determination period. Required If the plan provides for COB, does it contain provisions substantially as follows? Provisions: "If payments that should have been made under this plan are made by another plan, the issuer has WAC 284-51-220 of the right, at its discretion, to remit to the other plan the amount it determines appropriate to satisfy “Facility Payment” the intent of this provision. To the extent of such payments, the issuer is fully discharged from liability under this plan." "The issuer has the right to recover excess payment whenever it has paid allowable expenses in WAC 284-51-225 of “Right excess of the maximum amount of payment necessary to satisfy the intent of this provision. The Recovery” issuer may recover excess payment from any person, other issuer or plan that has received payment. A plan must include the following statement in the enrollee contract or booklet provided to covered WAC 284-51-235 persons: to “Notice "If you are covered by more than one health benefit plan, and you do not know which is your Covered Coordination primary plan, you or your provider should contact any one of the health plans to verify which plan is Persons” of Benefits primary. The health plan you contact is responsible for working with the other plan to determine which is primary and will let you know within thirty calendar days. CAUTION: All health plans have timely claim filing requirements. If you or your provider fail to submit your claim to a secondary health plan within that plan's claim filing time limit, the plan can deny the claim. If you experience delays in the processing of your claim by the primary health plan, you or your provider will need to submit your claim to the secondary health plan within its claim filing time limit to prevent a denial of the claim. To delays in claims processing, if you are covered by more than one plan you should promptly report to your providers and plans any changes in your coverage."
Coordination of Benefits determination period. Required Provisions: “Facility of Payment” “Right of Recovery” “Notice to Covered Persons” WAC 284-51-220 WAC 284-51-225 WAC 284-51-235 If the plan provides for COB, does it contain provisions substantially as follows? "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." "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 issuer may recover excess payment from any person, other issuer or plan that has received payment. A plan must include the following statement in the enrollee contract or booklet provided to covered persons: "If you are covered by more than one health benefit plan, and you do not know which is your primary plan, you or your provider should contact any one of the health plans to verify which plan is primary. The health plan you contact is responsible for working with the other plan to determine which is primary and will let you know within thirty calendar days. CAUTION: All health plans have timely claim filing requirements. If you or your provider fail to submit your claim to a secondary health plan within that plan's claim filing time limit, the plan can deny the claim. If you experience delays in the processing of your claim by the primary health plan, you or your provider will need to submit your claim to the secondary health plan within its claim filing time limit to prevent a denial of the claim. To delays in claims processing, if you are covered by more than one plan you should promptly report to your providers and plans any changes in your coverage."
checklist-forms-hcsc-large-group.docx