§ 26-43-106 — Minimum benefits; limitations

Wyoming § 26-43-106

• Jurisdiction: Wyoming
• Title 26: Insurance Code
• Ch. 43: HEALTH CARE

Text

(a) Pool coverage shall be offered to eligible persons
subject to the termination and disenrollment provisions of W.S
26-43-103(e). The commissioner shall establish by rule and
regulation the pool coverage, its schedule of benefits,
exclusions and other limitations consistent with this act and
taking into consideration the advice and recommendations of the
board. The commissioner and the board annually shall review the
pool coverage, its schedule of benefits, exclusions and
limitations and make changes to reflect the levels of health
insurance coverage provided in this state.
(b) In establishing the pool coverage, the commissioner
shall:
(i) Consider the levels of health insurance provided
in the state, medical economic factors deemed appropriate and
the advice and recommendations of the board;
(ii) Promulgate benefit levels, deductibles,
coinsurance factors, exclusions and limitations determined to be
generally reflective of and commensurate with health insurance
plans marketed in the state and required by this act. The
commissioner shall offer at least two (2) plans that may include
a higher deductible option or a health savings account option in
order to provide less expensive coverage alternatives for pool
participants;
(iii) Repealed by Laws 2005, ch. 57, § 2.
(iv) Repealed By Laws 2005, ch. 57, § 2.
(v) Design and employ cost containment measures and
controls which may include but are not limited to, preadmission
certification, concurrent inpatient review, case management,
utilization reviews, exclusions or limitations concerning
treatment and services, and member deductibles;
(vi) Offer for those individuals described in W.S.
26-43-103(d) a catastrophic health plan having a deductible
level of twenty-five thousand dollars ($25,000.00), subject to
the termination and disenrollment provisions of W.S. 26-43-
103(e).
(c) Pool coverage shall not include medical costs
associated with:
(i) Repealed by Laws 2019, ch. 16, § 2.
(ii) Cosmetic surgery;
(iii) Other procedures as determined by the board.
(d) Repealed by Laws 2019, ch. 16, § 2.