What is a categorical exclusion?

A categorical exclusion is a type of exemption from certain rules or regulations that are established in Washington State’s health insurance law. This type of exemption allows certain groups or individuals to receive certain health insurance benefits that would otherwise not be available. For example, a categorical exclusion may exempt a person with a pre-existing medical condition from having to meet the same standards of coverage as the rest of the population. In other words, the categorical exclusion allows an individual to receive health insurance coverage even if they may not normally be eligible under the specific terms of the law. For example, in Washington State, older individuals may be eligible to receive additional financial assistance when they purchase health insurance plans through the Marketplace. This assistance may be provided in the form of a categorical exclusion. In this instance, the exclusion would exempt individuals over the age of 65 from having to meet the normal guidelines for health insurance coverage. This exclusion would ensure that those individuals can access the health care and coverage that they need. Categorical exclusions are a key part of Washington’s health insurance law, providing individuals with access to health coverage when they would otherwise not be eligible. As such, it is important to understand the rules and regulations for categorical exclusions so that people can ensure that they are getting the health coverage that they need.

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