No Required RCW 48.43.016(5) Carrier may not require a provider to provide a discount from usual Discounts and customary rates for services not covered under a plan to which the provider is a party. Prosthodontic Required WAC Plan must cover removable prosthodontics and prosthodontic-related Services See, procedures in a manner substantially equal to the base benchmark plan (Removable) also, WAC including, at a minimum: Services WAC One resin based partial denture; replacement covered if provided at least three years after the seat date; Prosthodontic Required WAC One complete denture upper and lower and one replacement denture Services per lifetime after at least 5 years from the seat date; (Removable) WAC Rebasing and relining of complete or partial dentures once in a 3 year (Cont’d) Services period, if performed at least 6 months from the seat date. (Cont’d) Benchmark plan Occlusal guards for enrollees age 12 and Benchmark plan Adjustment and repair of dentures and bridges; Benefits need not be provided for adjustments or repairs done within one year of insertion. Provider Participating 284-170-130(23) “Participating provider” must be defined (whether or not this definition Requirements Provider is set forth in the policy) consistent with the statutory and regulatory Definition definitions: "’Participating provider’ a facility or provider who, under a contract with the health carrier or with the carrier’s contractor or subcontractor, has agreed to provide health care services to covered persons with an expectation of receiving payment, other than coinsurance, copayments, or deductibles, from the health carrier rather than from the covered person.”
No Required Discounts RCW 48.43.016(5) Carrier may not require a provider to provide a discount from usual and customary rates for services not covered under a plan to which the provider is a party. Prosthodontic Services (Removable) Prosthodontic Services (Removable) (Cont’d) Required Services Required Services WAC See, also, WAC Plan must cover removable prosthodontics and prosthodontic-related procedures in a manner substantially equal to the base benchmark plan including, at a minimum: WAC One resin based partial denture; replacement covered if provided at least three years after the seat date; WAC One complete denture upper and lower and one replacement denture per lifetime after at least 5 years from the seat date; WAC Rebasing and relining of complete or partial dentures once in a 3 year period, if performed at least 6 months from the seat date. (Cont’d) Benchmark plan Occlusal guards for enrollees age 12 and Benchmark plan Adjustment and repair of dentures and bridges; Benefits need not be provided for adjustments or repairs done within one year of insertion. Provider Requirements Participating Provider Definition 284-170-130(23) “Participating provider” must be defined (whether or not this definition is set forth in the policy) consistent with the statutory and regulatory definitions: "’Participating provider’ a facility or provider who, under a contract with the health carrier or with the carrier’s contractor or subcontractor, has agreed to provide health care services to covered persons with an expectation of receiving payment, other than coinsurance, copayments, or deductibles, from the health carrier rather than from the covered person.”
cl-forms-19-disability-ind-stand-alone-dental-w-pediatric-ehbs.docx