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

WAC 284-54-050

No agency filings affecting this section since 2003

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.]