for Native incomes are at or below three hundred percent of federal poverty Americans level. Small Group WAC Small group health benefit plan that includes the essential health Cost-Sharing (2) benefits package may not impose annual cost-sharing or deductibles Contract that exceed the maximum annual amounts that apply to high Standards deductible plans linked to health savings accounts, as set forth in the (Cont’d) most recent version of IRS Publication 969, pursuant to Section 106(c)(2) of the Internal Revenue Code of 1986, and Section 1302(c)(2) of PPACA. Reasonable WAC Plan may include reasonable medical management to control Medical including promoting the use of appropriate, high value preventive Management services, providers and settings. Plan must permit waiver of an otherwise applicable copayment for a service that is tied to one setting but not the preferred setting, if the enrollee's provider determines that it would be medically inappropriate to have the service provided in the lower-value setting. Issuer may still apply applicable in-network requirements. Contracting RCW 48.43.085 Contract must state that the issuer may not prohibit enrollees from for Outside freely contracting to obtain any health care services outside the plan Services on any terms the enrollees choose. No Annual or WAC An issuer must not impose annual or lifetime dollar limits on an Lifetime essential health benefit, other than those specifically permitted under Dollar Limits WAC 284-43-5642, 284-43, 5702, and 284-43-5782. Discretionary WAC That the carrier’s interpretation of the terms of the contract is Clauses binding; Prohibited WAC That the carrier’s decision regarding eligibility or continued receipt of benefits is binding;
for Native Americans incomes are at or below three hundred percent of federal poverty level. Contract Standards (Cont’d) Small Group Cost-Sharing WAC (2) Small group health benefit plan that includes the essential health benefits package may not impose annual cost-sharing or deductibles that exceed the maximum annual amounts that apply to high deductible plans linked to health savings accounts, as set forth in the most recent version of IRS Publication 969, pursuant to Section 106(c)(2) of the Internal Revenue Code of 1986, and Section 1302(c)(2) of PPACA. Reasonable Medical Management WAC Plan may include reasonable medical management to control including promoting the use of appropriate, high value preventive services, providers and settings. Plan must permit waiver of an otherwise applicable copayment for a service that is tied to one setting but not the preferred setting, if the enrollee's provider determines that it would be medically inappropriate to have the service provided in the lower-value setting. Issuer may still apply applicable in-network requirements. Contracting for Outside Services RCW 48.43.085 Contract must state that the issuer may not prohibit enrollees from freely contracting to obtain any health care services outside the plan on any terms the enrollees choose. No Annual or Lifetime Dollar Limits WAC An issuer must not impose annual or lifetime dollar limits on an essential health benefit, other than those specifically permitted under WAC 284-43-5642, 284-43, 5702, and 284-43-5782. Discretionary Clauses WAC That the carrier’s interpretation of the terms of the contract is binding; Prohibited WAC That the carrier’s decision regarding eligibility or continued receipt of benefits is binding;