Washington Code 43.71.065 – Qualified health plans — Certification — Criteria stand-alone dental plans — Direct primary care medical home plans — Appeals
Current as of: 2023 | Check for updates
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(1) The board shall certify a plan as a qualified health plan to be offered through the exchange if the plan is determined by the:
Terms Used In Washington Code 43.71.065
- Board: means the governing board established in RCW 43. See Washington Code 43.71.010
- Commissioner: means the insurance commissioner, established in Title 48 RCW. See Washington Code 43.71.010
- Exchange: means the Washington health benefit exchange established in RCW 43. See Washington Code 43.71.010
(a) Insurance commissioner to meet the requirements of Title 48 RCW and rules adopted by the commissioner pursuant to chapter 34.05 RCW to implement the requirements of Title 48 RCW;
(b) Board to meet the requirements of applicable federal law for certification as a qualified health plan; and
(c) Board to include tribal clinics and urban Indian clinics as essential community providers in the plan’s provider network consistent with federal law. If consistent with federal law, integrated delivery systems shall be exempt from the requirement to include essential community providers in the provider network.
(2) Consistent with applicable federal law, the board shall allow stand-alone dental plans to offer coverage in the exchange beginning January 1, 2014. Dental benefits offered in the exchange must be offered and priced separately to assure transparency for consumers.
(3) The board may permit direct primary care medical home plans, consistent with applicable federal law, to be offered in the exchange.
(4) Upon request by the board, a state agency shall provide information to the board for its use in determining if the requirements under subsection (1)(b) or (c) of this section have been met. Unless the agency and the board agree to a later date, the agency shall provide the information within sixty days of the request. The exchange shall reimburse the agency for the cost of compiling and providing the requested information within one hundred eighty days of its receipt.
(5) A decision by the board denying a request to certify or recertify a plan as a qualified health plan may be appealed according to procedures adopted by the board.