(1) Subject to the
limitation provided in subsection (3) of this section, the
comprehensive pool policy offered under RCW 48.41.110(4) shall
impose a deductible as provided in this subsection. Deductibles
of five hundred dollars and one thousand dollars on a per person
per calendar year basis shall initially be offered. The board
may authorize deductibles in other amounts. The deductible shall
be applied to the first five hundred dollars, one thousand
dollars, or other authorized amount of eligible expenses incurred
by the covered person.
(2) Subject to the limitations provided in subsection (3) of
this section, a mandatory coinsurance requirement shall be
imposed at a rate not to exceed twenty percent of eligible
expenses in excess of the mandatory deductible and which supports
the efficient delivery of high quality health care services for
the medical conditions of pool enrollees.
(3) The maximum aggregate out of pocket payments for
eligible expenses by the insured in the form of deductibles and
coinsurance under the comprehensive pool policy offered under RCW 48.41.110(4) shall not exceed in a calendar year:
(a) One thousand five hundred dollars per individual, or
three thousand dollars per family, per calendar year for the five
hundred dollar deductible policy;
(b) Two thousand five hundred dollars per individual, or
five thousand dollars per family per calendar year for the one
thousand dollar deductible policy; or
(c) An amount authorized by the board for any other
deductible policy.
(4) Except for those enrolled in a high deductible health
plan qualified under federal law for use with a health savings
account, eligible expenses incurred by a covered person in the
last three months of a calendar year, and applied toward a
deductible, shall also be applied toward the deductible amount in
the next calendar year.
(5) The board may modify cost-sharing as an incentive for
enrollees to participate in care management services and other
cost-effective programs and policies.
[2007 c 259 § 31; 2000 c 79 § 14; 1989 c 121 § 8; 1987 c 431 § 12.]
NOTES:
Severability -- Subheadings not law -- 2007 c 259: See notes following RCW 41.05.033.
Effective date -- Severability -- 2000 c 79: See notes following RCW 48.04.010.