Section 284-43-7250 - Filing requirements(1) For health plans and student health plans subject to RCW 48.43.072 and 48.43.073, the carrier must ensure that the health plan and student health plan forms clearly inform covered persons of their rights to access contraceptive services and supplies, voluntary sterilization and abortion. The health plan and student health plan forms must clearly inform covered persons how they access these services and supplies.(2) A health plan's forms and student health plan's forms must include a detailed description of the plan's benefits provided to covered persons that specifically instructs covered persons where and how they access coverage of contraceptive supplies, including over-the-counter supplies. This information must include:(a) Whether covered supplies are available from in-net-work and out-of-network providers; and(b) How to submit a claim including, at a minimum:(i) Whether covered persons may purchase covered supplies and seek reimbursement from the carrier;(ii) How to access and submit any necessary claim forms; and(iii) Where to send a claim, such as a mailing address or instructions for submitting a claim electronically.(3) If a health plan or student health plan limits the number of covered over-the-counter contraceptive supplies, the health plan or student health plan must include with its filing supporting evidence showing that the limitation does not impose any restriction or delay on the coverage of contraceptive supplies in violation of RCW 48.43.072 or any other state or federal law.(4) If a health plan or student health plan limits the number of covered contraceptive services or supplies, the plan forms must include a detailed description of the plan's benefits that specifically instructs covered persons how to request coverage of additional contraceptive services or supplies. The process may not impose any restrictions or delays on the coverage or access of contraceptive services or supplies in violation of RCW 48.43.072, or any other state or federal law.Wash. Admin. Code § 284-43-7250
Adopted by WSR 19-24-039, Filed 11/26/2019, effective 12/27/2019Amended by WSR 21-24-032, Filed 11/22/2021, effective 12/23/2021