If no in-network RCW Issuer is not required to provide for referral to an out-of-network provider 48.43.043 provider, unless the carrier does not have an in-network provider available (3)(a) that is appropriate, available and accessible to administer the screening exam. RCW If issuer has no appropriate in-network provider, then 48.43.043 screening exam services and resulting treatment, if any, (3)(b) must be provided at no additional cost to the enrollee beyond what he/she pay for in-network services. Congenital Requirement RCW If plan provides coverage for dependent children of the enrollee, Abnormalities for Coverage 48.20.430(1) must provide coverage for newborn infants of the enrollee from and after the moment of birth. Coverage must include, but not be limited to, coverage for congenital anomalies of such infant children from the moment of birth. Congenital Requirement RCW If payment of an additional premium is required to provide Abnormalities for Coverage 48.20.430(2) coverage for a child, the contract may require that notification of (Cont’d) birth of a newly born child and payment of the required premium must be furnished to the issuer. The notification period must be no less than sixty days from the date of birth. Contract Rate and Form WAC Filing must be complete and comply with The SERFF Industry Examination Filing Manual, and Washington State SERFF Health and Disability Form Instructions Filing General Instructions. and Standards WAC Rates must be filed concurrently with forms. Examination/ RCW The filing must not: 48.18.110 Disapproval contain any inconsistent, ambiguous, misleading clauses, (1)(c) exceptions, or conditions, unreasonably or deceptively
If no in-network provider available RCW 48.43.043 (3)(a) Issuer is not required to provide for referral to an out-of-network provider, unless the carrier does not have an in-network provider that is appropriate, available and accessible to administer the screening exam. RCW 48.43.043 (3)(b) If issuer has no appropriate in-network provider, then screening exam services and resulting treatment, if any, must be provided at no additional cost to the enrollee beyond what he/she pay for in-network services. Congenital Abnormalities Congenital Abnormalities Requirement for Coverage RCW 48.20.430(1) If plan provides coverage for dependent children of the enrollee, must provide coverage for newborn infants of the enrollee from and after the moment of birth. Coverage must include, but not be limited to, coverage for congenital anomalies of such infant children from the moment of birth. Requirement for Coverage (Cont’d) RCW 48.20.430(2) If payment of an additional premium is required to provide coverage for a child, the contract may require that notification of birth of a newly born child and payment of the required premium must be furnished to the issuer. The notification period must be no less than sixty days from the date of birth. Contract Examination and Standards Rate and Form Filing Instructions WAC Filing must be complete and comply with The SERFF Industry Manual, and Washington State SERFF Health and Disability Form Filing General Instructions. WAC Rates must be filed concurrently with forms. Examination/ Disapproval RCW 48.18.110 (1)(c) The filing must not: contain any inconsistent, ambiguous, misleading clauses, exceptions, or conditions, unreasonably or deceptively
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