benefits, and insurance coverages written in connection with a closed panel plan to provide out-of-network benefits.) Coordination WAC Order of benefit determination. Each plan determines its order of of Benefits benefits using the first of the following rules that applies: (Cont’d) WAC Nondependent or dependent. 284-51-205 Subject to the following, the plan that covers the person other (4)(a)(i) than as a dependent (e.g., as an employee, member, subscriber, policyholder or retiree) is the primary plan and the plan that covers the person as a dependent is the secondary plan. WAC If the person is a Medicare beneficiary, and, as a result of the 284-51-205 provisions of Title XVIII of the Social Security Act and (4)(a)(ii) implementing regulations, Medicare is: WAC Secondary to the plan covering the person as a dependent; and WAC Primary to the plan covering the person as other than a dependent (e.g., a retired employee); WAC Then the order of benefits is reversed so that the plan covering the person as an employee, member, subscriber, policyholder or retiree is the secondary plan and the other plan covering the person as a dependent is the primary plan. WAC Dependent child covered under more than one plan. Unless 284-51-205(4)(b) there is a court decree stating otherwise, plans covering a dependent child must determine the order of benefits as follows: WAC 284-51-205 For a dependent child whose parents are married or are living (4)(b)(i) together, whether or not they have ever been married:
Coordination of Benefits (Cont’d) benefits, and insurance coverages written in connection with a closed panel plan to provide out-of-network benefits.) WAC Order of benefit determination. Each plan determines its order of benefits using the first of the following rules that applies: WAC 284-51-205 (4)(a)(i) Nondependent or dependent. Subject to the following, the plan that covers the person other than as a dependent (e.g., as an employee, member, subscriber, policyholder or retiree) is the primary plan and the plan that covers the person as a dependent is the secondary plan. WAC 284-51-205 (4)(a)(ii) If the person is a Medicare beneficiary, and, as a result of the provisions of Title XVIII of the Social Security Act and implementing regulations, Medicare is: WAC Secondary to the plan covering the person as a dependent; and WAC Primary to the plan covering the person as other than a dependent (e.g., a retired employee); WAC Then the order of benefits is reversed so that the plan covering the person as an employee, member, subscriber, policyholder or retiree is the secondary plan and the other plan covering the person as a dependent is the primary plan. WAC 284-51-205(4)(b) Dependent child covered under more than one plan. Unless there is a court decree stating otherwise, plans covering a dependent child must determine the order of benefits as follows: WAC 284-51-205 (4)(b)(i) For a dependent child whose parents are married or are living together, whether or not they have ever been married:
cklist-forms-18-disability-ind-s-a-dental-w-pediatric-ehbs.docx