coinsurance for similar benefits. If the plan does not cover a similar benefit, a deductible or coinsurance may not be set that materially diminishes the value of the colorectal cancer benefit required. If no in-network RCW 48.43.043 Issuer is not required to provide for referral to an out-of-network provider (3)(a) provider, unless the carrier does not have an in-network provider that available is appropriate, available and accessible to administer the screening exam. RCW 48.43.043 If issuer has no appropriate in-network provider, then (3)(b) screening exam services and resulting treatment, if any, must be provided at no additional cost to the enrollee beyond what he/she would pay for in-network services. Congenital Requirement for RCW If plan provides coverage for dependent children of the enrollee, Abnormalities Coverage 48.44.212(1) must provide coverage for newborn infants of the enrollee from and after the moment of birth. Coverage must include, but not be limited to, coverage for congenital anomalies of such infant children from the moment of birth. Congenital Requirement for RCW If payment of an additional premium is required to provide Abnormalities Coverage 48.44.212(2) coverage for a the contract may require that notification of (Cont’d) (Cont’d) birth of a newly born child and payment of the required premium must be furnished to the issuer. The notification period must be no less than sixty days from the date of birth. Contract Rate and Form Filing must comply with The SERFF Industry Manual, and Washington Standards Filing WAC State SERFF Health and Disability Form Filing General Instructions. Required Instructions Rates must be filed concurrently with forms.
coinsurance for similar benefits. If the plan does not cover a similar benefit, a deductible or coinsurance may not be set that materially diminishes the value of the colorectal cancer benefit required. If no in-network provider available RCW 48.43.043 (3)(a) Issuer is not required to provide for referral to an out-of-network provider, unless the carrier does not have an in-network provider that is appropriate, available and accessible to administer the screening exam. RCW 48.43.043 (3)(b) If issuer has no appropriate in-network provider, then screening exam services and resulting treatment, if any, must be provided at no additional cost to the enrollee beyond what he/she would pay for in-network services. Congenital Abnormalities Congenital Abnormalities (Cont’d) Requirement for Coverage Requirement for Coverage (Cont’d) RCW 48.44.212(1) If plan provides coverage for dependent children of the enrollee, must provide coverage for newborn infants of the enrollee from and after the moment of birth. Coverage must include, but not be limited to, coverage for congenital anomalies of such infant children from the moment of birth. RCW 48.44.212(2) If payment of an additional premium is required to provide coverage for a the contract may require that notification of birth of a newly born child and payment of the required premium must be furnished to the issuer. The notification period must be no less than sixty days from the date of birth. Contract Standards Required Rate and Form Filing Instructions WAC Filing must comply with The SERFF Industry Manual, and Washington State SERFF Health and Disability Form Filing General Instructions. Rates must be filed concurrently with forms.
cl-forms-19-hcsc-sg-analyst-checklist.docx