Section 26-43-106 - Minimum Benefits; Limitations

26-43-106. Minimum benefits; limitations. (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

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a health savings account option in order to provide less expensive coverage alternatives for pool participants; (iii) Repealed by Laws 2005, ch. 57, 2. (iv) Repealed By Laws 2005, ch. 57, 2.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 (c) Pool coverage shall not include medical costs associated with: (i) Repealed by Laws 2019, ch. 16, 2.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 (d) Repealed by Laws 2019, ch. 16, 2.