Rules for WAC If the plan is secondary, all secondary gatekeeper Secondary 284-51-230(2)(a) requirements will be waived if the gatekeeper requirements Plan Payment of the primary plan have been met. (Cont’d) WAC 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 When a plan is secondary, it may reduce its benefits so the total 284-51-230(4) 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. Required If the plan provides for COB, it must contain provisions Provisions: substantially as follows: “Facility of WAC "If payments that should have been made under this plan are Payment” made by another plan, the issuer has the right, at its discretion, to remit to the other plan the amount it determines appropriate to satisfy the intent of this provision. To the extent of such payments, the issuer is fully discharged from liability under this plan." “Right of WAC "The issuer has the right to recover excess payment whenever it Recovery” has paid allowable expenses in excess of the maximum amount of payment necessary to satisfy the intent of this provision. The
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 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 total 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. Required Provisions: If the plan provides for COB, it must contain provisions substantially as follows: “Facility of Payment” WAC "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 satisfy the intent of this provision. To the extent of such payments, the issuer is fully discharged from liability under this plan." “Right of Recovery” WAC "The issuer has the right to recover excess payment whenever it has paid allowable expenses in excess of the maximum amount of payment necessary to satisfy the intent of this provision. The
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