284-52-020  <<  284-52-030 >>   284-52-040

WAC 284-52-030

Other provisions applicable to mandated conversion plans.

Except as otherwise required or permitted by this chapter, mandated conversion plans shall:
(1) Use a format no less favorable to the covered individual than those set forth in RCW 48.20.012, with respect to insurers, or WAC 284-44-030, with respect to health care service contractors and health maintenance organizations;
(2) Contain a provision providing for the return of the contract for a refund of payment, consistent with RCW 48.20.013, 48.44.230 or 48.46.260, as appropriate;
(3) Contain provisions consistent with and no less favorable to the covered individual than the following laws and regulations thereunder:
(a) With respect to insurers, the requirements and standard provisions set forth in chapter 48.20 RCW;
(b) With respect to health care service contractors, the requirements of chapter 48.44 RCW and WAC 284-44-040, except that lifetime maximum benefits under a conversion plan are not required to be renewed or restored;
(c) With respect to health maintenance organizations, the requirements of chapter 48.46 RCW;
(4) Be administered by the carrier in full compliance with any applicable laws which prohibit denials of payments for services performed by certain licensed providers of service.
[Statutory Authority: RCW 48.02.060, 48.44.050 and 48.46.200. WSR 84-19-055 (Order R 84-4), ยง 284-52-030, filed 9/19/84.]
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