insolvency—Commissioner's duties—Participants' options—Allocation of coverage.
48.46.272 - Diabetes coverage—Definitions.
48.46.274 - Prescribed, self-administered anticancer medication.
48.46.275 - Mammograms—Insurance coverage.
48.46.277 - Prostate cancer screening.
48.46.280 - Reconstructive breast surgery.
48.46.285 - Mastectomy, lumpectomy.
48.46.291 - Mental health services—Health plans—Definition—Coverage required, when.
48.46.292 - Mental health treatment—Waiver of preauthorization for persons involuntarily committed.
48.46.300 - Future dividends or refunds, restricted—Issuance or sale of securities regulated.
48.46.310 - Registration not endorsement.
48.46.320 - Dependent children, termination of coverage, conditions.
48.46.325 - Option to cover child under age twenty-six.
48.46.340 - Return of agreement within ten days.
48.46.350 - Chemical dependency treatment.
48.46.355 - "Chemical dependency" defined.
48.46.370 - Coverage not denied for disability.
48.46.380 - Notice of reason for cancellation, denial, or refusal to renew agreement.
48.46.400 - False or misleading advertising prohibited.
48.46.410 - Misrepresentations to induce termination or retention of agreement prohibited.
48.46.420 - Penalty for violations.
48.46.430 - Enforcement authority of commissioner.
48.46.440 - Continuation option to be offered.
48.46.450 - Conversion agreement to be offered—Exceptions, conditions.
48.46.460 - Conversion agreement—Restrictions and requirements—Rules.
48.46.470 - Endorsement of modifications.
48.46.480 - Continuation of coverage of former family members.
48.46.490 - Coverage for adopted children.
48.46.500 - Cancellation of rider.
48.46.520 - Neurodevelopmental therapies—Employer-sponsored group contracts.
48.46.530 - Temporomandibular joint disorders—Insurance coverage.
48.46.540 - Nonresident pharmacies.
48.46.565 - Foot care services.
48.46.570 - Denturist services.
48.46.580 - When injury caused by intoxication or use of narcotics.
48.46.600 - Disclosure of certain material transactions—Report—Information is confidential.
48.46.605 - Material acquisitions or dispositions.
48.46.610 - Asset acquisitions—Asset dispositions.
48.46.615 - Report of a material acquisition or disposition of assets—Information required.
48.46.620 - Material nonrenewals, cancellations, or revisions of ceded reinsurance agreements.
48.46.900 - Liberal construction.
48.46.930 - Construction—Chapter applicable to state registered domestic partnerships—2009 c 521.