WAC Transplant services, supplies and treatment for donors and recipients, including the transplant or donor facility fees (3)(a)(iii) performed in either a hospital setting or outpatient setting; (3)(a)(iv) Dialysis services delivered in a hospital; WAC Artificial organ transplants based on an issuer's medical guidelines and manufacturer recommendations; and Required (a)(v) Hospitalization Services WAC Respite care services delivered on an inpatient basis in a (EHB) (Cont’d) hospital or skilled nursing facility. (Cont’d) (a)(vi) WAC Optional Plan may, but is not required to, include the following services as Hospitalization part of the EHB-benchmark package. The base-benchmark plan (3)(b) Services specifically excludes these services. If an issuer includes these benefits in a health plan, the issuer should not include the following benefits in establishing actuarial value for the hospitalization category: WAC Hospitalization where mental illness is the primary diagnosis to the extent that it is classified under the mental health and (b)(i) substance use disorder benefits category; WAC Cosmetic or reconstructive services and supplies except in the treatment of a congenital anomaly, to restore a physical bodily (3)(b)(ii);
Hospitalization (EHB) (Cont’d) Required Services (Cont’d) WAC (3)(a)(iii) Transplant services, supplies and treatment for donors and recipients, including the transplant or donor facility fees performed in either a hospital setting or outpatient setting; (3)(a)(iv) Dialysis services delivered in a hospital; WAC (a)(v) Artificial organ transplants based on an issuer's medical guidelines and manufacturer recommendations; and WAC (a)(vi) Respite care services delivered on an inpatient basis in a hospital or skilled nursing facility. Optional Hospitalization Services WAC (3)(b) Plan may, but is not required to, include the following services as part of the EHB-benchmark package. The base-benchmark plan specifically excludes these services. If an issuer includes these benefits in a health plan, the issuer should not include the following benefits in establishing actuarial value for the hospitalization category: WAC (b)(i) Hospitalization where mental illness is the primary diagnosis to the extent that it is classified under the mental health and substance use disorder benefits category; WAC (3)(b)(ii); Cosmetic or reconstructive services and supplies except in the treatment of a congenital anomaly, to restore a physical bodily
checklist-forms-2018-disability-individual-analyst-checklist.docx