Washington Code 48.43.740 – Dental only plan — Emergency dental conditions — Definitions
Current as of: 2023 | Check for updates
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(1) A health carrier offering a dental only plan may not deny coverage for treatment of emergency dental conditions that would otherwise be considered a covered service of an existing benefit contract on the basis that the services were provided on the same day the covered person was examined and diagnosed for the emergency dental condition.
Terms Used In Washington Code 48.43.740
- Contract: A legal written agreement that becomes binding when signed.
- person: may be construed to include the United States, this state, or any state or territory, or any public or private corporation or limited liability company, as well as an individual. See Washington Code 1.16.080
(2) For purposes of this section:
(a) “Emergency dental condition” means a dental condition manifesting itself by acute symptoms of sufficient severity, including severe pain or infection such that a prudent layperson, who possesses an average knowledge of health and dentistry, could reasonably expect the absence of immediate dental attention to result in:
(i) Placing the health of the individual, or with respect to a pregnant woman the health of the woman or her unborn child, in serious jeopardy;
(ii) Serious impairment to bodily functions; or
(iii) Serious dysfunction of any bodily organ or part.
(b) “Health carrier,” in addition to the definition in RCW 48.43.005, also includes health care service contractors, limited health care service contractors, and disability insurers offering dental only coverage.
[ 2015 c 9 § 1.]
NOTES:
Effective date—2015 c 9: “This act takes effect January 1, 2017.” [ 2015 c 9 § 3.]