Loading (50 kb)...'
(continued)
(i) Each independent provider's program director must possess and hold in good standing a Washington agent's or broker's license.
(ii) Each insurer provider's program director must possess such a license or comparable scholastic or professional credentials that the commissioner deems equivalent to such a license.
(iii) The requirements of (a)(i) and (ii) of this subsection shall not apply to program directors employed by approved providers governed by chapters 28B.19 and 28B.50 RCW, community colleges within Washington state; or to program directors employed by vocational-technical institutes governed by the superintendent of public instruction and the state board of education.
(b) An employment history involving administrative educational experience.
(c) Trustworthiness. A program director is untrustworthy if he or she has violated any statute or regulation pertaining to insurance, or to any other regulated occupation; or has had an occupational license revoked in any state; or has been convicted of a crime evidencing lack of fitness to assume fiduciary duties.
(2) Information on the program director which must be submitted to the commissioner includes the full disclosure of any regulatory or legal action involving the program director's professional or occupational activities.
(3) A program director's responsibilities include:
(a) Conducting a competent background investigation to ascertain that each instructor is trustworthy and qualified under WAC 284-17-537 and under WAC 284-17-540 or 284-17-545 for the line of insurance he or she has been designated to instruct; except that:
(i) In the event of an emergency created by the unavoidable absence of an approved instructor, the program director may appoint an interim instructor who was not previously certified and approved, to complete the current course offering, however:
(ii) The program director must immediately notify the commissioner of the nature of the emergency, the name of the interim instructor, and the date upon which the current course offering will conclude.
(iii) At the conclusion of the current course offering the program director and provider shall suspend operation of the affected course until an approved instructor is available to conduct the classes.
(b) Supervising each approved course and reviewing all completed student evaluations of the course; and
(c) Insuring that instructors properly issue certificates of completion according to WAC 284-17-539 to the students at the completion of each course.
[Statutory Authority: RCW 48.02.060. 89-19-036 (Order R 89-9), § 284-17-535, filed 9/15/89, effective 10/16/89; 89-14-045 (Order R 89-8), § 284-17-535, filed 6/29/89. Statutory Authority: RCW 48.02.060 and 48.17.070. 89-01-055 (Order R 88-14), § 284-17-535, filed 12/16/88.]
--------------------------------------------------------------------------------
284-17-537
Instructor qualifications and responsibilities.
The provider must submit the name(s) of each proposed instructor to the commissioner.
(1) To qualify as an instructor for an approved provider, each proposed instructor must:
(a) Demonstrate any combination of at least three years of experience instructing insurance education courses, supervising students completing self-paced insurance instructional materials, or experience as a licensed insurance agent or broker.
(b) Be trustworthy. An instructor is untrustworthy if he or she has violated any statute or regulation pertaining to insurance, or to any other regulated occupation; or has had an occupational license revoked in any state; or has been convicted of a crime evidencing lack of fitness to assume fiduciary duties.
(c) Demonstrate competence in the line of insurance he or she proposes to teach:
(i) Each independent provider's instructor must possess and hold in good standing a Washington agent's or broker's license for the applicable line(s) of insurance.
(ii) Each insurer provider's instructor must possess such a license or scholastic or professional credentials that the commissioner deems equivalent to such a license.
(2) The instructor of each approved course shall perform the following instructional and administrative duties:
(a) At the beginning session of each approved course, assure that each student has been properly registered.
(b) Remain on the premises whenever instruction is being offered.
(c) Ensure that the study materials utilized, incorporate the prescribed curriculum, and comply with the lesson plans filed with the commissioner.
(d) The instructor may teach approved courses on a live-instruction basis, or combine live instruction with the use of other instructional aids, or proctor student use of self-paced insurance instructional materials.
(e) At the conclusion of the course, distribute the standard course evaluation form prescribed by the commissioner, to each student who has completed the course; and collect the completed forms.
(f) To each student who has completed the course, issue a certificate of completion by signing each certificate, and thereby certify that the student actually completed the course.
(g) Review course evaluations with the program director.
[Statutory Authority: RCW 48.02.060. 89-14-045 (Order R 89-8), § 284-17-537, filed 6/29/89. Statutory Authority: RCW 48.02.060 and 48.17.070. 89-01-055 (Order R 88-14), § 284-17-537, filed 12/16/88.]
--------------------------------------------------------------------------------
284-17-539
Certificates of completion.
(1) A "certificate of completion," in the standard form prescribed by the commissioner, shall be completed in its entirety, signed by the instructor, and issued by the approved prelicense education provider to each student in the student's legal name, who has completed an approved course.
(2) Both the student and the instructor(s) shall certify that the course was conducted and completed according to the hours and curriculum required, by affixing their original signatures in the spaces provided on the certificate of completion.
(3) The provider shall indicate, on the face of the certificate of completion, the correct codes assigned by the commissioner to each approved prelicense education provider and to each approved course.
(4) The approved prelicense education provider must issue each valid certificate of completion within twenty-four hours from the time the course was completed.
(5) No instructor may issue a certificate of completion to herself or himself.
(6) Completion of less than the full course curriculum, or of individual classes, does not qualify for a certificate of completion.
(7) A valid certificate of completion (or a valid waiver) for the line of insurance on which the student will be examined, and a certificate of completion for the statutes and regulations curriculum, must be presented to the independent testing service as a prerequisite to participating in any of the agent's license examination(s) for life, disability, property, or casualty insurance.
(8) The certificate is valid for twelve months from the course completion date shown on its face.
