Title of Rule and Other Identifying Information: To
bring chapter 284-52 WAC into compliance with statute changes.
THIS RULE IS BEING PROPOSED UNDER AN EXPEDITED RULE-MAKING PROCESS THAT WILL ELIMINATE THE NEED FOR THE AGENCY TO HOLD PUBLIC HEARINGS, PREPARE A SMALL BUSINESS ECONOMIC IMPACT STATEMENT, OR PROVIDE RESPONSES TO THE CRITERIA FOR A SIGNIFICANT LEGISLATIVE RULE. IF YOU OBJECT TO THIS USE OF THE EXPEDITED RULE-MAKING PROCESS, YOU MUST EXPRESS YOUR OBJECTIONS IN WRITING AND THEY MUST BE SENT TO Kacy Scott, Insurance Commissioner, P.O. Box 40258, Olympia, WA 98504-0258, e-mail firstname.lastname@example.org , AND RECEIVED BY December 25, 2007.
Purpose of the Proposal and Its Anticipated Effects, Including Any Changes in Existing Rules: RCW 48.20.580, 48.44.341, and 48.46.291, enacted during the 2006 legislative session, require that mental health parity requirements be extended to individual and small group plans effective January 1, 2008. WAC 284-52-070(1) would be amended to remove this exclusion.
Reasons Supporting Proposal: The proposed amendments would conform chapter 284-52 WAC to the applicable statutes.
Statutory Authority for Adoption: RCW 48.02.060, 48.44.050, and 48.46.200.
Statute Being Implemented: RCW 48.20.580, 48.44.341, 48.46.291.
Rule is not necessitated by federal law, federal or state court decision.
Name of Proponent: Mike Kreidler, Insurance Commissioner, governmental.
Name of Agency Personnel Responsible for Drafting: Donna Dorris, P.O. Box 40258, Olympia, WA 98504-0258, (360) 725-7040; Implementation: Beth Berendt, P.O. Box 40255, Olympia, WA 98504-0255, (360) 725-7119; and Enforcement: Carol Sureau, P.O. Box 40255, Olympia, WA 98504-0255, (360) 725-7050.
October 24, 2007
AMENDATORY SECTION(Amending Order R 84-4, filed 9/19/84)
WAC 284-52-070 Exclusions. No policy or contract set forth in WAC 284-52-040, 284-52-050, and 284-52-060 may exclude coverage by type of illness, injury, accident, treatment, or medical condition, except with respect to the following:
Mental or emotional disorders,)) Alcoholism and
(2) Pregnancy, except for complications of pregnancy.
(3) Illness, treatment or medical condition arising out of:
(a) War or act of war (whether declared or undeclared); participation in a felony, riot or insurrection; service in the armed forces or units auxiliary thereto.
(b) Suicide (sane or insane), attempted suicide or intentionally self-inflicted injury.
(4) Cosmetic surgery, except that "cosmetic surgery" shall not include reconstructive surgery when such service is incidental to or follows covered surgery resulting from trauma, infection or other diseases of the involved part, reconstructive breast surgery covered pursuant to RCW 48.20.395, 48.21.230, 48.44.330 and 48.46.280, and reconstructive surgery because of congenital disease or anomaly of a covered dependent child which has resulted in a functional defect.
(5) Foot care in connection with corns, calluses, flat feet, fallen arches, weak feet, or chronic foot strain.
(6) Treatment (except emergency treatment for which legal liability exists to the covered person for the costs thereof) provided in a government hospital; benefits provided under Medicare or other governmental program (except Medicaid), any state or federal worker's compensation, employer's liability or occupational disease law; service rendered by employees of hospitals, laboratories or other institutions; services performed by a member of the covered person's immediate family and services for which no charge is normally made in the absence of insurance.
(7) Dental care or treatment.
(8) Eye glasses, hearing aids, and examination for the prescription or fitting thereof.
(9) Rest cures, custodial care, transportation, and routine physical examinations.
(10) Territorial limitations.
(11) Other exclusions commonly used by the particular carrier in group contracts providing hospital or medical benefits to employee groups.
[Statutory Authority: RCW 48.02.060, 48.44.050 and 48.46.200. 84-19-055 (Order R 84-4), § 284-52-070, filed 9/19/84.]