WAC 284-43-130(6), which states: RCW 48.43.005(13) Medical Condition’ means the emergent and acute onset of a symptom or “’Emergency WAC symptoms, including severe pain, that would lead a prudent layperson acting reasonably to believe that a health condition exists that requires immediate medical attention, if failure to provide medical attention would result in serious impairment to bodily functions or serious dysfunction of a bodily organ or part, or would place the person's health in serious jeopardy’? RCW 48.43.093 (1)(a) Does the plan cover emergency services necessary to screen and stabilize a covered person if a prudent layperson acting reasonably would have believed that an emergency medical condition 42 U.S.C. Emergency existed? Treatment The contract must not require prior authorization of emergency services provided prior to the (Cont’d) point of stabilization if a prudent layperson acting reasonably would have believed that an RCW emergency medical condition existed. 48.43.093 (1)(a) The plan must cover out-of-network emergency services necessary to screen and stabilize a 42 U.S.C. covered person if a prudent layperson would have reasonably believed that use of an in-network emergency department would result in a delay that would worsen the emergency, or if a provision 45 C.F.R. of federal, state, or local law requires the use of a specific provider or facility. 147.138(b)(2)(ii) The issuer must not require prior authorization of emergency services provided prior to the point of stabilization if a prudent layperson acting reasonably would have believed that an emergency medical condition existed and that use of an in-network emergency department 42 U.S.C. would result in a delay that would worsen the emergency. Emergency out-of-network coverage must be consistent with scope of regular contract RCW benefits. 48.43.093 (1)(c) Coverage of emergency services may be subject to applicable copayments, coinsurance, and deductibles, and an issuer may impose reasonable differential cost-sharing arrangements for RCW emergency services, if such differential between in-network and out-of-network 48.43.093 (1)(c) does not exceed fifty dollars.
Emergency Treatment (Cont’d) RCW 48.43.005(13) WAC RCW 48.43.093 (1)(a) 42 U.S.C. RCW 48.43.093 (1)(a) 42 U.S.C. 45 C.F.R. 147.138(b)(2)(ii) 42 U.S.C. RCW 48.43.093 (1)(c) RCW 48.43.093 (1)(c) WAC 284-43-130(6), which states: “’Emergency Medical Condition’ means the emergent and acute onset of a symptom or symptoms, including severe pain, that would lead a prudent layperson acting reasonably to believe that a health condition exists that requires immediate medical attention, if failure to provide medical attention would result in serious impairment to bodily functions or serious dysfunction of a bodily organ or part, or would place the person's health in serious jeopardy’? Does the plan cover emergency services necessary to screen and stabilize a covered person if a prudent layperson acting reasonably would have believed that an emergency medical condition existed? The contract must not require prior authorization of emergency services provided prior to the point of stabilization if a prudent layperson acting reasonably would have believed that an emergency medical condition existed. The plan must cover out-of-network emergency services necessary to screen and stabilize a covered person if a prudent layperson would have reasonably believed that use of an in-network emergency department would result in a delay that would worsen the emergency, or if a provision of federal, state, or local law requires the use of a specific provider or facility. The issuer must not require prior authorization of emergency services provided prior to the point of stabilization if a prudent layperson acting reasonably would have believed that an emergency medical condition existed and that use of an in-network emergency department would result in a delay that would worsen the emergency. Emergency out-of-network coverage must be consistent with scope of regular contract benefits. Coverage of emergency services may be subject to applicable copayments, coinsurance, and deductibles, and an issuer may impose reasonable differential cost-sharing arrangements for emergency services, if such differential between in-network and out-of-network does not exceed fifty dollars.
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