(4)(c) o A person could have elected an option under another plan Coordination of Benefits General that pays a higher level of benefits than what he elected. (Cont’d) (Cont’d) WAC • Plan may not provide that its benefits are "always excess" or "always secondary" except as permitted in Chapter 284-51 WAC. RCW • A carrier may not administer COB in a way that reduces 48.21.200(1) benefits payable below an amount equal to 100% of total allowable expenses. (Note: by its terms, this statute applies to HCSCs) WAC • Any secondary plan must pay an amount which, together with 284-51-230(1) the payment made by the primary plan, cannot be less than the same allowable expense as the secondary plan would have paid if it was the primary plan. In no event will a secondary plan be required to pay an amount in excess of its maximum benefit plus accrued savings. WAC • When Medicare, Part A, Part B, Part C, or Part D is primary, 284-51-195(1) Medicare's allowable amount is the allowable expense. Time Limit WAC Plan must not unreasonably delay payment of a claim due to a 284-51-215(1) COB provision. Any time limit in excess of 30 days is unreasonable. Definition of "Plan" means coverage with which coordination is allowed. WAC “Plan” Separate parts of a plan provided through alternative contracts 284-51-195(12) intended to be part of a coordinated package of benefits are considered one plan. There is no COB among the separate parts of the plan.
Coordination of Benefits (Cont’d) General (Cont’d) (4)(c) o A person could have elected an option under another plan that pays a higher level of benefits than what he elected. WAC • 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 benefits payable below an amount equal to 100% of total allowable expenses. (Note: by its terms, this statute applies to HCSCs) WAC 284-51-230(1) • Any secondary plan must pay an amount which, together with the payment made by the primary plan, cannot be less than the same allowable expense as the secondary plan would have paid if it was the primary plan. In no event will a secondary plan be required to pay an amount in excess of its maximum benefit plus accrued savings. WAC 284-51-195(1) • When Medicare, Part A, Part B, Part C, or Part D is primary, Medicare's allowable amount is the allowable expense. Time Limit WAC 284-51-215(1) Plan must not unreasonably delay payment of a claim due to a COB provision. Any time limit in excess of 30 days is unreasonable. Definition of “Plan” WAC 284-51-195(12) "Plan" means coverage with which coordination is allowed. Separate parts of a plan provided through alternative contracts intended to be part of a coordinated package of benefits are considered one plan. There is no COB among the separate parts of the plan.
cl-forms-19-hcsc-ind-analyst-checklist.docx