(1)(b)(i) At least fifty years old; or RCW 48.43.043 Less than fifty years old and at high risk or very high risk for (1)(b)(ii) colorectal cancer according to such guidelines or recommendations. Burdensome RCW Plan design must not require patients and providers to meet Requirements 48.43.043(2) burdensome criteria or overcome significant obstacles to secure Prohibited such coverage. Enrollee may not be required to pay an additional deductible or coinsurance for testing greater than a deductible or 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 RCW Issuer is not required to provide for referral to an out-of-network 48.43.043(3)(a) provider, unless the carrier does not have an in-network provider provider that is appropriate, available and accessible to administer the available screening exam. RCW If issuer has no appropriate in-network provider, then 48.43.043(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 RCW If plan provides coverage for dependent children of the enrollee, Abnormalities for Coverage 48.44.212(1) must provide coverage for newborn infants of the enrollee from and 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 If payment of an additional premium is required to provide 48.44.212(2) coverage for a child, the contract may require that notification of
(1)(b)(i) At least fifty years old; or RCW 48.43.043 (1)(b)(ii) Less than fifty years old and at high risk or very high risk for colorectal cancer according to such guidelines or recommendations. Burdensome Requirements Prohibited RCW 48.43.043(2) Plan design must not require patients and providers to meet burdensome criteria or overcome significant obstacles to secure such coverage. Enrollee may not be required to pay an additional deductible or coinsurance for testing greater than a deductible or 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 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 Requirement for Coverage 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 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 child, the contract may require that notification of
cl-forms-19-hcsc-ind-analyst-checklist.docx