RCW 48.46.280 function lost as a result of injury or illness, or related to breast reconstruction following a medically necessary mastectomy; WAC The following types of surgery: Bariatric surgery and supplies; WAC Orthognathic surgery and supplies unless due to temporomandibular joint disorder or injury, sleep apnea or congenital anomaly. (3)(b)(iv) Reversal of sterilizations; and WAC Surgical procedures to correct refractive errors, astigmatism or reversals or revisions of surgical procedures which alter the refractive character of the eye. Prohibited WAC Plan may not include a waiting period for transplant services. limitations (3)(c)(i)&(ii) Prohibited Hospitalization 42 U.S.C. Plan may not exclude coverage for sexual reassignment treatment, Limitations (EHB) 18116, §1557 surgery or counseling services. (Cont’d) (Cont’d) RCW 48.30.300; RCW 49.60.040; WAC 284-43-5642(3)(c)(ii) Allowable WAC Plan may include the following limitations on services in the limitations on hospitalization category: Hospitalization Sixty inpatient days per calendar year for illness, injury or physical benefits 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. benefit RCW 48.43.185; State benefit requirements classified to the hospitalization category are: requirements in WAC
RCW 48.46.280 function lost as a result of injury or illness, or related to breast reconstruction following a medically necessary mastectomy; WAC The following types of surgery: Bariatric surgery and supplies; WAC Orthognathic surgery and supplies unless due to temporomandibular joint disorder or injury, sleep apnea or congenital anomaly. (3)(b)(iv) Reversal of sterilizations; and WAC Surgical procedures to correct refractive errors, astigmatism or reversals or revisions of surgical procedures which alter the refractive character of the eye. Prohibited limitations Prohibited Limitations (Cont’d) WAC (3)(c)(i)&(ii) Plan may not include a waiting period for transplant services. Hospitalization (EHB) (Cont’d) 42 U.S.C. 18116, §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 Hospitalization benefits WAC Plan may include the following limitations on services in the hospitalization category: Sixty 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. benefit requirements in RCW 48.43.185; WAC State benefit requirements classified to the hospitalization category are:
checklist-forms-2018-disability-sg-analyst-checklist.docx