allowable expense. Coordination Time No issuer shall unreasonably delay payment of a claim by reason of the application of a COB WAC of Benefits 284-51-215(1) provision. Any time limit in excess of 30 days is unreasonable. (Cont’d) Definition of "Plan" means a form of coverage with which coordination is allowed. Separate parts of a plan that WAC 284-51-195(12) for are provided through alternative contracts that are intended to be part of a coordinated package of “Plan” purposes of benefits are considered one plan and there is no COB among the separate parts of the plan. WAC COB If a plan coordinates benefits, its contract must the types of coverage that will be considered 284-51-195(12)(a) in applying the COB provision of that contract. Whether the contract uses the term "plan" or some other term such as "program," the contractual definition may be no broader than this definition. No plan may use a COB provision, or any other provision that allows it to reduce its benefits with respect to any other coverage its insured may have that does not meet the definition of plan as defined in Chapter 284-51 WAC. WAC "Plan" includes: 284-51-195(12)(b) Group, individual or blanket disability insurance contracts, and group or individual contracts (12)(b)(i) marketed by issuers; Closed panel plans or other forms of group or individual coverage; (ii) (iii) The medical care components of long-term care contracts, such as skilled nursing care; and Medicare or other governmental benefits, as permitted by law. That part of the definition of (iv) plan may be limited to the hospital, medical and surgical benefits of the governmental program. "Plan" does not include: WAC 284-51-195(12)(c)(i) Hospital indemnity or fixed payment coverage benefits or other fixed indemnity or payment WAC coverage; 284-51-195(12)(c)(ii) Accident only coverage; (iii) Specified disease or specified accident coverage; (iv) Limited benefit health coverage, as defined in WAC ; (v)
Coordination of Benefits (Cont’d) allowable expense. Time WAC 284-51-215(1) No issuer shall unreasonably delay payment of a claim by reason of the application of a COB provision. Any time limit in excess of 30 days is unreasonable. Definition of “Plan” for purposes of COB WAC 284-51-195(12) WAC 284-51-195(12)(a) WAC 284-51-195(12)(b) (12)(b)(i) (ii) (iii) (iv) WAC 284-51-195(12)(c)(i) WAC 284-51-195(12)(c)(ii) (iii) (iv) (v) "Plan" means a form of coverage with which coordination is allowed. Separate parts of a plan that are provided through alternative contracts that are intended to be part of a coordinated package of benefits are considered one plan and there is no COB among the separate parts of the plan. If a plan coordinates benefits, its contract must the types of coverage that will be considered in applying the COB provision of that contract. Whether the contract uses the term "plan" or some other term such as "program," the contractual definition may be no broader than this definition. No plan may use a COB provision, or any other provision that allows it to reduce its benefits with respect to any other coverage its insured may have that does not meet the definition of plan as defined in Chapter 284-51 WAC. "Plan" includes: Group, individual or blanket disability insurance contracts, and group or individual contracts marketed by issuers; Closed panel plans or other forms of group or individual coverage; The medical care components of long-term care contracts, such as skilled nursing care; and Medicare or other governmental benefits, as permitted by law. That part of the definition of plan may be limited to the hospital, medical and surgical benefits of the governmental program. "Plan" does not include: Hospital indemnity or fixed payment coverage benefits or other fixed indemnity or payment coverage; Accident only coverage; Specified disease or specified accident coverage; Limited benefit health coverage, as defined in WAC ;
checklist-forms-hmo-large-group.docx