Benchmark plan Local anesthesia and regional blocks, including office-based oral or parenteral conscious sedation, deep sedation or general Required anesthesia; and Oral Surgery Services Benchmark plan Post-surgical complications. and (Cont’d) (*Although RCW requires this benefit for children under 7, base benchmark plan covers this benefit for children under 8. Requirements of RCW 48.43.185 apply to base benchmark plan as a small group plan, thus because they are covered in the (Cont’d) base benchmark plan, these benefits are EHBs for an individual plan.) Allowable Benchmark Plan Base benchmark plan specifically excludes oral surgery to treat a exclusion fractured jaw, and orognathic surgery. Periodontics WAC Required Plan must cover periodontic services in a manner substantially equal Periodontic See, to the base benchmark plan including, at a minimum: also, Services WAC WAC Periodontal scaling and root planning once per quadrant in a period for ages thirteen and older; WAC Periodontal maintenance once per quadrant in a twelve-month period for ages thirteen and older; Benchmark plan Complex periodontal procedures (osseous surgery including flap and closure and mucogingivoplastic surgery) limited to once per Member per quadrant in a five-year period;
Oral Surgery and (Cont’d) Required Services (Cont’d) Benchmark plan Local anesthesia and regional blocks, including office-based oral or parenteral conscious sedation, deep sedation or general anesthesia; and Benchmark plan Post-surgical complications. (*Although RCW requires this benefit for children under 7, base benchmark plan covers this benefit for children under 8. Requirements of RCW 48.43.185 apply to base benchmark plan as a small group plan, thus because they are covered in the base benchmark plan, these benefits are EHBs for an individual plan.) Allowable exclusion Benchmark Plan Base benchmark plan specifically excludes oral surgery to treat a fractured jaw, and orognathic surgery. Periodontics Required Periodontic Services WAC See, also, WAC Plan must cover periodontic services in a manner substantially equal to the base benchmark plan including, at a minimum: WAC Periodontal scaling and root planning once per quadrant in a period for ages thirteen and older; WAC Periodontal maintenance once per quadrant in a twelve-month period for ages thirteen and older; Benchmark plan Complex periodontal procedures (osseous surgery including flap and closure and mucogingivoplastic surgery) limited to once per Member per quadrant in a five-year period;
cl-forms-19-all-filers-ind-embedded-pediatric-dent-w-ehbs.docx