Wash. Admin. Code § 284-46-110 - Mammography coverage
(1) The purpose of
this regulation is to effectuate the provisions of
RCW
48.43.076, by requiring coverage and
prohibiting cost-sharing for certain types of mammography services.
(2) Except as provided in subsection (3) of
this section, for nongrandfathered health plans issued or renewed on or after
January 1, 2024, that include coverage of supplemental and diagnostic breast
examinations, health carriers may not impose cost-sharing for such
examinations.
(3) For a health plan
that provides coverage of supplemental and diagnostic breast examinations and
is offered as a qualifying health plan for a health savings account, the health
carrier shall establish the plan's cost-sharing for the coverage of the
services described in this section at the minimum level necessary to preserve
the enrollee's ability to claim tax exempt contributions from their health
savings account under Internal Revenue Service laws and regulations.
(4) For purposes of this section:
(a) "Diagnostic breast examination" means a
medically necessary and appropriate examination of the breast, as defined in
RCW
48.43.076. Diagnostic breast examinations are
used to evaluate an abnormality either seen or suspected from a breast cancer
screening examination, or detected by another means of examination.
(b) "Supplemental breast examination" has the
meaning set forth in
RCW
48.43.076.
(5) Coverage of mammograms may be subject to
standard contract provisions, other than the cost-sharing provisions prohibited
by RCW
48.43.076, which may be applicable to other
diagnostic X-ray benefits.
Notes
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