[Statutory Authority: RCW 48.02.060 and 48.17.070. 89-01-055 (Order R 88-14), § 284-17-539, filed 12/16/88.]
--------------------------------------------------------------------------------
284-17-540
Requirements applicable to independent prelicense education providers.
This section applies to all persons, other than insurers, offering life, disability, property, or casualty insurance courses to license applicants for purposes of satisfying the educational requirement prescribed by WAC 284-17-505 through 284-17-520.
(1) In addition to the general conditions for approval set out at WAC 284-17-530 through 284-17-539, and in addition to complying with the requirements of WAC 284-17-550, each noninsurer prelicense education provider shall:
(a) Describe any existing insurance education program:
(i) Class titles and curricula covered;
(ii) Number of students per course during previous year;
(iii) Name(s) and qualifications of instructor(s);
(iv) Name and qualifications of the person responsible for the previous program.
(b) Describe the changes necessary to bring any existing program into compliance with WAC 284-17-530 through 284-17-539, 284-17-550 and 284-17-551, and each applicable section of WAC 284-17-552 through 284-17-555.
(c) Reveal the provider's department of revenue registration number.
(2) To qualify a provider for the commissioner's approval, the provider's proposed program director must hold in good standing a valid Washington agent's or broker's license and present evidence of teaching experience, the combination to total a minimum of five consecutive years' qualifications.
(a) After November 1, 1994, the license(s) must have been held in good standing for at least five years.
(b) The requirements of this subsection shall not apply to program directors employed by community colleges governed by chapters 28B.19 and 28B.50 RCW, or to program directors employed by vocational-technical institutes governed by the superintendent of public instruction and the state board of education.
(3) To qualify a provider for the commissioner's approval, each of the provider's proposed instructors must hold in good standing a valid Washington agent's or broker's license for the line(s) of insurance he or she will be instructing, and present evidence of teaching experience or experience supervising student completion of self-paced instructional materials, the combination to total a minimum of three consecutive years' qualifications. After November 1, 1992, the license(s) must have been held in good standing for at least three years.
(4) An independent provider shall establish and maintain records and an appropriate accounting system for all tuition payments received by the provider.
(a) All tuition funds received must be deposited promptly into a bank account or depository separate from any other account or depository.
(b) The accounting system used must effectively isolate the separate account from any other operating or personal accounts, and must provide an audit trail so that details underlying the summary data may be identified.
(c) The provider shall make such records available for inspection by the commissioner during regular business hours upon demand during the three years immediately after the date of the transaction.
(5) Noninsurer course providers shall have an exact physical location or locations.
[Statutory Authority: RCW 48.02.060. 89-19-036 (Order R 89-9), § 284-17-540, filed 9/15/89, effective 10/16/89; 89-14-045 (Order R 89-8), § 284-17-540, filed 6/29/89. Statutory Authority: RCW 48.02.060 and 48.17.070. 89-01-055 (Order R 88-14), § 284-17-540, filed 12/16/88.]
--------------------------------------------------------------------------------
284-17-545
Requirements applicable to insurer prelicense education providers.
This section applies to all admitted insurers regulated by the commissioner, and offering life, disability, property, or casualty insurance education courses to license applicants for purposes of satisfying the educational requirements prescribed by WAC 284-17-505 through 284-17-520.
(1) In addition to the general conditions for approval set out at WAC 284-17-530 through 284-17-539, and in addition to complying with the requirements of WAC 284-17-550, each insurer applying for prelicense education provider approval must exhibit an existing, bona fide insurance education function which is supervised from the corporate level. The insurer shall:
(a) Describe the existing program:
(i) Class titles and curricula covered;
(ii) Number of students per course during previous year;
(iii) Name(s) and qualifications of instructor(s);
(iv) Name and qualifications of person responsible for the program.
(b) Describe the insurer's plan for agent development.
(c) Submit the prelicense education plan to be applied throughout Washington state.
(2) For each program director not licensed as a Washington agent or broker, the provider shall in the request for approval identify the program director's equivalent qualifications, including educational degrees or professional designations earned, and certified evidence of past insurance education and licenses held in this or other states, and identify the program director's past teaching experience.
(3) For each instructor not licensed as a Washington agent or broker in the line of insurance which is the subject of instruction, the insurer's program director shall in the request for approval identify the instructor's equivalent qualifications, including educational degrees or professional designations earned, and certified evidence of past insurance education and licenses held in this or other states.
(4) The commissioner retains discretion to determine whether the proposed instructor'(s) and the proposed program director's asserted qualifications meet the minimum scholastic and professional criteria required herein.
[Statutory Authority: RCW 48.02.060 and 48.17.070. 89-01-055 (Order R 88-14), § 284-17-545, filed 12/16/88.]
--------------------------------------------------------------------------------
284-17-550
Course standards.
(1) No course will be approved unless the Washington insurance statutes and regulations applicable to the specific line are incorporated into each specific line(s) curriculum offered by the provider. These line specific statutes and regulations are not to be contained in the statutes and regulations curriculum of general application found at WAC 284-17-551.
(2) To qualify for approval, each course shall be presented under the supervision of an approved instructor, utilizing study materials that include all the prescribed curriculum, and shall be presented under the general supervision of an approved prelicense education provider.
(a) Each instructor's qualifications shall be identified, according to the requirements of WAC 284-17-530 (2)(d) and 284-17-537, and 284-17-540 or 284-17-545, for approval by the commissioner.
