Benchmark Plan Photographic images (oral and facial) when dentally appropriate. Diagnostic Diagnostic Services Services to (cont’d) be Provided without Cost Sharing (Cont’d) Statement that limitations or restrictions on access to participating Disclosures Referral and WAC providers and facilities may from the health service referral and and (14) authorization practices of the issuer; Practices Description of the health plan's referral and authorization practices, WAC Provider including information about how to contact customer service for guidance, Tiering and (14) must be set forth as an introduction or preamble to the provider directory for a health plan OR may be included in the summary of benefits and explanation of coverage for the health plan. If the contract includes different tiers of providers or facilities, and the WAC network design results in cost differentials for enrollees, contract must disclose to enrollees the cost difference and the basis for the issuer's placement of providers or facilities in one tier or another. Disclosures Provider The lowest cost-sharing tier of a tiered network must provide enrollees with WAC (Cont’d) Tiering adequate access and choice among health care providers and facilities for (Cont’d) essential health benefits.
Diagnostic Services (cont’d) Diagnostic Services to be Provided without Cost Sharing (Cont’d) Benchmark Plan Photographic images (oral and facial) when dentally appropriate. Disclosures Disclosures (Cont’d) Referral and Practices WAC and (14) Statement that limitations or restrictions on access to participating providers and facilities may from the health service referral and authorization practices of the issuer; Provider Tiering Provider Tiering (Cont’d) WAC and (14) Description of the health plan's referral and authorization practices, including information about how to contact customer service for guidance, must be set forth as an introduction or preamble to the provider directory for a health plan OR may be included in the summary of benefits and explanation of coverage for the health plan. WAC If the contract includes different tiers of providers or facilities, and the network design results in cost differentials for enrollees, contract must disclose to enrollees the cost difference and the basis for the issuer's placement of providers or facilities in one tier or another. WAC The lowest cost-sharing tier of a tiered network must provide enrollees with adequate access and choice among health care providers and facilities for essential health benefits.