RCW 48.46.530
Temporomandibular joint disorders—Insurance coverage.
(1) Except as provided in this section, a health maintenance agreement entered into or renewed after December 31, 1989, shall offer optional coverage for the treatment of temporomandibular joint disorders.
(a) Health maintenance organizations offering medical coverage only may limit benefits in such coverages to medical services related to treatment of temporomandibular joint disorders. No health maintenance organizations offering medical and dental coverage may limit benefits in such coverage to dental services related to treatment of temporomandibular joint disorders. No health maintenance organization offering medical coverage only may define all temporomandibular joint disorders as purely dental in nature.
(b) Health maintenance organizations 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 health maintenance organization 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 § 4.]
NOTES:
Legislative finding—Effective date—1989 c 331: See notes following RCW 48.21.320.
Structure Revised Code of Washington
Chapter 48.46 - Health Maintenance Organizations.
48.46.010 - Legislative declaration—Purpose.
48.46.012 - Filings with secretary of state—Copy for commissioner.
48.46.027 - Registration, required—Issuance of securities—Penalty.
48.46.033 - Unregistered activities—Acts committed in this state—Sanctions.
48.46.045 - Catastrophic health plans permitted.
48.46.062 - Schedule of rates for individual agreements—Loss ratio—Definitions.
48.46.064 - Calculation of premiums—Adjusted community rate—Definitions.
48.46.068 - Requirements for plans offered to small employers—Definitions.
48.46.080 - Annual statement—Filings—Contents—Fee—Penalty for failure to file—Accuracy required.
48.46.090 - Standard of services provided.
48.46.100 - Grievance procedure.
48.46.135 - Fine in addition to or in lieu of suspension, revocation, or refusal.
48.46.170 - Effect of chapter as to other laws—Construction.
48.46.190 - Payroll deductions for capitation payments to health maintenance organizations.
48.46.200 - Rules and regulations.
48.46.210 - Compliance with federal funding requirements—Construction.
48.46.220 - Review of administrative action.
48.46.225 - Financial failure—Supervision of commissioner—Priority of distribution of assets.
48.46.235 - Minimum net worth—Requirement to maintain—Determination of amount.
48.46.237 - Minimum net worth—Domestic or foreign health maintenance organization.
48.46.240 - Funded reserve requirements.
48.46.243 - Contract—Participant liability.
48.46.245 - Plan for handling insolvency—Commissioner's review.
48.46.247 - Insolvency—Commissioner's duties—Participants' options—Allocation of coverage.
48.46.272 - Diabetes coverage—Definitions.
48.46.274 - Prescribed, self-administered anticancer medication.
48.46.275 - Mammograms—Insurance coverage.
48.46.277 - Prostate cancer screening.
48.46.280 - Reconstructive breast surgery.
48.46.285 - Mastectomy, lumpectomy.
48.46.291 - Mental health services—Health plans—Definition—Coverage required, when.
48.46.292 - Mental health treatment—Waiver of preauthorization for persons involuntarily committed.
48.46.300 - Future dividends or refunds, restricted—Issuance or sale of securities regulated.
48.46.310 - Registration not endorsement.
48.46.320 - Dependent children, termination of coverage, conditions.
48.46.325 - Option to cover child under age twenty-six.
48.46.340 - Return of agreement within ten days.
48.46.350 - Chemical dependency treatment.
48.46.355 - "Chemical dependency" defined.
48.46.370 - Coverage not denied for disability.
48.46.380 - Notice of reason for cancellation, denial, or refusal to renew agreement.
48.46.400 - False or misleading advertising prohibited.
48.46.410 - Misrepresentations to induce termination or retention of agreement prohibited.
48.46.420 - Penalty for violations.
48.46.430 - Enforcement authority of commissioner.
48.46.440 - Continuation option to be offered.
48.46.450 - Conversion agreement to be offered—Exceptions, conditions.
48.46.460 - Conversion agreement—Restrictions and requirements—Rules.
48.46.470 - Endorsement of modifications.
48.46.480 - Continuation of coverage of former family members.
48.46.490 - Coverage for adopted children.
48.46.500 - Cancellation of rider.
48.46.520 - Neurodevelopmental therapies—Employer-sponsored group contracts.
48.46.530 - Temporomandibular joint disorders—Insurance coverage.
48.46.540 - Nonresident pharmacies.
48.46.565 - Foot care services.
48.46.570 - Denturist services.
48.46.580 - When injury caused by intoxication or use of narcotics.
48.46.600 - Disclosure of certain material transactions—Report—Information is confidential.
48.46.605 - Material acquisitions or dispositions.
48.46.610 - Asset acquisitions—Asset dispositions.
48.46.615 - Report of a material acquisition or disposition of assets—Information required.
48.46.620 - Material nonrenewals, cancellations, or revisions of ceded reinsurance agreements.
48.46.900 - Liberal construction.
48.46.930 - Construction—Chapter applicable to state registered domestic partnerships—2009 c 521.