WSU employees have various medical plans available to choose from, but plan subscribers may be surprised by some of the services that are not covered.
The state requires that medical insurance providers cover some aspects of care. Certain procedures, such as prostate cancer screening and mammograms, are required to be covered if recommended by a physician, according to the Revised Code of Washington, Chapter 41.05. To learn more about coverage requirements in Washington, visit ONLINE @ http://apps.leg.wa.gov/RCW/default.aspx?cite=41.05.
But other coverage is at the discretion of the insurance provider, according to the Washington State Legislature website. For example, there are more than 20 exclusions — items not covered — listed online for Group Health Classic and Group Health Value’s managed-care plans, and there are 55 exclusions under the Uniform Medical Plan.
View these ONLINE @ www.pebb.hca.wa.gov/benefits/medexclusion.shtml.
Because of these exceptions, it is often a good idea to contact your provider or look at their list of services covered — in print or online — before you go to a physician for services. This is particularly true if you are being referred to a specialist or seeking services that are a bit out of the ordinary.
Below are some of the exceptions outlined by Group Health and Uniform Medical Plan, two of the major WSU insurance providers offered through the state Public Employees Benefits Board. Employees who use a different medical plan should contact the provider for a complete and accurate list of exclusions.
Group Health plans do not cover:
• Additional portions of a physical exam beyond a routine physical that is specifically required for the purpose of employment, travel, immigration, licensing or insurance and related reports.
• Testing or treatment of infertility and sterility, including artificial insemination and in-vitro fertilization.
• Evaluation and treatment of learning disabilities, including dyslexia, except as provided for neurodevelopmental therapies.
• Drugs and medicines not prescribed by a plan-designated provider, except for emergency treatment.
• Experimental or investigational services, supplies and drugs.
Uniform Medical does not cover:
• Dietary program designed for weight control and weight loss.
• Immunizations for the purpose of travel or employment, or required because of where you reside, or any others not listed (under preventive care in the Certificate of Coverage).
• Prescription drug charges over the Uniform Medical Plan allowed charge, regardless of where purchased.
• Eye surgery to alter the refractive character of the cornea, such as radial keratotomy, photokeratectomy or LASIK surgery.
• Court-ordered care, unless determined by the insurer to be medically necessary and otherwise covered.
