42 U.S.C. Plan may not exclude coverage for sexual reassignment §1557 treatment, surgery or counseling services. RCW 48.30.300; RCW Hospitalization benefits 49.60.040; WAC 284-43-5642(3)(c)(ii) (EHB) Allowable WAC Plan may include the following limitations on services in the (Cont’d) limitations on hospitalization category: inpatient days per calendar year for illness, injury or physical disability in a skilled nursing facility; benefits WAC Thirty inpatient rehabilitation service days per calendar year. For purposes of determining actuarial value, this benefit may be classified to the hospitalization category or to the rehabilitation services category, but not to both. State RCW benefit ; State benefit requirements classified to the hospitalization WAC requirements category are: classified to General anesthesia and facility charges for dental procedures the for those who would be at risk if the service were performed elsewhere and without anesthesia; category RCW Reconstructive breast surgery resulting from a mastectomy that resulted from disease, illness or injury. WAC State benefit RCW 48.44 Coverage for all stages of one reconstructive breast reduction requirements 330(2) on the nondiseased breast to make it in size with the classified to diseased breast after definitive reconstructive surgery on the the diseased breast has been performed; and RCW Coverage for treatment of temporomandibular joint disorder. category WAC 284-43-5642(3)(e)(iii) (Cont’d) RCW ; WAC IF a plan covers care in a long term care facility, carrier must 284-43-5642 allow enrollee to return to the same long term care facility after (3)(e)(iv) hospitalization, as long as the following criteria are met:
Hospitalization (EHB) (Cont’d) benefits 42 U.S.C. §1557 Plan may not exclude coverage for sexual reassignment treatment, surgery or counseling services. RCW 48.30.300; RCW 49.60.040; WAC 284-43-5642(3)(c)(ii) Allowable limitations on benefits WAC Plan may include the following limitations on services in the hospitalization category: inpatient days per calendar year for illness, injury or physical disability in a skilled nursing facility; WAC Thirty inpatient rehabilitation service days per calendar year. For purposes of determining actuarial value, this benefit may be classified to the hospitalization category or to the rehabilitation services category, but not to both. State benefit requirements classified to the category State benefit requirements classified to the category (Cont’d) RCW ; WAC State benefit requirements classified to the hospitalization category are: General anesthesia and facility charges for dental procedures for those who would be at risk if the service were performed elsewhere and without anesthesia; RCW Reconstructive breast surgery resulting from a mastectomy that resulted from disease, illness or injury. WAC RCW 48.44 330(2) Coverage for all stages of one reconstructive breast reduction on the nondiseased breast to make it in size with the diseased breast after definitive reconstructive surgery on the diseased breast has been performed; and RCW Coverage for treatment of temporomandibular joint disorder. WAC 284-43-5642(3)(e)(iii) RCW ; WAC 284-43-5642 (3)(e)(iv) IF a plan covers care in a long term care facility, carrier must allow enrollee to return to the same long term care facility after hospitalization, as long as the following criteria are met:
checklist-forms-2018-hcsc-individual-analyst-checklist.docx