(b) The course instructor shall be on the premises whenever instruction is being offered.
(3) Each course shall be broken into individual lesson components covering the prescribed curriculum.
(a) Instruction may include coverage of related subject matter; however, such peripheral instruction must be presented in the individual lesson components as supplementary to the prescribed curriculum hours.
(b) The provider may choose the prelicense education study materials, and shall certify that the study materials include all of the prescribed curriculum.
(4) "Hours" are approved by the commissioner for an approved course. Each "hour" shall represent at least fifty minutes of actual instruction on a topic within the prescribed prelicense education curriculum.
(5) No course may be represented as approved until the approved prelicense education provider has received the commissioner's written approval of the instructor and of the course.
(a) Approved prelicense education providers must apply to the commissioner for amended course approval if any of the following changes or revisions are instituted before the original course approval expiration date:
(i) Change of study materials;
(ii) Change of location; or
(iii) Change of course tuition or rebate policy.
(b) Amended approval, if granted, is valid only until the original course approval expiration date.
[Statutory Authority: RCW 48.02.060. 89-14-045 (Order R 89-8), § 284-17-550, filed 6/29/89. Statutory Authority: RCW 48.02.060 and 48.17.070. 89-01-055 (Order R 88-14), § 284-17-550, filed 12/16/88.]
--------------------------------------------------------------------------------
284-17-551
Statutes and regulations curriculum.
Every prelicense education course shall incorporate study of the:
(1) Nature of insurance:
(a) Definition of insurance; insurance transaction;
(b) Insurer;
(c) Public interest;
(d) Risk management;
(e) Law of large numbers;
(f) Indemnification.
(2) Insurance commissioner:
(a) Authority and duties;
(b) Broad powers;
(c) Rate and form filings;
(d) Examination of records;
(e) Penalties;
(f) Notice of hearing;
(g) Examinations:
(i) Insurers' financial status;
(ii) License applicant's qualifications.
(h) Hearings and appeals;
(i) Public access to records.
(3) Insurers:
(a) Definitions:
(i) Domestic, foreign, alien;
(ii) Life, disability - stock, mutual, fraternal;
(iii) Property, casualty, vehicle, surety - stock, mutual, reciprocal, Lloyds;
(iv) Authorized, unauthorized insurers; certificate of authority.
(b) Financial status:
(i) Mergers, insider trading;
(ii) Rehabilitation, liquidation; Washington Insurance Guaranty Associations.
(c) Insuring powers - defining the separate lines;
(d) Assets and liabilities:
(i) Investments;
(ii) Reserves.
(e) Fees and taxes.
(4) The insurance contract:
(a) General provisions;
(b) Exclusions and limitations;
(c) Insured;
(d) Cancellation and nonrenewal;
(e) Premium;
(f) Binder.
(5) Agents, brokers, solicitors, adjusters:
(a) Company appointment or affiliation:
(i) Purpose, contractual authority, and liability;
(ii) Termination.
(b) Types of licenses:
(i) Exemptions;
(ii) Limited lines;
(iii) Temporary;
(iv) Nonresident;
(v) Authority and liability under the regulation:
(A) Solicitor;
(B) Agent;
(C) Broker;
(D) Surplus lines broker;
(E) Adjuster: Independent, public.
(6) Major lines:
(a) Life insurance;
(b) Disability insurance;
(c) Property insurance;
(d) Casualty insurance.
(7) Other lines:
(a) Vehicle insurance;
(b) Surety;
(c) Credit life and credit accident/health;
(d) Travel insurance.
(8) Penalties for noncompliance:
(a) Refusal/nonrenewal;
(b) Suspension/revocation;
(c) Fines;
(9) Maintenance and duration of license:
(a) Appointments/terminations of appointments;
(b) Renewal procedures;
(10) Licensing requirements:
(a) Purpose;
(b) Licensing procedures:
(i) Resident;
(ii) Nonresident.
(iii) Temporary license.
(c) Continuing education; renewal procedures:
(i) Penalties for misconduct;
(ii) Exemption from the licensing requirement.
(iii) Temporary license.
(11) Agent responsibilities:
(a) Recordkeeping;
(b) Reply promptly to inquiry by the commissioner; notify the commissioner of a change of address;
(c) Application completion;
(d) Policy delivery;
(e) Separate account requirement;
(f) Premium accountability;
(g) Fiduciary accountability.
(12) Compensation of licensees:
(a) Sharing commissions;
(b) Charges for extra services.
(13) Protection of public interest.
(14) Unfair practices:
(a) Advertising, comparisons, and defamation;
(b) Charges, inducements, rebating;
(c) Misrepresentation;
(d) Twisting;
(e) Illegal dealing in premiums;
(f) Illegal inducements;
(g) Failure to issue proper receipts;
(h) Unfair claims methods and trade practices;
(i) Broker's fees disclosed;
(j) Penalties;
(k) Discrimination.
[Statutory Authority: RCW 48.02.060 and 48.17.150. 91-12-033 (Order R 91-3), § 284-17-551, filed 6/3/91, effective 7/4/91. Statutory Authority: RCW 48.02.060 and 48.17.070. 89-01-055 (Order R 88-14), § 284-17-551, filed 12/16/88.]
--------------------------------------------------------------------------------
284-17-552
Life insurance curriculum.
(1) Life insurance needs:
(a) Monetary value of human life;
(b) Social security:
(i) Contributions;
(ii) Qualification and restrictions;
(iii) Benefit periods;
(iv) Blackout period.
