Disclosures Required Offer RCW Plan must clearly and prominently display an offer to provide of Disclosure 48.43.510 the information listed below before purchase or selection. (Cont’d) Items (1)(g) Information must be provided upon request (either by paper or WAC electronic, whichever is requested). Must be prominently displayed and accessible on the issuer’s website and easily understood by the average plan participant. RCW listing of covered benefits, including RX benefits, if any, 48.43.510 copy of the current formulary, if any is used (1)(a) definitions of such as generic versus brand name, and policies regarding coverage of drugs, such as how they become approved or taken off the formulary, and how consumers may be involved in decisions about benefits; RCW listing of exclusions, reductions, and limitations to covered 48.43.510 benefits, and any definition of medical necessity or other (1)(b) coverage criteria upon which they may be based; 48.43.510 statement of the carrier's policies for protecting the (1)(c) confidentiality of health information; 48.43.510 statement of the cost of premiums and any enrollee (1)(d) sharing requirements; 48.43.510 summary explanation of the carrier's review of adverse (1)(e) benefit determinations and grievance processes; 48.43.510 statement regarding the availability of a point-of-service (1)(f) option, if any, and how the option operates; and RCW convenient means of obtaining lists of participating primary 48.43.510 care and specialty care providers, including disclosure of (1)(g); network arrangements that restrict access to providers within any plan network.
Disclosures (Cont’d) Required Offer of Disclosure Items RCW 48.43.510 (1)(g) WAC Plan must clearly and prominently display an offer to provide the information listed below before purchase or selection. Information must be provided upon request (either by paper or electronic, whichever is requested). Must be prominently displayed and accessible on the issuer’s website and easily understood by the average plan participant. RCW 48.43.510 (1)(a) listing of covered benefits, including RX benefits, if any, copy of the current formulary, if any is used definitions of such as generic versus brand name, and policies regarding coverage of drugs, such as how they become approved or taken off the formulary, and how consumers may be involved in decisions about benefits; RCW 48.43.510 (1)(b) listing of exclusions, reductions, and limitations to covered benefits, and any definition of medical necessity or other coverage criteria upon which they may be based; 48.43.510 (1)(c) statement of the carrier's policies for protecting the confidentiality of health information; 48.43.510 (1)(d) statement of the cost of premiums and any enrollee requirements; 48.43.510 (1)(e) summary explanation of the carrier's review of adverse benefit determinations and grievance processes; 48.43.510 (1)(f) statement regarding the availability of a point-of-service option, if any, and how the option operates; and RCW 48.43.510 (1)(g); convenient means of obtaining lists of participating primary care and specialty care providers, including disclosure of network arrangements that restrict access to providers within any plan network. sharing
checklist-forms-2018-disability-individual-analyst-checklist.docx