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(1) "Actuary" means any person who is a member of the American Academy of Actuaries.
(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) "Broker of record" means the insurance producer licensed in the state of Washington who, through a contractual agreement with the self-insurance program, procures insurance on behalf of the self-insurance program.
(5) "Claim" means a demand for payment for the delivery of a covered service or services.
(6) "Claim adjustment expense" means expenses, other than claim payments, incurred in the course of processing and settling claims.
(7) "Claims auditor" means a person who has the following qualifications:
(a) Has experience in auditing the same manner of claims filed against the program being audited;
(b) Provides proof of professional liability insurance; and
(c) Provides a statement that the auditor is independent from the program being audited, its brokers and third-party administrators.
(8) "Competitive solicitation" means a documented competitive selection process providing an equal and open opportunity to qualified parties and culminating in a selection based on criteria which may include such factors as the consultant'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.
(9) "Consultant" means an independent individual or firm contracting with a self-insurance program to perform actuarial, claims auditing or third-party administration services, represent the program as broker of record, or render an opinion or recommendation according to the consultant's methods, all without being subject to the control of the program, except as to satisfaction of the contracted deliverables.
(10) "Contingent reserve policy" means a policy adopted by the governing body of an individual or joint program which establishes the amount of money (contingent reserves) necessary to fund the termination costs of the program and to insulate the program against unusual severity or frequency of claims.
(11) "Contingent reserves" means:
(a) For joint programs, an amount of money equal to eight weeks of program expenses as stated in the contingent reserve policy established by ordinance or resolution of the governing body;
(b) For individual programs, an amount of money equal to eight weeks of program expenses as recommended by the state risk manager or equal to a different amount as stated in the contingent reserve policy established by ordinance or resolution of the governing body.
(12) "Contribution" means the amount paid or payable by the employee into a health and welfare self-insurance program.
(13) "Governing body" means the multimember board, commission, committee, council, or other policy or rule-making body of a public agency, or any committee thereof when the committee acts on behalf of the governing body, conducts hearings, or takes testimony or public comment.
(14) "Individual self-insurance program" means a formal program established and maintained by a local government entity to provide advance funding to self-insure health and welfare benefits on its own behalf as opposed to risk assumption, which means a decision to absorb the entity's financial exposure to a risk of financial loss without the creation of a formal program of advance funding of anticipated losses.
(15) "Interlocal agreement" means an agreement joining local government members of a self-insurance program that is established under the Interlocal Cooperation Act defined in chapter 39.34
(16) "Joint self-insurance program" means any two or more local government entities 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
(17) "Member" means a local government entity that:
(a) Is a signatory to a joint insurance program's interlocal agreement;
(b) Agrees to pay assessments as part of the program's joint self-insurance program; and
(c) Is a past or present participant in a joint self-insurance program subject to regulation under chapter 48.62
(18) "Program liability" means an amount as of fiscal year end determined by each program to be either:
(a) Eight weeks of total program expenses based on total program expenses paid during the previous year; or
(b) The program's liability as determined by an actuary.
(19) "Program reserves" means moneys set aside to pay expenses of an individual or joint self-insurance program.
(20) "Risk sharing" means a decision by the members of a joint self-insurance program to jointly absorb certain or specified financial exposures to risks of loss through the creation of a formal program of advance funding of anticipated losses; and/or joint purchase of insurance as a member of a joint self-insurance program formed under chapter 48.62
(21) "Self-insurance program" means any individual or joint local government entity self-insurance program required by chapter 48.62
RCW to comply with this chapter.
(22) "Services" means administrative, electronic, management, training, wellness or other ongoing significant support services which do not include the participation in or purchase of the pool's commercial or self-insured insurance programs.
(23) "Stop-loss insurance" means a promise by an insurance company that it will cover losses of the entity it insures over and above an agreed-upon individual or aggregated amount.
(24) "Termination cost" means an estimate of the program's liabilities at the time the program ceases to operate, which shall include, at a minimum, final claim payments, claim adjustment expenses, unallocated loss adjustment expenses, and costs attributed to increased utilization.
(25) "Third-party administrator" means an independent association, agency, entity or enterprise which, through a contractual agreement, provides one or more of the following ongoing services: Program management or administration services, claims administration services, risk management services, or services for the termination of an individual or joint self-insurance program.
(26) "Unallocated loss adjustment expense (ULAE)" means costs that cannot be associated with specific claims but are related to the claims adjustment process, such as administrative and internal expenses related to settlement of claims at the termination of the program.
[Statutory Authority: 2011 c 43. WSR 11-23-093, recodified as § 200-110-020, filed 11/17/11, effective 11/17/11. Statutory Authority: RCW 48.62.061
. WSR 10-20-102, § 82-65-020, filed 10/1/10, effective 11/1/10.]