(c) Federal government employee/military benefits/railroad retirement benefits;
(d) Needs analysis:
(i) Premature death/retirement;
(ii) Theory of decreasing need;
(iii) Earnings approach, depletion approach;
(iv) Capital retention/estate conservation;
(v) Mortality/life expectancy tables.
(2) Types of individual life insurance:
(a) Term insurance policies:
(i) General nature;
(ii) Basic types of term contracts;
(iii) Special features;
(iv) Level, decreasing or increasing benefit.
(A) Renewability;
(B) Convertibility;
(C) Reentry.
(b) Whole life insurance:
(i) General nature;
(ii) Economic values of whole life;
(c) Basic types of whole life contracts:
(i) Straight (ordinary) life;
(ii) Limited pay life;
(iii) Endowment insurance.
(d) Universal life:
(i) General nature;
(ii) Features and characteristics;
(iii) Fixed versus variable.
(e) Single premium whole life:
(i) Fixed;
(ii) Variable.
(3) Premium variations:
(a) Single;
(b) Level;
(c) Adjustable;
(d) Modified;
(e) Graded.
(4) Annuities:
(a) The annuity principle;
(b) Nature and purpose;
(c) Premium-payment method:
(i) Single;
(ii) Fixed installment;
(iii) Flexible.
(d) Tax-qualified plans; nonqualified plans;
(e) Fixed versus variable benefits;
(f) When benefits begin;
(g) Number of lives covered;
(h) Payout options:
(i) Period certain;
(ii) Interest only;
(iii) Fixed/variable.
(i) Guarantee prior to annuity starting date;
(j) Guarantee of minimum total benefit:
(i) Straight (pure) life annuity;
(ii) Annuity with period certain;
(iii) Cash or installment refund annuity.
(5) Other life insurance products:
(a) Keogh (HR-10) plan;
(b) Individual retirement account (IRA);
(c) Simplified employee pension plan (SEP);
(d) Key person;
(e) Buy-sell;
(f) Executive bonus;
(g) Split dollar;
(h) Tax sheltered annuity.
(6) Group life insurance:
(a) Types of contracts:
(i) Term, including survivorship;
(ii) Contracts with permanent benefits;
(iii) Credit or mortgage life.
(b) Group underwriting principles;
(c) Master policy and certificates;
(d) Conversion rights and limitations.
(7) Combination policies and variations in basic forms:
(a) Double or triple indemnity;
(b) Term riders;
(c) Family policies/riders;
(d) Family income, family maintenance;
(e) Retirement income;
(f) Face amount plus cash value/return of premium;
(g) Mortgage protection.
(h) Joint life;
(i) Last survivor;
(j) Juvenile;
(k) Adjustable life;
(l) Variable life.
(8) Policy provisions, options, and other features:
(a) General provisions and clauses;
(i) Insuring agreement/consideration;
(ii) Owner/applicant/insured;
(iii) Assignment;
(iv) Entire contract;
(v) Incontestability;
(vi) Grace period/reinstatement;
(vii) Misstatement of age or sex;
(viii) Suicide;
(ix) War;
(x) Aviation;
(xi) Free look;
(xii) Representations;
(xiii) Uniform Simultaneous Death Act;
(xiv) Settlement on proof of death;
(xv) Morbidity and mortality tables;
(xvi) Age, health, marital status, occupation;
(xvii) Loan provisions: Nature, interest, automatic premium loan.
(9) Life insurance statutes and regulations:
(a) Disclosure;
(b) Fair Credit Reporting Act;
(c) Replacement;
(d) Washington Life and Disability Insurance Guaranty Association;
(e) Fraternal benefit society;
(f) Standard nonforfeiture law.
(10) Policy riders:
(a) Policy loan provision;
(b) Automatic premium loan;
(c) Waiver of premium;
(d) Guaranteed insurability;
(e) Dividends/excess interest declarations;
(f) Nonforfeiture values, annuity tables;
(g) Accidental death/dismemberment;
(h) Disability income rider;
(i) Cost of living rider.
(11) Beneficiary designations:
(a) Estate/named party/class;
(b) Primary/contingent;
(c) Revocable/irrevocable;
(d) Trust.
(e) Common disaster, short-term survivorship; Uniform Simultaneous Death Act;
(f) Minor as beneficiary;
(g) Changing the beneficiary.
(12) Application process:
(a) Application completion;
(b) Application as part of contract;
(c) Fair Credit Reporting Act compliance;
(d) Receipts;
(e) Modified/issued as requested;
(f) Nonprepaid/prepaid;
(g) Modes of payment/effect of nonpayment;
(h) Good health upon delivery;
(i) Ten-day free look.
(13) Claims process:
(a) Notice of claim;
(b) Proof of loss;
(c) Statute of limitations on claims/defenses;
(d) Settlement options:
(i) Right to elect or change;
(ii) Owner's rights;
(iii) Beneficiary's rights.
(e) Types of settlements:
(i) Lump sum;
(ii) Interest only;
(iii) Period certain, fixed amount.
(14) Federal taxation:
(a) Life insurance premiums;
(b) Proceeds;
(c) Dividends:
(i) Nature of dividends;
(ii) Four basic options for the use of dividends;
(iii) One-year term (fifth) dividend option.
(d) Policy loans/withdrawals.
(15) Other topics:
(a) Social Security survivors, death, and retirement benefits;
(b) Legal concepts:
(i) Insurable interest;
(ii) Misrepresentation and concealment;
(c) Evaluation of life insurance needs:
(i) Needs approach;
(ii) Human life value approach.
