ANALYST CHECKLIST Disability Carrier INDIVIDUAL MAJOR MEDICAL PLANS – Issuer: ___________________________ SERFF Tracker ID: ___________________ GENERAL REVIEW REQUIREMENTS – Authority to Review Contract RCW 48.18.100, RCW 48.43.715 WAC 284-43-5622, WAC 284-43-5642, WAC 284-43-5702, WAC 284-43-5782 Topic Sub Topic Reference Specific Issue Form and Additional page Information or section / Comments Alternative to Requirement WAC As an alternative to hospitalization or institutionalization and with Hospitalization To cover home the intent to cover placement of the enrollee in the most care in lieu of appropriate, cost-effective setting, plan must include substitution hospitalization of home health care in lieu of hospitalization or other institutional care, furnished by home health, hospice and home care agencies licensed under chapter RCW, at equal or lesser cost. WAC Such expenses may include coverage for durable medical equipment which permits the insured to stay at home, care provided in Alzheimer's centers, adult family homes, assisted living facilities, congregate care facilities, adult day health care, home health, hospice and home care, or similar alternative care arrangements which provide necessary care in less restrictive or less expensive environments.
ANALYST CHECKLIST Disability Carrier – INDIVIDUAL MAJOR MEDICAL PLANS Issuer: ___________________________ SERFF Tracker ID: ___________________ GENERAL REVIEW REQUIREMENTS Authority to Review Contract – RCW 48.18.100, RCW 48.43.715 WAC 284-43-5622, WAC 284-43-5642, WAC 284-43-5702, WAC 284-43-5782 Topic Sub Topic Reference Specific Issue Form and page or section Additional Information / Comments Alternative to Hospitalization Requirement To cover home care in lieu of hospitalization WAC As an alternative to hospitalization or institutionalization and with the intent to cover placement of the enrollee in the most appropriate, cost-effective setting, plan must include substitution of home health care in lieu of hospitalization or other institutional care, furnished by home health, hospice and home care agencies licensed under chapter RCW, at equal or lesser cost. WAC Such expenses may include coverage for durable medical equipment which permits the insured to stay at home, care provided in Alzheimer's centers, adult family homes, assisted living facilities, congregate care facilities, adult day health care, home health, hospice and home care, or similar alternative care arrangements which provide necessary care in less restrictive or less expensive environments.
checklist-forms-2018-disability-individual-analyst-checklist.docx