Discrimination RCW 48.44.220 Form provisions cannot result in denial of coverage to any person Prohibited solely on account of race, religion, national origin, or the presence of any sensory, mental, or physical handicap. Injury due to RCW 48.44.305 Plan must not deny coverage for treatment of an injury solely Intoxication or because the injury was caused by the enrolled participant's being narcotics intoxicated or under the influence of a narcotic. Cost Sharing WAC 284-43-5800(5) If plan has cost-sharing structures or tiers for EHBs, they must not Levels be discriminatory. Unfair and Cost Sharing WAC Plan must not apply cost-sharing or coverage limitations Discriminatory Levels differently to enrollees with chronic disease or complex Practices (Cont’d) underlying medical conditions than to other enrollees, unless (Cont’d) the difference provides the enrollee with care and treatment commensurate with his specific medical needs, without additional cost to the enrollee beyond normal cost-sharing requirements under the plan. WAC Plan must not establish a different cost-sharing structure or tier for a benefit than is applied to the plan in general if the sole type of enrollee who access that benefit or benefit tier is one with a chronic illness or medical condition.
Unfair and Discriminatory Practices (Cont’d) Discrimination Prohibited RCW 48.44.220 Form provisions cannot result in denial of coverage to any person solely on account of race, religion, national origin, or the presence of any sensory, mental, or physical handicap. Injury due to Intoxication or narcotics RCW 48.44.305 Plan must not deny coverage for treatment of an injury solely because the injury was caused by the enrolled participant's being intoxicated or under the influence of a narcotic. Cost Sharing Levels Cost Sharing Levels (Cont’d) WAC 284-43-5800(5) If plan has cost-sharing structures or tiers for EHBs, they must not be discriminatory. WAC Plan must not apply cost-sharing or coverage limitations differently to enrollees with chronic disease or complex underlying medical conditions than to other enrollees, unless the difference provides the enrollee with care and treatment commensurate with his specific medical needs, without additional cost to the enrollee beyond normal cost-sharing requirements under the plan. WAC Plan must not establish a different cost-sharing structure or tier for a benefit than is applied to the plan in general if the sole type of enrollee who access that benefit or benefit tier is one with a chronic illness or medical condition.
cklist-forms-2018-hcsc-sg-stand-alone-dental-w-pediatric-ehbs.docx