(d) Cost comparison methods;
(i) Interest-adjusted cost;
(ii) Traditional net cost.
(e) Credit life.
(f) Business uses of life insurance:
(i) Buy and sell agreements;
(ii) Cross-purchase plan;
(iii) Entity plan.
(g) Key person insurance.
[Statutory Authority: RCW 48.02.060 and 48.17.150. 91-12-033 (Order R 91-3), § 284-17-552, filed 6/3/91, effective 7/4/91. Statutory Authority: RCW 48.02.060 and 48.17.070. 89-01-055 (Order R 88-14), § 284-17-552, filed 12/16/88.]
--------------------------------------------------------------------------------
284-17-553
Disability insurance curriculum.
(1) Nature and purpose:
(a) Medical expenses;
(b) Loss of income;
(c) Insuring agreement and perils covered;
(d) Definition of total disability:
(i) Own occupation;
(ii) Any occupation for which the insured is reasonably suited;
(iii) Any occupation;
(iv) Combination definitions;
(v) Presumptive disability.
(e) Temporary disability;
(f) Permanent disability;
(i) Partial;
(ii) Total;
(g) Residual disability;
(h) Recurrent disability;
(2) Underwriting considerations:
(a) Elimination (waiting) period;
(b) Probationary period;
(c) Benefit period:
(i) Short-term versus long-term;
(ii) Accident versus sickness;
(d) Nonoccupational versus full coverage;
(e) Costs of illness or injury; morbidity tables:
(i) Age, sex, height, and weight;
(ii) Marital, financial status;
(iii) Occupation, avocation;
(iv) Current state of health;
(v) Illegal occupation;
(f) Rating standards:
(i) Reasonable, equitable, adequate;
(ii) Class exposures to a degree of risk;
(g) Common exclusions;
(3) Accidental death/dismemberment;
(4) Needs analysis: Human life value, economic value;
(5) Disability insurance policy provisions:
(a) Mandatory individual policy provisions:
(i) Grace period;
(ii) Reinstatement;
(iii) Misstatement of age or sex;
(iv) Change of beneficiary;
(v) Entire contract;
(vi) Time limit on certain defenses;
(vii) Notice of claim;
(viii) Claim forms;
(ix) Proof of loss;
(x) Time of payment of claims;
(xi) Payment of claims;
(xii) Physical examination and autopsy;
(xiii) Legal actions.
(b) Optional individual policy provisions and clauses:
(i) Unpaid premium;
(ii) Cancellation/renewability;
(iii) Nonoccupation/full coverage;
(iv) Change of occupation;
(v) Other insurance with this insurer;
(vi) Insurance with other insurer(s):
(A) On expense incurred basis;
(B) On another basis.
(vii) Chemical dependency;
(viii) Relation of earnings to insurance;
(ix) Unpaid premiums;
(x) Cancellation;
(xi) Conformity with state statute;
(6) Other provisions:
(a) Consideration/premium payment;
(b) Modes of payment;
(c) Effect of nonpayment;
(d) Claims control;
(i) Second surgical opinion;
(ii) Precertification;
(iii) Ambulatory treatment.
(e) Conversion;
(f) Waiver of premium;
(g) Assignment;
(h) Preexisting conditions;
(i) Right to examine;
(j) Policy continuation:
(i) Cancellable;
(ii) Optionally renewable;
(iii) Conditionally renewable;
(iv) Guaranteed renewable;
(v) Noncancellable.
(7) Benefit features, options:
(a) Cost of living adjustment;
(b) Accident medical expense;
(c) Guaranteed insurability option;
(d) Accidental death and dismemberment;
(e) Social Security rider;
(f) Lifetime/extended benefit;
(g) Assignment of benefits;
(h) Benefit periods:
(i) Long term/short term;
(ii) Illness/injury.
(i) Nonduplication of benefits:
(i) Other insurers;
(ii) Benefit maximum.
(j) Special policy provisions:
(i) Disability buy-out;
(ii) Lump sum;
(iii) Periodic payment;
(k) Specified injury or illness.
(8) Disability benefits in life insurance contracts.
(9) Business overhead expense coverage.
(10) Hospital income coverage.
(11) Credit protection/mortgage protection.
(12) Sources of medical (accident and health) benefits:
(a) Insurance companies;
(b) Health care service contractors (HCSC);
(c) Health maintenance organizations (HMO);
(d) Preferred provider organizations (PPO);
(e) Health Insurance Coverage Access Act:
(i) Nature and purpose;
(ii) Eligibility;
(iii) Coverage available.
(13) Basic medical expense insurance:
(a) Nature and purpose;
(b) Insuring agreements and perils covered;
(c) Hospitalization expense;
(i) Room and board;
(ii) Intensive care;
(iii) Ancillary (miscellaneous) charges.
(d) Surgical expense:
(i) Schedules: Absolute value versus relative value;
(ii) Usual and customary.
(e) Regular medical expense (other physician charges):
(i) Charges covered;
(ii) Common limitations on benefits.
(f) Common exclusions.
(g) Other benefit features, options, or expense coverages:
(i) Maternity;
(ii) Private duty nursing;
(iii) Dental;
(iv) Prescription drug;
(v) Vision;
(vi) Home health care;
(vii) Dread disease and limited (e.g., cancer) coverage.
