WAC 182-524-0600 Payments.
Revised June 17, 2019
- 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.
- We pay your mandatory out-of-pocket costs separate from your premium costs through cost-sharing funds.
- Cost-sharing funds are only for your out-of-pocket costs.
- 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.
- You are responsible for ensuring the services you receive are covered under your QHP and rendered as in-network.
- We may stop payments of your silver level QHP premium costs and your cost-sharing funds when you:
- Fail to provide verification of payments through us or an agency-contracted vendor;
- Fail to respond to a request for information from us or an agency-contracted vendor;
- Misuse your cost-sharing funds by:
- Purchasing anything not considered an out-of-pocket cost; or
- Allowing another person access to your cost-sharing funds.
- Are no longer eligible for COFA islander health care as de-scribed under WAC 182-524-0300.
- You must follow the requirements of any agency-contracted vendor that provides services enabling you to access your cost-sharing funds.
- We monitor payments and cost-sharing transactions under COFA islander health care.