Coordination WAC If the plan is secondary, all secondary gatekeeper requirements of Benefits 284-51-230(2)(a) will be waived if the gatekeeper requirements of the primary (Cont’d) plan have been met. WAC If the primary plan becomes secondary during a course of 284-51-230(2)(b) treatment, the new primary plan must make reasonable provision for continuity of care if one or more treating providers are not in the new primary plan's network. WAC When a plan is secondary, it may reduce its benefits so the 284-51-230(4) benefits provided by all plans during a claim determination period Rules for do not exceed one hundred percent of the total allowable Secondary expenses. The secondary plan must calculate and record its savings Plan from the amount it would have paid had it been primary, and must Payment use these savings to pay any allowable expenses not otherwise (Cont’d) paid, that are incurred by the covered person during the claim determination period, so that one hundred percent of the total allowable expenses incurred are paid during the claim determination period. If the plan provides for COB, it must contain provisions substantially as follows: WAC 284-51-220 "If payments that should have been made under this plan are made by another plan, the issuer has the right, at its discretion, to remit to the other plan the amount it determines appropriate to
Coordination of Benefits (Cont’d) Rules for Secondary Plan Payment (Cont’d) WAC 284-51-230(2)(a) If the plan is secondary, all secondary gatekeeper requirements will be waived if the gatekeeper requirements of the primary plan have been met. WAC 284-51-230(2)(b) If the primary plan becomes secondary during a course of treatment, the new primary plan must make reasonable provision for continuity of care if one or more treating providers are not in the new primary plan's network. WAC 284-51-230(4) When a plan is secondary, it may reduce its benefits so the benefits provided by all plans during a claim determination period do not exceed one hundred percent of the total allowable expenses. The secondary plan must calculate and record its savings from the amount it would have paid had it been primary, and must use these savings to pay any allowable expenses not otherwise paid, that are incurred by the covered person during the claim determination period, so that one hundred percent of the total allowable expenses incurred are paid during the claim determination period. If the plan provides for COB, it must contain provisions substantially as follows: WAC 284-51-220 "If payments that should have been made under this plan are made by another plan, the issuer has the right, at its discretion, to remit to the other plan the amount it determines appropriate to