(14) Major medical expense insurance:
(a) Nature and purpose;
(b) Covered charges (expenses);
(c) Inside (internal) limits;
(d) Waiting period, preexisting/named conditions;
(e) Common limitations/exclusions/optional coverages:
(i) Self-inflicted injury;
(ii) Injured while engaged in illegal activity or under the influence of a controlled substance;
(iii) Injury caused by military conflict;
(iv) Elective cosmetic surgery;
(v) Optical, dental, audio care;
(vi) Maternity and childbirth;
(vii) Prescription drugs.
(f) Deductible:
(i) Per injury or sickness versus cumulative (e.g., annual);
(ii) Corridor;
(iii) Common accident/common sickness;
(iv) Family maximum;
(v) Basic or other plan benefits;
(vi) Carryover provision;
(vii) Coinsurance, copayment, stop loss;
(viii) Waiting periods;
(ix) Standards for coordination of benefits/nonduplication of benefits;
(x) Maximum limits:
(A) Per injury or illness versus lifetime;
(B) Unlimited;
(C) Restoration of used benefits.
(15) Comprehensive coverage:
(a) Basic plan plus major medical;
(b) Comprehensive major medical.
(16) Group insurance and related coverages:
(a) Types of benefits;
(b) Group underwriting considerations;
(c) Group enrollment restrictions:
(i) Age of applicant;
(ii) Coverage for dependents;
(iii) Time period for enrollment;
(iv) Preexisting condition.
(d) Master policy and certificates;
(e) Conversion;
(f) Probationary employment period;
(g) Extended benefits;
(h) Mandatory benefits and options;
(i) Nonduplication and coordination of benefits provision;
(j) Approaches related to group insurance:
(i) Franchise coverage;
(ii) Blanket coverage.
(k) Consolidated Omnibus Budget Reconciliation Act (COBRA).
(17) Government entitlement programs.
(18) Medicare:
(a) Eligibility and enrollment;
(b) Part A (Hospital);
(i) Hospital coverage:
(A) Benefits;
(B) Diagnostic related groups (DRG's).
(ii) Skilled nursing facilities;
(iii) Home health care;
(iv) Hospice care.
(c) Part B (Medical):
Medical coverage:
(i) Premium requirement;
(ii) Benefits;
(iii) Deductibles;
(iv) Coinsurance;
(v) Assignment;
(vi) Allowable charges versus usual and customary.
(d) Definitions:
(i) Carrier;
(ii) Intermediary;
(iii) Spell of illness;
(iv) Coverage outside the United States.
(19) Medicare supplements:
(a) Nature and purpose;
(b) Minimum standards;
(c) Preexisting conditions;
(d) Disclosure;
(e) Renewability;
(f) Replacement.
(20) Social Security disability and medical expense benefits.
(21) Long-term care:
(a) Nature and purpose;
(b) Policies and contracts;
(c) Skilled/intermediate care;
(d) Disclosure;
(e) Free look;
(f) Prohibited practices.
(22) Policy delivery:
(a) Modified versus issued as requested;
(b) Explanation of coverage;
(c) Payment of premium:
(i) Paid upon application;
(ii) Paid upon delivery;
(iii) Mode of payment;
(iv) Effect of nonpayment.
(d) Good health upon delivery;
(e) Ten-day free look;
(f) Application completion;
(g) Fair Credit Reporting Act compliance.
(23) Insurance statutes and regulations:
(a) Applicable to disability insurers only:
(i) Disability insurance advertising restrictions;
(ii) Group/blanket disability insurance:
(A) Extended health;
(B) Disability insurance loss ratios.
(iii) Washington Life and Disability Insurance Guaranty Association;
(iv) Trade practices:
(A) Trade practice rules;
(B) Unfair claims practices.
(b) Applicable to all medical service coverage carriers:
(i) Standards for group chemical dependency coverage;
(ii) Rules pertaining to AIDS;
(iii) Health Care False Claim Act;
(c) Misrepresentation and concealment.
(24) Claims:
(a) Notice, forms, time limit;
(b) Proof of claim: Physical examination/autopsy;
(c) Legal action:
(i) Statute of limitations;
(ii) Coordination of benefits.
(d) Settlement:
(i) Payment of claims;
(ii) Time and method of payment.
(25) Other topics:
(a) Accidental death and dismemberment coverage:
(i) Insuring agreements and perils covered;
(ii) Principle (capital) sum;
(iii) Beneficiary designations.
(b) Business uses: The disability buy-out.
(26) Federal income taxation:
(a) Disability insurance premium;
(b) Disability insurance benefits.
[Statutory Authority: RCW 48.02.060 and 48.17.150. 91-12-033 (Order R 91-3), § 284-17-553, filed 6/3/91, effective 7/4/91. Statutory Authority: RCW 48.02.060 and 48.17.070. 89-01-055 (Order R 88-14), § 284-17-553, filed 12/16/88.]
--------------------------------------------------------------------------------
284-17-554
Casualty insurance curriculum.
(1) Defining casualty insurance. Insurable interest; insured's legal liability for:
(a) Bodily injury, disability or death of any human being:
(i) Medical, hospital, surgical costs;
(ii) Funeral benefits.
(b) Liability for loss of/damage to the property of others;
(c) Coverage for personal injury:
(i) Libel, slander, defamation of character;
(ii) Wrongful eviction.
(d) Any other kind of loss, damage, or liability which is:
(i) Properly the subject of insurance;
(ii) Not within another insurance definition; and
(iii) Not contrary to law or public policy.
