RCW 48.44.460
Temporomandibular joint disorders—Insurance coverage.
(1) Except as provided in this section, a group health care service contract entered into or renewed after December 31, 1989, shall offer optional coverage for the treatment of temporomandibular joint disorders.
(a) Health care service contractors offering medical coverage only may limit benefits in such coverages to medical services related to treatment of temporomandibular joint disorders. Health care service contractors offering dental coverage only may limit benefits in such coverage to dental services related to treatment of temporomandibular joint disorders. No health care service contractor offering medical coverage only may define all temporomandibular joint disorders as purely dental in nature, and no health care service contractor offering dental coverage only may define all temporomandibular joint disorders as purely medical in nature.
(b) Health care contractors offering optional temporomandibular joint disorder coverage as provided in this section may, but are not required to, offer lesser or no temporomandibular joint disorder coverage as part of their basic group disability contract.
(c) Benefits and coverage offered under this section may be subject to negotiation to promote broad flexibility in potential benefit coverage. This flexibility shall apply to services to be reimbursed, determination of treatments to be considered medically necessary, systems through which services are to be provided, including referral systems and use of other providers, and related issues.
(2) Unless otherwise directed by law, the insurance commissioner shall adopt rules, to be implemented on January 1, 1993, establishing minimum benefits, terms, definitions, conditions, limitations, and provisions for the use of reasonable deductibles and copayments.
(3) A contractor need not make the offer of coverage required by this section to an employer or other group that offers to its eligible enrollees a self-insured health plan not subject to mandated benefit statutes under Title 48 RCW that does not provide coverage for temporomandibular joint disorders.
[ 1989 c 331 § 3.]
NOTES:
Legislative finding—Effective date—1989 c 331: See notes following RCW 48.21.320.
Structure Revised Code of Washington
Chapter 48.44 - Health Care Services.
48.44.013 - Filings with secretary of state—Copy for commissioner.
48.44.015 - Registration by health care service contractors required—Penalty.
48.44.016 - Unregistered activities—Acts committed in this state—Sanctions.
48.44.017 - Schedule of rates for individual contracts—Loss ratio—Definitions.
48.44.022 - Calculation of premiums—Adjusted community rate—Definitions.
48.44.024 - Requirements for plans offered to small employers—Definitions.
48.44.026 - Payment for certain health care services.
48.44.030 - Underwriting of indemnity by insurance policy, bond, securities, or cash deposit.
48.44.033 - Financial failure—Supervision of commissioner—Priority of distribution of assets.
48.44.035 - Limited health care service—Uncovered expenditures—Minimum net worth requirements.
48.44.037 - Minimum net worth—Requirement to maintain—Determination of amount.
48.44.039 - Minimum net worth—Domestic or foreign health care service contractor.
48.44.040 - Registration with commissioner—Fee.
48.44.050 - Rules and regulations.
48.44.055 - Plan for handling insolvency—Commissioner's review.
48.44.057 - Insolvency—Commissioner's duties—Participants' options—Allocation of coverage.
48.44.095 - Annual financial statement—Filings—Contents—Fee—Penalty for failure to file.
48.44.100 - Filing inaccurate financial statement prohibited.
48.44.110 - False representation, advertising.
48.44.120 - Misrepresentations of contract terms, benefits, etc.
48.44.130 - Future dividends or refunds—When permissible.
48.44.140 - Misleading comparisons to terminate or retain contract.
48.44.150 - Certificate of registration not an endorsement—Display in solicitation prohibited.
48.44.166 - Fine in addition to or in lieu of suspension, revocation, or refusal.
48.44.170 - Hearings and appeals.
48.44.215 - Option to cover child under age twenty-six.
48.44.220 - Discrimination prohibited.
48.44.225 - Podiatric physicians and surgeons not excluded.
48.44.245 - "Chemical dependency" defined.
48.44.260 - Notice of reason for cancellation, denial, or refusal to renew contract.
48.44.270 - Immunity from libel or slander.
48.44.290 - Registered nurses or advanced registered nurses.
48.44.299 - Legislative finding.
48.44.300 - Podiatric medicine and surgery—Benefits not to be denied.
48.44.305 - When injury caused by intoxication or use of narcotics.
48.44.309 - Legislative finding.
48.44.310 - Chiropractic care, coverage required, exceptions.
48.44.315 - Diabetes coverage—Definitions.
48.44.323 - Prescribed, self-administered anticancer medication.
48.44.325 - Mammograms—Insurance coverage.
48.44.327 - Prostate cancer screening.
48.44.330 - Reconstructive breast surgery.
48.44.335 - Mastectomy, lumpectomy.
48.44.341 - Mental health services—Health plans—Definition—Coverage required, when.
48.44.342 - Mental health treatment—Waiver of preauthorization for persons involuntarily committed.
48.44.360 - Continuation option to be offered.
48.44.370 - Conversion contract to be offered—Exceptions, conditions.
48.44.380 - Conversion contract—Restrictions and requirements—Rules.
48.44.390 - Modification of basis of agreement, endorsement required.
48.44.400 - Continuance provisions for former family members.
48.44.420 - Coverage for adopted children.
48.44.430 - Cancellation of rider.
48.44.450 - Neurodevelopmental therapies—Employer-sponsored group contracts.
48.44.460 - Temporomandibular joint disorders—Insurance coverage.
48.44.470 - Nonresident pharmacies.
48.44.495 - Dental services that are not subject to contract or provider agreement.
48.44.500 - Denturist services.
48.44.530 - Disclosure of certain material transactions—Report—Information is confidential.
48.44.535 - Material acquisitions or dispositions.
48.44.540 - Asset acquisitions—Asset dispositions.
48.44.545 - Report of a material acquisition or disposition of assets—Information required.
48.44.550 - Material nonrenewals, cancellations, or revisions of ceded reinsurance agreements.
48.44.900 - Construction—Chapter applicable to state registered domestic partnerships—2009 c 521.