RCW 48.43.510(1)(e) summary explanation of the carrier's review of adverse benefit determinations and grievance processes; RCW 48.43.510(1)(f) statement regarding the availability of a point-of-service option, if any, and how the option operates; and RCW 48.43.510(1)(g) convenient of obtaining lists of participating primary care and specialty care providers, including disclosure of network arrangements that restrict access to providers within any plan network. RCW 48.43.510(2) Does the contract contain the following written information or notify the enrollee that he is entitled to it upon request: RCW 48.43.510(2)(a) Any documents, instruments, or other information referred to in the medical coverage agreement; RCW A full description of the procedures to be followed by an enrollee for consulting a provider other 48.43.510(2)(b) than the primary care provider and whether any entity must authorize the referral; Procedures, if any, that an enrollee must first follow for obtaining prior authorization RCW 48.43.510(2)(c) for health care services; A written description of any reimbursement or payment arrangements between the issuer and RCW 48.43.510(2)(d) providers, including capitation provisions, fee-for-service provisions, and health care delivery efficiency provisions; Descriptions and justifications for provider compensation programs, including any incentives or RCW 48.43.510(2)(e) penalties that are intended to encourage providers to withhold services or minimize or avoid referrals to specialists; An annual accounting of all payments made by the carrier have been counted against any RCW 48.43.510(2)(f) payment limitations, visit limitations, or other overall limitations on a person's coverage under a plan; A copy of the carrier's review of adverse benefit determinations grievance process for claim or RCW 48.43.510(2)(g) service denial and its grievance process for dissatisfaction with care; and Accreditation status with one or more national managed care accreditation organizations, and
RCW 48.43.510(1)(e) RCW 48.43.510(1)(f) RCW 48.43.510(1)(g) RCW 48.43.510(2) RCW 48.43.510(2)(a) RCW 48.43.510(2)(b) RCW 48.43.510(2)(c) RCW 48.43.510(2)(d) RCW 48.43.510(2)(e) RCW 48.43.510(2)(f) RCW 48.43.510(2)(g) summary explanation of the carrier's review of adverse benefit determinations and grievance processes; statement regarding the availability of a point-of-service option, if any, and how the option operates; and convenient of obtaining lists of participating primary care and specialty care providers, including disclosure of network arrangements that restrict access to providers within any plan network. Does the contract contain the following written information or notify the enrollee that he is entitled to it upon request: Any documents, instruments, or other information referred to in the medical coverage agreement; A full description of the procedures to be followed by an enrollee for consulting a provider other than the primary care provider and whether any entity must authorize the referral; Procedures, if any, that an enrollee must first follow for obtaining prior authorization for health care services; A written description of any reimbursement or payment arrangements between the issuer and providers, including capitation provisions, fee-for-service provisions, and health care delivery efficiency provisions; Descriptions and justifications for provider compensation programs, including any incentives or penalties that are intended to encourage providers to withhold services or minimize or avoid referrals to specialists; An annual accounting of all payments made by the carrier have been counted against any payment limitations, visit limitations, or other overall limitations on a person's coverage under a plan; A copy of the carrier's review of adverse benefit determinations grievance process for claim or service denial and its grievance process for dissatisfaction with care; and Accreditation status with one or more national managed care accreditation organizations, and
checklist-forms-hmo-large-group.docx