(2) Legal basis for liability:
(a) Intentional tort;
(b) Statutory liability;
(c) Product/absolute/strict liability;
(d) Negligence:
(i) Principles:
(A) Duty of care;
(B) Breach of duty was proximate cause of injury;
(C) Injury in fact.
(ii) Defenses:
(A) Contributory negligence;
(B) Comparative negligence;
(C) Last clear chance;
(D) Assumption of risk.
(iii) Degrees of care owed to:
(A) Trespasser;
(B) Licensee;
(C) Invitee;
(D) Children.
(iv) Reasonable person standard applied to:
(A) Attractive nuisance;
(B) Extra hazardous operations.
(e) Sources of liability:
(i) Direct;
(ii) Contingent;
(iii) Contractual;
(iv) Vicarious.
(3) Evaluating casualty insurance needs:
(a) Maximum probable loss:
(i) Personal injury;
(ii) Bodily injury;
(iii) Injury to insured's reputation;
(iv) Mental distress; insured's lost wages;
(v) Defense costs;
(vi) Property damage.
(b) Factors affecting rates:
(i) Risks, perils, hazards;
(ii) Personal, business habits;
(iii) Blanket/specific coverage;
(iv) Monoline/package policy;
(v) Other primary or excess insurance;
(vi) Experience rating;
(vii) Deposit premium/audit.
(c) Liability limits:
(i) Per person;
(ii) Per occurrence;
(iii) Aggregate;
(iv) Split/single limit.
(d) Occurrence policy; claims made policy;
(e) Application content and binders.
(4) Major classes of policy provisions:
(a) Declarations:
(i) First named insured, additional insureds;
(ii) Policy period, policy territory, perils;
(iii) Liability limits.
(b) Insuring agreement;
(c) Conditions:
(i) Liberalization;
(ii) Subrogation;
(iii) Assignment.
(d) Exclusions;
(e) Definitions:
(i) Entire contract;
(ii) Agency binding authority;
(iii) Rating and premium determination.
(5) Homeowners (section II) coverage - ISO HO-84 and Washington amendatory endorsement HO-300 (01/89):
(a) Nature and eligibility;
(b) Liability insuring agreement/exclusions;
(c) Medical payment insuring agreement/exclusions;
(d) Additional coverages and conditions;
(e) Common endorsements:
(i) Business pursuits;
(ii) Permitted incidental occupancy;
(iii) Watercraft;
(iv) Additional resident premises rented to others.
(f) Other personal packages:
Mobile home owner.
(g) Miscellaneous personal casualty coverages:
(i) Umbrella;
(ii) Excess auto liability;
(iii) Recreational vehicles;
(iv) Watercraft/yacht.
(h) Incidental farming.
(6) Automobile coverage:
(a) Financial responsibility:
(i) Proof defined;
(ii) Persons required to show proof;
(iii) Methods of satisfying financial responsibility;
(iv) Penalty for noncompliance.
(b) Coverages:
(i) Bodily injury;
(ii) Personal injury protection;
(iii) Medical payments;
(iv) Property damage;
(v) Collision;
(vi) Other than collision;
(vii) Towing expense, rental reimbursement;
(viii) Supplementary payments;
(ix) Uninsured motorist;
(x) Under-insured motorist.
(c) Personal auto:
(i) Common policies and endorsements:
(A) Personal auto policy;
(B) Broad form named operator;
(C) Extended nonowned liability;
(D) Debt and financing coverage.
(ii) Cancellation or nonrenewal:
(A) By insured/by insurer;
(B) Statutory requirements, notice; return of premium;
(C) Trade practice regulations.
(d) Business auto:
(i) Owned;
(ii) Nonowned;
(iii) Hired;
(iv) Garage liability;
(v) Garagekeeper's liability.
(7) Commercial casualty:
(a) Basic hazards:
(i) General liability;
(ii) Contractual liability;
(iii) Independent contractors;
(iv) Pollution/environmental impairment;
(v) Premises and operations;
(vi) Products and completed operations;
(vii) Personal and advertising injury;
(viii) Liquor liability.
(b) Types of commercial package policies:
(i) Commercial package policy;
(ii) Businessowner's policy (section II):
(A) Nature and purpose;
(B) Standard/special form;
(C) Coverages, exclusions;
(D) Optional coverages.
(c) Miscellaneous commercial casualty coverages:
(i) Fire legal liability;
(ii) Professional liability;
(iii) Director's/officer's liability;
(iv) Stop-gap;
(v) Umbrella;
(vi) Excess insurance;
(vii) Boiler and machinery;
(viii) Motor vehicle mechanical breakdown;
(ix) Ocean marine.
(8) Crime coverage:
(a) Major perils:
(i) Forgery/alteration;
(ii) Theft/disappearance, destruction/vandalism;
(iii) Safe burglary;
(iv) Robbery, burglary.
(b) Primary crime coverage forms:
(i) Premises burglary;
(ii) Robbery and safe burglary;
(iii) Theft, disappearance and destruction.
(c) Fidelity:
(i) Employee dishonesty coverage form:
(A) Individual;
(B) Scheduled;
(C) Blanket.
(ii) Financial institution bond.
(d) Forgery;
(e) Employee Retirement Income Security Act (ERISA);
(f) Surety bond:
(i) Surety distinguished from insurance;
(ii) Parties to the contract;
(iii) Promise of the surety;
(iv) Major classes of surety bond.
(9) Government programs:
(a) Worker's compensation;
(b) The Jones Act;
(c) The Longshore and Harbor Workers' Act;
(d) National crime program;
(e) Washington automobile insurance plan.
