Washington Code 48.46.245 – Plan for handling insolvency — Commissioner’s review
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Each health maintenance organization shall have a plan for handling insolvency which allows for continuation of benefits for the duration of the agreement period for which premiums have been paid and continuation of benefits to members who are confined on the date of insolvency in an inpatient facility until their discharge or expiration of benefits. The commissioner shall approve such a plan if it includes:
Terms Used In Washington Code 48.46.245
- Commissioner: means the insurance commissioner. See Washington Code 48.46.020
- Health maintenance organization: means any organization receiving a certificate of registration by the commissioner under this chapter which provides comprehensive health care services to enrolled participants of such organization on a group practice per capita prepayment basis or on a prepaid individual practice plan, except for an enrolled participant's responsibility for copayments and/or deductibles, either directly or through contractual or other arrangements with other institutions, entities, or persons, and which qualifies as a health maintenance organization pursuant to RCW 48. See Washington Code 48.46.020
- insolvency: means that the organization has been declared insolvent and is placed under an order of liquidation by a court of competent jurisdiction. See Washington Code 48.46.020
- Provider: means any health professional, hospital, or other institution, organization, or person that furnishes any health care services and is licensed or otherwise authorized to furnish such services. See Washington Code 48.46.020
(1) Insurance to cover the expenses to be paid for continued benefits after insolvency;
(2) Provisions in provider contracts that obligate the provider to provide services for the duration of the period after the health maintenance organization’s insolvency for which premium payment has been made and until the enrolled participants’ discharge from inpatient facilities;
(3) Use of insolvency reserves established under RCW 48.46.240;
(4) Acceptable letters of credit or approved surety bonds; or
(5) Any other arrangements the commissioner and the organization mutually agree are appropriate to assure that benefits are continued.
[ 1990 c 119 § 8.]