Disclosures (Cont’d) Prescription WAC If a carrier requires cost-sharing for enrollees receiving an as Drug defined in WAC 284-170-470, then issuers must disclose that information to enrollees within their policy forms. A clear statement explaining that members may be eligible to receive an emergency fill for prescription drugs under the circumstances described in WAC 284-170-470 must be disclosed. This disclosure must include the process that members use to obtain an emergency fill, and cost-sharing requirements, if any, for an emergency fill. The applicable WAC also does not limit the fill to one per prescription medication per calendar year. – WAC 284-43-5110(5), WAC 284-43-5170 (1)(c), and WAC 284-170-470(8)(c). Eligibility Collection 42 U.S.C. 300gg- Plan may not establish rules for eligibility (including continued and Use of 4(a)(6); 45 CFR eligibility) based on genetic information. (Genetic Information Genetic 148.180(b)(1) Nondiscrimination Act (“GINA”)) Information 42 U.S.C. Plan may not request or require individuals to undergo genetic testing. 45 CFR §148.180(e)(1) 42 U.S.C. No genetic information may be required prior to enrollment, in 4(d)(2) connection with that enrollment. 45 CFR 148.180(f)(2)(i)
Disclosures (Cont’d) Prescription Drug WAC If a carrier requires cost-sharing for enrollees receiving an as defined in WAC 284-170-470, then issuers must disclose that information to enrollees within their policy forms. A clear statement explaining that members may be eligible to receive an emergency fill for prescription drugs under the circumstances described in WAC 284-170-470 must be disclosed. This disclosure must include the process that members use to obtain an emergency fill, and cost-sharing requirements, if any, for an emergency fill. The applicable WAC also does not limit the fill to one per prescription medication per calendar year. – WAC 284-43-5110(5), WAC 284-43-5170 (1)(c), and WAC 284-170-470(8)(c). Eligibility Collection and Use of Genetic Information 42 U.S.C. 45 CFR 148.180(b)(1) Plan may not establish rules for eligibility (including continued eligibility) based on genetic information. (Genetic Information Nondiscrimination Act (“GINA”)) 42 U.S.C. Plan may not request or require individuals to undergo genetic testing. 45 CFR §148.180(e)(1) 42 U.S.C. 300gg- 4(d)(2) No genetic information may be required prior to enrollment, in connection with that enrollment. 45 CFR 148.180(f)(2)(i) 4(a)(6);
cl-forms-19-hcsc-sg-analyst-checklist.docx