WAC Except as provided below, a plan that contains noncompliant (2)(a) COB provisions is always the primary plan unless the provisions of both plans state that the complying plan is primary. Coordination WAC A plan with of benefit determination rules that comply of Benefits (2)(a) with the WAC rules (complying plan) may coordinate its (Cont’d) benefits with a plan that is "excess" or "always secondary", or that uses order of benefit determination rules inconsistent with the WAC rules (noncomplying plan) on the following basis: Rules for (2)(a)(i) If the complying plan is the primary plan, it must provide Coordination its benefits first; of Benefits WAC If the complying plan is the secondary plan under (Cont’d) (2)(a)(ii) Chapter 284-51 WAC, it must provide its benefits first, but the amount of benefits payable must be determined as if the complying plan were the secondary plan. In this situation, the payment is the limit of the complying plan's liability; and WAC If the noncomplying plan does not provide the (2)(a)(iii) information needed by the complying plan to determine its benefits within forty-five days after the date on the letter making the request, the complying plan may assume the benefits of the noncomplying plan are identical to its own, and pay its benefits accordingly. If, within twenty-four months after payment, the complying plan receives information as to the actual benefits of the noncomplying plan, it must adjust payments accordingly between the plans.
Coordination of Benefits (Cont’d) Rules for Coordination of Benefits (Cont’d) WAC (2)(a) Except as provided below, a plan that contains noncompliant COB provisions is always the primary plan unless the provisions of both plans state that the complying plan is primary. WAC (2)(a) A plan with of benefit determination rules that comply with the WAC rules (complying plan) may coordinate its benefits with a plan that is "excess" or "always secondary", or that uses order of benefit determination rules inconsistent with the WAC rules (noncomplying plan) on the following basis: (2)(a)(i) If the complying plan is the primary plan, it must provide its benefits first; WAC (2)(a)(ii) If the complying plan is the secondary plan under Chapter 284-51 WAC, it must provide its benefits first, but the amount of benefits payable must be determined as if the complying plan were the secondary plan. In this situation, the payment is the limit of the complying plan's liability; and WAC (2)(a)(iii) If the noncomplying plan does not provide the information needed by the complying plan to determine its benefits within forty-five days after the date on the letter making the request, the complying plan may assume the benefits of the noncomplying plan are identical to its own, and pay its benefits accordingly. If, within twenty-four months after payment, the complying plan receives information as to the actual benefits of the noncomplying plan, it must adjust payments accordingly between the plans.
checklist-forms-2018-hcsc-individual-analyst-checklist.docx