(1) "Actuary" means any person who is qualified under WAC
284-05-060 to provide actuarial services.
(2) "Assessment" means the moneys paid by the members to a joint self-insurance program.
(3) "Beneficiary" means any individual entitled to payment of all or part of a covered claim under a local government health and welfare self-insurance program.
(4) "Claim adjustment expense" means expenses, other than claim payments, incurred in the course of investigating and settling claims.
(5) "Claim" means a demand for payment for damages or policy benefit because of the occurrence of an event such as:
(a) For health and welfare benefits, a covered service or services being delivered; or
(b) For property and liability, the destruction or damage of property or related deaths or injuries.
Unless specifically referenced, the term "claim" is used for both health and welfare and property and liability programs.
(6) "Competitive process" means a documented formal process providing a fair and open opportunity to qualified parties and culminating in a selection based on criteria which may include such factors as the party's fees or costs, ability, capacity, experience, reputation, responsiveness to time limitations, responsiveness to solicitation requirements, quality of previous performance, and compliance with statutes and rules relating to contracts or services.
(7) "Contribution" means the amount paid or payable by the employee into a health and welfare self-insurance program.
(8) "Incurred but not reported, or IBNR" means claims and claim adjustment expenses for covered events which have occurred but have not yet been reported to the self-insurance program as of the date of the financial statement. IBNR claims include (a) known loss events that are expected to be presented later as claims, (b) unknown loss events that are expected to become claims, and (c) expected future development on claims already reported.
(9) "Individual self-insurance program" means a program established and maintained by a local government entity to self-insure health and welfare benefits or property and liability risks on its own behalf.
(10) "Joint self-insurance program" means any two or more local government entities, two or more nonprofit corporations or a combination of local government entities and nonprofit corporations which have entered into a cooperative risk sharing agreement pursuant to the provisions of the Interlocal Cooperation Act (chapter
39.34 RCW) and/or subject to regulation under chapter
48.62 RCW.
(11) "Liability for unpaid claims" means the amount needed to provide for the estimated ultimate cost of settling claims which have occurred on or before a particular date. The estimated liability includes the amount of money that will be needed for future payments on both claims which have been reported and IBNR claims.
(12) "Liability for unpaid claim adjustment expenses" means the amount needed to provide for the estimated ultimate costs required to investigate and settle claims for covered events that have occurred on or before a particular date, whether or not reported to the government entity or nonprofit corporation at that date.
(13) "Member" means a local government entity or nonprofit corporation that is a past or present participant in a joint self-insurance program subject to regulation under chapter
48.62 RCW.
(14) "Nonprofit corporation," as defined in RCW
24.03.005(3), means a corporation no part of the income of which is distributable to its members, directors or officers.
(15) "Self-insurance program" means any individual or joint local government entity or nonprofit corporation self-insurance program required by chapter
48.62 RCW to comply with this chapter.
(16) "Stop-loss insurance" means insurance against the risk of economic loss assumed under a self-insurance program.
(17) "Third-party administrator" means:
(a) An independent association, agency, entity or enterprise which, through a contractual agreement is responsible for the overall operational and financial management of the self-insurance program; or
(b) An independent association, agency, entity or enterprise which, through a contractual agreement, provides a professional service for the analysis, design, implementation, or termination of a self-insurance program; or
(c) An independent association, agency, entity or enterprise which, through a contractual agreement, administers the claim payment process on behalf of a self-insurance program. Such claim administration process includes, but is not limited to, receiving requests for claim payments, investigation, verification and adjustment of the claim. Claim payment disbursement is also considered an administrative process.
[Statutory Authority: RCW 48.62.061. 05-04-072, amended and recodified as § 82-60-020, filed 2/1/05, effective 3/4/05. Statutory Authority: Chapter 48.62 RCW. 93-16-079, § 236-22-020, filed 8/3/93, effective 9/3/93.]