Wash. Admin. Code § 284-50-270 [Effective 1/1/2024] Mammograms-Coverage Requirements and Exceptions
Library | Washington Administrative Code |
Edition | 2023 |
Currency | Current through Register Vol. 23-24, December 15, 2023 |
Citation | Wash. Admin. Code § 284-50-270 |
Year | 2023 |
(1) The purpose of this regulation is to effectuate the provisions of RCW and 48.20.393, by establishing definitions for the exceptions to coverage for mammograms. This regulation shall apply to every group and individual disability insurance contract, which is delivered or issued for delivery or renewed in this state on or after September 1, 1992, that provides coverage for hospital or medical expenses. 48.21.225
(2) For the purposes of RCW and 48.20.393 and this regulation, supplemental contracts covering specified disease shall be defined to mean and include only those contracts or policies which provide benefits to a policyholder only in the event that the policy-holder contracts the disease or diseases specifically named in the policy. Also for the purposes of 48.21.225RCW and 48.20.393 and this regulation, supplemental contracts covering limited benefits shall be defined to mean and include only those contracts providing only one of the following benefits: Hospital indemnity, accident only coverage, dental care, vision care, mental health care, chemical dependency care, pharmaceutical care, and podiatric care. 48.21.225
(3) Coverage of mammograms may be subject to standard policy provisions, other than the cost-sharing provisions prohibited by RCW , which may be applicable to other diagnostic X-ray benefits. 48.43.076
(4) For purposes of RCW and 48.20.393 and this regulation, a contract is "renewed" when it is continued beyond the earliest date, after September 1, 1992, upon which, at the insurer's sole option: 48.21.225
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(a) The contract's termination could have
been effectuated, for other than nonpayment of premium; or
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(b) The contract could have been amended to
add the mammogram coverage, with, if justified, an appropriate rate increase
for any increased cost in providing mammogram coverage under the contract
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