adoption becomes the first effective date of coverage; WAC For applicants enrolling after the fifteenth of the month, the issuer must begin coverage not later than the first date of the second month after the application is received, unless the applicant is enrolling due to marriage or the commencement of a domestic partnership. An issuer may establish an earlier effective date at their discretion. An issuer may establish an earlier effective date at their discretion; Eligibility Special WAC applicants enrolling because of marriage or the commencement (Cont’d) Enrollment of a domestic partnership, when notice of the marriage or domestic (Cont’d) partnership is received within days of the marriage or commencement of the domestic partnership, either as spouse, domestic partner or as a dependent child, coverage must begin no later than the first date of the month immediately following the date of marriage or domestic partnership. WAC An issuer must not refuse to enroll an applicant who applies within sixty days of the qualifying event, if the applicant would be eligible had the application been received during open enrollment. Emergency Required 42 USC Plan must cover "emergency medical services" in a manner substantially Medical Emergency (a)(1)(B); equal to the base-benchmark plan. For purposes of determining a plan's Services 42 USC actuarial value, an issuer must classify as emergency medical services the Services (EHB) 18022(b)(1)(B) care and services related to an emergency medical condition. WAC WAC Plan must include the following services which are specifically covered by the base-benchmark plan and classify them as emergency services: WAC Ambulance transportation to an emergency room and treatment provided as part of the ambulance service; WAC Emergency room and department based services, supplies and treatment, including professional charges, facility costs, and
adoption becomes the first effective date of coverage; WAC For applicants enrolling after the fifteenth of the month, the issuer must begin coverage not later than the first date of the second month after the application is received, unless the applicant is enrolling due to marriage or the commencement of a domestic partnership. An issuer may establish an earlier effective date at their discretion. An issuer may establish an earlier effective date at their discretion; Eligibility (Cont’d) Special Enrollment (Cont’d) WAC applicants enrolling because of marriage or the commencement of a domestic partnership, when notice of the marriage or domestic partnership is received within days of the marriage or commencement of the domestic partnership, either as spouse, domestic partner or as a dependent child, coverage must begin no later than the first date of the month immediately following the date of marriage or domestic partnership. WAC An issuer must not refuse to enroll an applicant who applies within sixty days of the qualifying event, if the applicant would be eligible had the application been received during open enrollment. Emergency Medical Services (EHB) Required Emergency Services 42 USC (a)(1)(B); 42 USC 18022(b)(1)(B) Plan must cover "emergency medical services" in a manner substantially equal to the base-benchmark plan. For purposes of determining a plan's actuarial value, an issuer must classify as emergency medical services the care and services related to an emergency medical condition. WAC WAC Plan must include the following services which are specifically covered by the base-benchmark plan and classify them as emergency services: WAC Ambulance transportation to an emergency room and treatment provided as part of the ambulance service; WAC Emergency room and department based services, supplies and treatment, including professional charges, facility costs, and
cl-forms-19-hmo-sg-analyst-checklist.docx