Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-55 - Medicare supplement insurance regulation › Section 284-55-040 - Prohibited policy provisions

Current through Register Vol. 24-14, July 15, 2024
(1) No
			 insurance policy or subscriber contract may be advertised, solicited or issued
			 for delivery in this state as a medicare supplement policy unless such policy
			 or contract meets the requirements of chapter 48.66 RCW, the Medicare
			 Supplemental Health Insurance Act.
(2) No medicare supplement policy or
			 certificate in force in this state shall contain benefits which duplicate
			 benefits provided by medicare.
(3)
			 No insurance policy or subscriber contract may be advertised, solicited, or
			 issued for delivery in this state as a medicare supplement policy if such
			 policy or subscriber contract limits or excludes coverage by type of illness,
			 accident, treatment, or medical condition, except as follows:
(a) Foot care in connection with corns,
			 calluses, flat feet, fallen arches, weak feet, chronic foot strain, or
			 symptomatic complaints of the feet;
(b) Mental or emotional disorders and
			 chemical dependency;
(c) Illness,
			 treatment, or medical condition arising out of:
(i) War or act of war (whether declared or
			 undeclared); participation in a felony, riot or insurrections; service in the
			 armed forces or units auxiliary thereto;
(ii) Suicide (sane or insane), attempted
			 suicide, or intentionally self-inflicted injury;
(iii) Aviation, other than as a fare-paying
			 passenger on a scheduled or charter flight operated by a scheduled
			 airline.
(d) Cosmetic
			 surgery, except that "cosmetic surgery" shall not include reconstructive
			 surgery when such service is incidental to or follows surgery resulting from
			 trauma, infection, or other diseases of the involved part;
(e) Care in connection with the detection and
			 correction by manual or mechanical means of structural imbalance, distortion,
			 or subluxation in the human body for purposes of removing nerve interference
			 and the effects thereof, where such interference is the result of or related to
			 distortion, misalignment, or subluxation of, or in the vertebral
			 column;
(f) Treatment provided in a
			 governmental hospital; benefits provided under medicare or other governmental
			 program (except medicaid), any state or federal workers' compensation,
			 employer's liability or occupational disease law, or any motor vehicle no-fault
			 law; services rendered by employees of hospitals, laboratories, or other
			 institutions; services performed by a member of the covered person's immediate
			 family and services for which no charge is normally made in the absence of
			 insurance;
(g) Dental care or
			 treatment;
(h) Eye glasses, hearing
			 aids, and examination for the prescription or fitting thereof;
(i) Rest cures, custodial care,
			 transportation, and routine physical examinations;
(j) Territorial limitations:
Provided, That medicare supplement insurance policies may not
				contain, when issued, limitations or exclusions of the type enumerated in (a),
				(e), (i) or (j) of this subsection that are more restrictive than those of
				medicare. Medicare supplement policies may exclude coverage for any expense to
				the extent of any benefit available to the insured under medicare.