Cost-sharing differentials between tiers must not be imposed on an enrollee WAC if the sole provider or facility type or category required to deliver a covered service is not available to the enrollee in the lowest cost-sharing tier of the network. All enrollees must have reasonable access to providers and facilities at WAC the lowest cost tier of cost-sharing. Provider and facility ranking program, and the criteria used to assign WAC providers and facilities to different tiers, must not be described in plan documents so as to deceive consumers as to issuer rating practices and their effect on available benefits. When a tiered network is used, issuer must provide detailed information WAC on its web site and if requested, make available in paper form information about the tiered network including, but not limited to: The providers and facilities participating in the tiered network; WAC The selection criteria, if any, used to place the providers and facilities, WAC 284-170-330 but not including the results of applying those selection criteria to a (6)(b) particular provider or facility; The potential for providers and facilities to move from one tier to WAC 284-170-330 another at any time; and (6)(c) The tier in which each participating provider or facility is assigned. WAC 284-170-330 (6)(d) Eligibility Domestic RCW 48.43.904 The spouse, marriage, marital, husband, wife, widow, widower, next Partner of kin, and family must apply equally to state registered domestic Coverage partnerships and individuals in state registered domestic partnerships. Eligibility Coverage of RCW 48.20.420 Contract provides that coverage of a dependent child shall (Cont’d) Dependent terminate upon attainment of a limiting age for dependent children Child Not to must also provide that coverage will not be terminated due to
WAC Cost-sharing differentials between tiers must not be imposed on an enrollee if the sole provider or facility type or category required to deliver a covered service is not available to the enrollee in the lowest cost-sharing tier of the network. WAC All enrollees must have reasonable access to providers and facilities at the lowest cost tier of cost-sharing. WAC Provider and facility ranking program, and the criteria used to assign providers and facilities to different tiers, must not be described in plan documents so as to deceive consumers as to issuer rating practices and their effect on available benefits. WAC When a tiered network is used, issuer must provide detailed information on its web site and if requested, make available in paper form information about the tiered network including, but not limited to: WAC The providers and facilities participating in the tiered network; WAC 284-170-330 (6)(b) The selection criteria, if any, used to place the providers and facilities, but not including the results of applying those selection criteria to a particular provider or facility; WAC 284-170-330 (6)(c) The potential for providers and facilities to move from one tier to another at any time; and WAC 284-170-330 (6)(d) The tier in which each participating provider or facility is assigned. Eligibility Eligibility (Cont’d) Domestic Partner Coverage RCW 48.43.904 The spouse, marriage, marital, husband, wife, widow, widower, next of kin, and family must apply equally to state registered domestic partnerships and individuals in state registered domestic partnerships. Coverage of Dependent Child Not to RCW 48.20.420 Contract provides that coverage of a dependent child shall terminate upon attainment of a limiting age for dependent children must also provide that coverage will not be terminated due to
cl-forms-19-disability-ind-stand-alone-dental-w-pediatric-ehbs.docx