Coordination Disclosure of If the plan satisfies both of the following criteria, you can skip of Benefits Coordination the rest of the COB section. If not, review for all COB requirements. WAC 284-51-200 Each certificate of coverage under a contract that provides for COB must contain a description of the COB provisions. Does the contract use the COB provisions in WAC 284-51-255 Appendix A? Does the contract use the model “plain language description” of COB in WAC 284-51-260, Appendix B? General WAC Plan need not use the specific and format provided in WAC 284-51-200(3) 284-51-255 and the plain language explanation in WAC Changes may be made to fit the language and style of the rest of the contract or to reflect differences among plans that provide services, that pay benefits for expenses incurred, and that indemnify, provided they do not conflict with the requirements of Chapter 284-51 WAC. WAC Plan cannot have a COB provision that permits it to reduce its 284-51-200 (4) benefits on the basis that: Another plan exists and the enrollee did not enroll in that plan; A person could have been covered under another plan; or A person have elected an option under another plan that pays a higher level of benefits than what he elected. Coordination General WAC 284-51-200(5) Plan may not provide that its benefits are "always excess" or of Benefits (Cont’d) "always secondary" except as permitted in Chapter 284-51 WAC. (Cont’d) RCW 48.21.200(1) A carrier may not administer COB in a way that reduces total benefits payable below an amount equal to 100% of total
Coordination of Benefits Coordination of Benefits (Cont’d) Disclosure of Coordination If the plan satisfies both of the following criteria, you can skip the rest of the COB section. If not, review for all COB requirements. WAC 284-51-200 Each certificate of coverage under a contract that provides for COB must contain a description of the COB provisions. Does the contract use the COB provisions in WAC 284-51-255 Appendix A? Does the contract use the model “plain language description” of COB in WAC 284-51-260, Appendix B? General General (Cont’d) WAC 284-51-200(3) Plan need not use the specific and format provided in WAC 284-51-255 and the plain language explanation in WAC Changes may be made to fit the language and style of the rest of the contract or to reflect differences among plans that provide services, that pay benefits for expenses incurred, and that indemnify, provided they do not conflict with the requirements of Chapter 284-51 WAC. WAC 284-51-200 (4) Plan cannot have a COB provision that permits it to reduce its benefits on the basis that: Another plan exists and the enrollee did not enroll in that plan; A person could have been covered under another plan; or A person have elected an option under another plan that pays a higher level of benefits than what he elected. WAC 284-51-200(5) Plan may not provide that its benefits are "always excess" or "always secondary" except as permitted in Chapter 284-51 WAC. RCW 48.21.200(1) A carrier may not administer COB in a way that reduces total benefits payable below an amount equal to 100% of total
checklist-forms-2017-disability-large-group-stand-alone-dental.docx