Freedom to RCW 48.43.085 Contract must provide that enrollees are free to contract for Contract for services outside the plan on any or conditions the enrollees Non-covered choose. Services RCW Contract may not: 48.44.495(1)(a) require, directly or indirectly, that a participating provider dentist provide non-covered services to an enrollee at a fee set by, or subject to the approval of, the issuer, including services that Freedom to be reimbursable but for the application of contractual limitations Contract for (e.g., benefit maximums, deductibles, coinsurance, waiting Non- periods, or frequency limitations), under the applicable group Covered contract or individual contract; nor Services RCW Prohibit, directly or indirectly, a participating provider dentist (Cont’d) 48.44.495(1)(b) from offering or providing enrollees non-covered services on any or conditions acceptable to the dentist and the enrolled participant. Plan May RCW 48.43.510(6) Plan must not preclude or discourage providers from: Not RCW 48.43.510(6) Informing enrollees of care they require, including treatment Discourage options; Providers RCW 48.43.510(6) Informing enrollees whether in the providers' view such care is from covered the plan; Informing RCW 48.43.510(6) Advocating on behalf of an enrollee with a carrier; or Enrollees RCW 48.43.510(7) Discussing the comparative merits of different carriers with their providers, even if providers are critical of a carrier. Denturist RCW 48.43.180 Plan must not deny benefits for any service performed by a Services RCW 48.44.500 denturist licensed under Chapter RCW if the service was within the lawful scope of their license, and the plan would have
Freedom to Contract for Non-covered Services Freedom to Contract for Services (Cont’d) RCW 48.43.085 Contract must provide that enrollees are free to contract for services outside the plan on any or conditions the enrollees choose. RCW 48.44.495(1)(a) Contract may not: require, directly or indirectly, that a participating provider dentist provide non-covered services to an enrollee at a fee set by, or subject to the approval of, the issuer, including services that be reimbursable but for the application of contractual limitations (e.g., benefit maximums, deductibles, coinsurance, waiting periods, or frequency limitations), under the applicable group contract or individual contract; nor RCW 48.44.495(1)(b) Prohibit, directly or indirectly, a participating provider dentist from offering or providing enrollees non-covered services on any or conditions acceptable to the dentist and the enrolled participant. Plan May Not Discourage Providers from Informing Enrollees RCW 48.43.510(6) Plan must not preclude or discourage providers from: RCW 48.43.510(6) Informing enrollees of care they require, including treatment options; RCW 48.43.510(6) Informing enrollees whether in the providers' view such care is covered the plan; RCW 48.43.510(6) Advocating on behalf of an enrollee with a carrier; or RCW 48.43.510(7) Discussing the comparative merits of different carriers with their providers, even if providers are critical of a carrier. Denturist Services Covered RCW 48.43.180 RCW 48.44.500 Plan must not deny benefits for any service performed by a denturist licensed under Chapter RCW if the service was within the lawful scope of their license, and the plan would have Non-
cklist-forms-18-hcsc-ind-stand-alone-dental-w-pediatric-ehbs.docx