Oral Services least the end of the month in which the enrollee turns age nineteen. EHB (Cont’d) WAC 284-43-5400; WAC 284-43-5602; WAC 284-43-5702 Lifetime and 42 USC Stand Alone Dental Plans, that include family coverage (coverage for Annual 42 USC those over age 18) as excepted benefits plans, may have lifetime and Dollar limits §300gg-21(c) annual limits, for those over age 18. Annual 45 CFR 156.150(a) The annual maximum cost sharing for pediatric EHBs cannot exceed on Cost $350 for one child and $700 for multiple children. Sharing Congenital Mandated RCW 48.44.212(1) If contract covers dependents, it must provide coverage from the Anomalies Benefit moment of birth. Coverage shall include, but not be limited to, coverage for congenital anomalies. Benchmark plan Must cover dentally appropriate services and supplies to treat a congenital anomaly and to restore a physical bodily function lost as a result of Injury or Illness, including cosmetic/reconstructive services. RCW 48.44.212(2) If payment of additional premium is required to provide coverage for the child, contract may require notification of birth and payment of the premium within no less than 60 days from date of birth. Contract Contract RCW The filing must not contain any inconsistent, ambiguous or Standards 48.44.020(2)(a) Format misleading clauses, or exceptions and conditions, which Required unreasonably or deceptively affect the risk purported to be assumed in the general coverage of the policy. Policy must contain clear, definitive, Washington state specific language for all terms, benefits and conditions.
Oral Services EHB (Cont’d) least the end of the month in which the enrollee turns age nineteen. WAC 284-43-5400; WAC 284-43-5602; WAC 284-43-5702 Lifetime and Annual Dollar limits 42 USC 42 USC §300gg-21(c) Stand Alone Dental Plans, that include family coverage (coverage for those over age 18) as excepted benefits plans, may have lifetime and annual limits, for those over age 18. Annual on Cost Sharing 45 CFR 156.150(a) The annual maximum cost sharing for pediatric EHBs cannot exceed $350 for one child and $700 for multiple children. Congenital Anomalies Mandated Benefit RCW 48.44.212(1) If contract covers dependents, it must provide coverage from the moment of birth. Coverage shall include, but not be limited to, coverage for congenital anomalies. Benchmark plan Must cover dentally appropriate services and supplies to treat a congenital anomaly and to restore a physical bodily function lost as a result of Injury or Illness, including cosmetic/reconstructive services. RCW 48.44.212(2) If payment of additional premium is required to provide coverage for the child, contract may require notification of birth and payment of the premium within no less than 60 days from date of birth. Contract Standards Contract Format Required RCW 48.44.020(2)(a) The filing must not contain any inconsistent, ambiguous or misleading clauses, or exceptions and conditions, which unreasonably or deceptively affect the risk purported to be assumed in the general coverage of the policy. Policy must contain clear, definitive, Washington state specific language for all terms, benefits and conditions.
cl-forms-19-hcsc-ind-stand-alone-dental-w-pediatric-ehbs.docx