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PDFWAC 182-524-0600


(1) We pay your silver level qualified health plan (QHP) premium costs directly to the QHP carrier unless we determine good cause exists to reimburse you for the premium costs.
(2) We pay your mandatory out-of-pocket costs separate from your premium costs through cost-sharing funds.
(3) Cost-sharing funds are only for your out-of-pocket costs.
(4) We will not pay for, or reimburse you for, costs not considered as out-of-pocket costs or expenses incurred by people not covered under COFA islander health care.
(5) You are responsible for ensuring the services you receive are covered under your QHP and rendered as in-network.
(6) We may stop payments of your silver level QHP premium costs and your cost-sharing funds when you:
(a) Fail to provide verification of payments through us or an agency-contracted vendor;
(b) Fail to respond to a request for information from us or an agency-contracted vendor;
(c) Misuse your cost-sharing funds by:
(i) Purchasing anything not considered an out-of-pocket cost; or
(ii) Allowing another person access to your cost-sharing funds.
(d) Are no longer eligible for COFA islander health care as described under WAC 182-524-0300.
(7) You must follow the requirements of any agency-contracted vendor that provides services enabling you to access your cost-sharing funds.
(8) We monitor payments and cost-sharing transactions under COFA islander health care.
[Statutory Authority: 2018 c 161, 2018 c 299 § 213 (1)(hhh) and (4)(d), RCW 41.05.021 and 41.05.160. WSR 19-11-082, § 182-524-0600, filed 5/17/19, effective 6/17/19.]
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