5782(2)(f)(i) One comprehensive low vision evaluation every five years; WAC High power spectacles, magnifiers and telescopes as medically necessary, with reasonable limitations permitted; and WAC Follow-up care of visits in any five-year period, with prior approval. Allowed WAC The plan may include the following exclusions: Exclusions Visual therapy that is otherwise covered under the medical/surgical benefits of the plan; and (3)(b) Ordering two of glasses in lieu of bifocals. PKU Requirement RCW Plan must provide coverage for the formulas necessary for the Phenylketonuria to 48.21.300(2) treatment of phenylketonuria. WAC Coverage may be limited to the and customary charge for Formula such formulas. Coverage may be subject to deductibles, copayments, coinsurance or other reductions applicable to other benefits. Premium charged must be no greater as a result of a family or individual receiving PKU benefits. PKU Coverage WAC Coverage for the formulas may be made subject to deductibles, (Cont’d) Requirement copayments, coinsurance or other reductions only to the extent that such deductibles, copayments, coinsurance or other reductions do not exceed those applicable to common sicknesses or disorders in the particular contract. Prescription Required 42 USC Plan must cover "prescription drug services" in a manner substantially Drug Services Prescription §18021(a)(1)(B); equal to the base-benchmark plan. For purposes of determining a (EHB) Drug Services plan's actuarial value, an issuer must classify as prescription drug
5782(2)(f)(i) One comprehensive low vision evaluation every five years; WAC High power spectacles, magnifiers and telescopes as medically necessary, with reasonable limitations permitted; and WAC Follow-up care of visits in any five-year period, with prior approval. Allowed Exclusions WAC The plan may include the following exclusions: Visual therapy that is otherwise covered under the medical/surgical benefits of the plan; and (3)(b) Ordering two of glasses in lieu of bifocals. PKU Phenylketonuria Requirement to RCW 48.21.300(2) Plan must provide coverage for the formulas necessary for the treatment of phenylketonuria. Formula WAC Coverage may be limited to the and customary charge for such formulas. Coverage may be subject to deductibles, copayments, coinsurance or other reductions applicable to other benefits. Premium charged must be no greater as a result of a family or individual receiving PKU benefits. PKU (Cont’d) Coverage Requirement WAC Coverage for the formulas may be made subject to deductibles, copayments, coinsurance or other reductions only to the extent that such deductibles, copayments, coinsurance or other reductions do not exceed those applicable to common sicknesses or disorders in the particular contract. Prescription Drug Services (EHB) Required Prescription Drug Services 42 USC §18021(a)(1)(B); Plan must cover "prescription drug services" in a manner substantially equal to the base-benchmark plan. For purposes of determining a plan's actuarial value, an issuer must classify as prescription drug
checklist-forms-2018-disability-sg-analyst-checklist.docx