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 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.
If you can answer yes to any of the nine questions below, you do not have to fill out a health questionnaire:
- Are you eligible for Medicare? Yes
- Have you changed residences from one part of Washington state to another part where
your current health plan is not offered, and you are submitting your application within 90
days of relocation?
- Is your health care provider no longer part of the provider network on your current
individual health plan?
To answer yes, all of the following must be true:
- Your health care provider is on the new health plan you are applying for; and
- You received services from that provider during the 12 months before he or she left your
current health plan; and
- You are submitting your application to the new health plan within 90 days of your provider
leaving your current health plan's network.
- Are you applying for individual health coverage within 90 days of using up your COBRA*
(This includes loss of COBRA coverage due to your employer going out of business or
discontinuing its health plan while you are on COBRA.)
To answer yes, you must have used up your COBRA coverage for any reason other than
misrepresentation, gross misconduct, or failure to pay your premium.
- Have you been covered by a group plan provided by an employer that is exempt from
COBRA, and you are applying for individual health coverage within 90 days of an event
which would qualify you for COBRA if your employer had not been exempt from COBRA,
and you had at least 24 months of continuous group coverage prior to such event?
- Are you applying for individual health coverage within 90 days of terminating your COBRA
coverage and you had at least 24 months of continuous group coverage prior to
termination? (Not applicable to BHP applicants.)
- Are you applying for individual health coverage 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 choose not to take COBRA coverage? (Not applicable to BHP applicants.)
- Have you been enrolled in the Washington State Basic Health Plan for at least 24
continuous months, and you are submitting your application within 90 days of
- Are you adding coverage to your existing individual policy for your newborn or adopted
child who has been born or placed for adoption with you within the last 60 days?
If you have not previously had 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 coverage, 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.
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