Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-43 - Health carriers and health plans › Subchapter H - HEALTH PLAN BENEFITS › Section 284-43-5940 - Nondiscrimination in health plans, short-term limited duration medical plans and student-only health plans

Current through Register Vol. 24-14, July 15, 2024
(1) An
				issuer offering a plan, and the issuer's officials, employees, agents, or
				representatives may not:
(a) Design plan
				benefits, or implement its plan benefits, in a manner that results in
				discrimination against individuals because of their age, expected length of
				life, present or predicted disability, degree of medical dependency, quality of
				life, or other health conditions; and
(b) With respect to the plan including, but
				not limited to, administration, member communication, medical protocols or
				criteria for medical necessity or other aspects of plan operations:
(i) Discriminate on the basis of race, color,
				national origin, sex, gender identity, sexual orientation, age, or
				disability;
(ii) Deny, cancel,
				limit, or refuse to issue or renew a plan, or deny or limit coverage of a
				claim, or impose additional cost sharing or other limitations or restrictions
				on coverage, on the basis of race, color, national origin, sex, gender
				identity, sexual orientation, age, or disability;
(iii) Have or implement marketing practices
				or benefit designs that discriminate on the basis of race, color, national
				origin, sex, gender identity, sexual orientation, age, or disability. In
				reviewing plan design, plan features that attempt to circumvent coverage of
				medically necessary benefits such as by labeling a benefit as a pediatric
				service, and thereby excluding adults, or by placing all or most drugs for a
				specific condition in the highest cost-sharing tier, absent an appropriate
				reason for the exclusion, are potentially discriminatory. In these or other
				instances, the commissioner may request a justification for the practice. If
				requested, issuers must identify an appropriate nondiscriminatory reason that
				supports their benefit design;
(iv)
				Deny or limit coverage, deny or limit coverage of a claim, issue automatic
				denials of coverage or impose additional cost sharing or other limitations or
				restrictions on coverage, for:
(A) Any health
				services that are ordinarily or exclusively available to individuals of one
				sex, based on the fact that an individual's sex assigned at birth, gender
				identity, or gender otherwise recorded is different from the one to which such
				health services are ordinarily or exclusively available. For example, a denial
				of coverage for medically necessary hormone prescriptions for transgender,
				gender nonconforming, or intersex individuals because the dosages exceed those
				typically prescribed for cisgender people would be discriminatory against
				transgender, nonbinary, gender nonconforming, or intersex individuals;
				or
(B) Gender affirming treatment,
				as defined in RCW  48.43.0128, when that treatment is:
(1) Prescribed to an individual because of,
				related to, or consistent with a person's gender expression or identity, as
				defined in
				RCW
				 49.60.040;
(II) Medically necessary; and
(III) Prescribed in accordance with accepted
				standards of care;
(v) Have or implement a categorical coverage
				exclusion or limitation for all medical, surgical, or behavioral health
				services related to a person's gender identity or sexual orientation, including
				gender affirming treatment; or
(vi)
				When prescribed as medically necessary, exclude facial gender affirming
				treatment (such as tracheal shaves), hair removal procedures, and other care
				(such as mastectomies, breast reductions, breast implants, or any combination
				of gender affirming procedures, including revisions to prior treatment) as
				cosmetic services; or
(vii)
				Otherwise deny or limit coverage, deny or limit coverage of a claim, or impose
				additional cost sharing or other limitations or restrictions on coverage, for
				specific medical, surgical, or behavioral health services related to a person's
				gender identity or sexual orientation if such denial, limitation, or
				restriction results in discrimination against a transgender, nonbinary, gender
				nonconforming or intersex individual.