provision for continuity of care if one or more treating providers are not in the new primary plan's network. Rules for WAC When a plan is secondary, it may reduce its benefits so the total Secondary 284-51-230(4) benefits provided by all plans during a claim determination period Plan Payment do not exceed one hundred percent of the total allowable (Cont’d) expenses. The secondary plan must calculate and record its savings from the amount it would have paid had it been primary, and must use these savings to pay any allowable expenses not otherwise paid, that are incurred by the covered person during the claim determination period, so that one hundred percent of the total allowable expenses incurred are paid during the claim determination period. Required If the plan provides for COB, it must contain provisions substantially Provisions: as follows: “Facility of "If payments that should have been made under this plan are Payment” WAC 284-51-220 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." “Right of WAC 284-51-225 "The issuer has the to recover excess payment whenever it Recovery” 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.” “Notice to WAC 284-51-235 The plan must include the following statement in the enrollee Covered contract or booklet provided to covered persons: 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
Rules for Secondary Plan Payment (Cont’d) provision for continuity of care if one or more treating providers are not in the new primary plan's network. WAC 284-51-230(4) When a plan is secondary, it may reduce its benefits so the total benefits provided by all plans during a claim determination period do not exceed one hundred percent of the total allowable expenses. The secondary plan must calculate and record its savings from the amount it would have paid had it been primary, and must use these savings to pay any allowable expenses not otherwise paid, that are incurred by the covered person during the claim determination period, so that one hundred percent of the total allowable expenses incurred are paid during the claim determination period. Required Provisions: If the plan provides for COB, it must contain provisions substantially as follows: “Facility of Payment” WAC 284-51-220 "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." “Right of Recovery” WAC 284-51-225 "The issuer has the 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.” “Notice to Covered Persons” WAC 284-51-235 The 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
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