[Statutory Authority: RCW 48.02.060 and 48.17.150. 91-12-033 (Order R 91-3), § 284-17-554, filed 6/3/91, effective 7/4/91. Statutory Authority: RCW 48.02.060 and 48.17.070. 89-01-055 (Order R 88-14), § 284-17-554, filed 12/16/88.]
--------------------------------------------------------------------------------
284-17-555
Property insurance curriculum.
(1) Defining property insurance:
(a) Loss of or damage to real or personal property;
(b) Loss of interest in real or personal property.
(2) Evaluation of risk:
(a) Maximum probable loss:
(i) Direct loss;
(ii) Indirect loss;
(iii) Concurrent causation.
(b) Factors affecting rates:
(i) Risks, perils, hazards;
(ii) Personal, business habits;
(iii) Blanket/specific coverage;
(iv) Coinsurance.
(3) Personal insurance coverages:
(a) Dwelling property forms - basic, broad, or special:
(i) Nature and eligibility;
(ii) Property covered/excluded;
(iii) Perils covered/excluded;
(iv) Deductibles;
(v) Limitation on loss settlement;
(vi) Other conditions and provisions.
(A) Entire contract;
(B) Agency binding authority.
(b) Homeowners (section I) coverage - ISO HO-84 and Washington amendatory endorsement HO-300 (01/89):
(i) Nature and eligibility;
(ii) Property covered:
(A) Personal dwelling;
(B) Other appurtenant private structures;
(C) Unscheduled personal property;
(D) Additional living expense.
(iii) Perils covered/excluded;
(iv) Property limited/excluded;
(v) Other provisions or conditions;
(vi) Cancellation or nonrenewal:
(A) Statutory requirements, notice; return of premium;
(B) Trade practice regulations.
(vii) Common endorsements:
(A) Replacement cost on contents;
(B) Guaranteed replacement cost on dwelling;
(C) Scheduled personal property;
(D) Earthquake;
(E) Inflation guard.
(c) Other personal packages:
Mobile home.
(4) Commercial property coverages:
(a) Property covered:
(i) Building;
(ii) Insured's business personal property;
(iii) Personal property of others.
(b) Cause of loss forms:
(i) Basic;
(ii) Broad;
(iii) Special.
(c) Property limited or excluded;
(d) Optional coverages;
(e) Conditions, provisions, and extensions of coverage;
(f) Types of commercial package policies:
(i) Commercial package policy;
(ii) Businessowner's policy (section I):
(A) Nature and purpose;
(B) Standard/special form;
(C) Coverages, exclusions;
(D) Property limited or excluded.
(g) Miscellaneous commercial property insurance:
(i) Business income:
(A) General nature;
(B) Losses covered.
(ii) Extra expense;
(iii) Glass;
(iv) Earthquake;
(v) Inland marine;
(vi) Ocean marine/yacht;
(vii) Farmowner's.
(5) Government programs:
(a) National flood insurance program;
(b) Fair access to insurance requirements (FAIR) plan;
(c) Washington Insurance Guaranty Association;
(d) Federal crop insurance program.
[Statutory Authority: RCW 48.02.060 and 48.17.150. 91-12-033 (Order R 91-3), § 284-17-555, filed 6/3/91, effective 7/4/91. Statutory Authority: RCW 48.02.060 and 48.17.070. 89-01-055 (Order R 88-14), § 284-17-555, filed 12/16/88.]
--------------------------------------------------------------------------------
284-17-560
Providers not approved.
The commissioner may deny approval to any prelicense education provider based upon:
(1) Such provider's refusal or failure to comply with any of the requirements of chapter 284-17 WAC, including but not limited to the provider's employment and use of an unqualified program director or instructor; or
(2) Any owner, operator, program director, instructor, or other employee of such provider has, directly or indirectly, compromised or attempted to compromise the integrity or security of Washington state licensing examination questions, or has induced another to do so; or
(3) Any owner, operator, program director, instructor, or other employee of such provider has been cited for noncompliance with any of the requirements of this chapter or chapter 284-12 WAC, or of any other statute or regulation pertaining to the sale of insurance or to insurance education; or has been cited for violations of statutes, regulations, or copyrights related to an examination for any occupational license.
[Statutory Authority: RCW 48.02.060 and 48.17.070. 89-01-055 (Order R 88-14), § 284-17-560, filed 12/16/88.]
--------------------------------------------------------------------------------
284-17-565
Approved providers — Loss of approval.
(1) The commissioner may suspend or revoke approval of any prelicense education provider based upon a finding that:
(a) Any owner, operator, program director, instructor, or other employee of such provider has failed to comply with any of the requirements of chapter 284-17 WAC, including but not limited to the failure to employ a qualified program director or instructor(s); or
(b) Any owner, operator, program director, instructor, or other employee of such provider has, directly or indirectly, compromised or attempted to compromise the integrity or security of Washington state licensing examination questions, or has induced another to do so; or
(c) Such provider has failed to maintain an effective instructional program, or has misrepresented the quality of the instruction provided, to the detriment of its students.
(2) The commissioner may suspend or revoke approval of any prelicense education provider based upon such provider's failure to:
(a) Reply promptly, in writing, to an inquiry of the commissioner.
(b) Submit revised course outlines requested by the commissioner. If changes are implemented in the prescribed prelicense curricula, affected providers must submit revised course outlines at least fifteen calendar days before the implementationdate. (continued)