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Most Washington individual health insurance plans are
managed care plans where you receive higher benefits when
you play by the rules of the plan. Some are Preferred Provider
plans where you receive the maximum benefit if you stay within
the plan’s provider network, the physicians, hospitals and
other medical providers who have agreed to the plan's schedule
of payments for services performed. These plans usually allow
you to receive healthcare services outside their network of
providers, but at an additional cost to you. Some may require
the selection of a Primary Care Physician (PCP), a personal
physician who directs all your care and who's written referral
you need prior to visiting a specialist.
Family insurance is simply an individual policy with more
than one insured member of the family included in the
application and coverage. Private and personal insurance are
other names for individual health insurance.
Applying for health care coverage requires filling out a
health questionnaire, in most cases. The insurance company
uses this to determine whether to approve you for coverage
or refer you to the Washington State Health Insurance Pool
(WSHIP), the state's high-risk pool. Do not try to hide
information about your health condition. Hiding information
can result in the insurance company retroactively terminating
your coverage back to its effective date, leaving you
responsible for all of your expenses, less any premiums paid.
You are not required to fill out a health questionnaire if you
apply within 90 days of meeting one of these conditions:
- You have exhausted COBRA coverage.
- Lose COBRA coverage because your former employer went out
of business.
- Relocate to a different area of Washington.
- Need to change in order to be able to continue to see your
personal physician.
- Apply within 90 days of losing group coverage after
24 months of uninterrupted active group coverage and COBRA is
not available.
- Apply within 90 days of losing group coverage
after 24 months of uninterrupted active group coverage and the
group is exempt from COBRA.
- Apply within 90 days of an event which qualifies
you for COBRA, and you had at least 24 months of continuous
group coverage prior to such event, but you chose not to take
COBRA coverage.
- Lose coverage due to a cancellation of your group
conversion plan.
- Lose coverage due to a cancellation of your group
conversion plan.
If you have not previously had health insurance coverage,
the insurance company may impose a 9–month waiting period before
your coverage starts for anything you were treated for, or
should have sought treatment for, during the six months
immediately prior to the start date of your new policy.
If you had prior health insurance, you will generally be
given equivalent credit towards meeting this 9-month waiting
period, provided you did not have a significant break in
coverage between the two plans.
If you do not find the information you need here, please use
the "Have You Help Us" choice at the
top of this page to let us know.
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