014-2 Wyo. Code R. §§ 2-4 - Eligibility for Medical Assistance Benefit

(a) To be eligible for the Medical Assistance Benefit a miner shall:
(i) Complete a Board registration form, have registered as an Eligible Miner as provided in Section 3 and receive a valid Miner's Hospital Program Identification Card;
(ii) Submit a State licensed medical provider's written statement that the miner is in need of the services or benefits described in W.S. 30-6-102,
(iii) The eligible miner shall provide a State licensed medical provider's statement of injury and inability to work as miner with Workers Compensation records; mine personnel records; medical records; Social Security Records; or any other information which verifies that the injury occurred and the miner is unable to work due to the injury.
(b) The following shall be submitted as evidence of an individual's eligibility for the benefit:
(i) Diagnosis of the condition from a State licensed medical provider that verifies the condition and need for treatment and
(ii) Verification that no other sources of benefits exist, which may include:
(A) Explanation of Benefits from the miner's insurance company, Medicaid or Medicare or any other third-party responsible to pay for treatment received:
(B) A statement from a State licensed medical provider that other third party sources of payment have been explored and exhausted or
(C) An affidavit from the claimant certifying that he or she is not covered by any policy of insurance that provides coverage of or reimbursement for prescription medications.
(iii) A statement from a State licensed medical provider, statement from a health insurance company, or statement under penalty of perjury from the miner, the miner's next of kin or personal representative of the amount of out of pocket expenses incurred.
(c) A miner may be required to submit additional evidence of eligibility for services or benefits.

Notes

014-2 Wyo. Code R. §§ 2-4
Amended, Eff. 1/8/2016. Amended, Eff. 4/29/2021.

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