284-54-040  <<  284-54-050 >>   284-54-100

Exclusions.

No contract shall limit or exclude coverage by type of illness, accident, treatment, or medical condition, except with respect to the following:
(1) Conditions arising out of war or act of war (whether declared or undeclared);
(2) Conditions arising out of participation in the commission of a felony, riot or insurrection;
(3) Conditions resulting from suicide, attempted suicide (while sane or insane) or intentionally self-inflicted injury;
(4) Benefits available under any state or federal workers' compensation, employer's liability or occupational disease law, or any motor vehicle no-fault law;
(5) Services performed by a member of the covered person's immediate family;
(6) Services for which no charge is made in the absence of insurance;
(7) Dental care or treatment;
(8) Eye glasses, hearing aids and examination for the prescription or fitting thereof;
(9) Rest cures and routine physical examinations;
(10) Chemical dependency;
(11) Treatment in a government hospital or in a government facility unless required by law;
(12) Benefits provided under medicare or other governmental programs (except medicaid);
(13) Experimental treatments, supplies, or services;
(14) Other exclusions appropriate to the particular contract, justified to the satisfaction of the commissioner, in connection with the filing of the contract form, may be permitted by prior written agreement.
[Statutory Authority: RCW 48.02.060(3), 48.30.010 and 48.84.910. WSR 87-15-027 (Order R 87-7), ยง 284-54-050, filed 7/9/87.]