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Washington Administrative Code (Last Updated: November 23, 2016) |
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Title 284. Insurance Commissioner, Office of |
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Chapter 284-54. Long-term care insurance rules. |
Section 284-54-050. Exclusions.
Latest version.
- 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.