Individual Medical Insurance Regulations in Washington

In the State of Washington, insurance companies can offer individual medical insurance using medical underwriting. Any person enrolling in a new health plan must complete a health questionnaire. The questions are then reviewed by the insurance companies and they use a point system to determine risk factors pertaining to the applicant. If an application scores 288 points or higher, then the applicant can be denied coverage. If someone has relocated to a new area, and the state in which their previous insurance company is located does not offer coverage, then they are excused from the point rating system and they do not have to complete the health questionnaire. Also, you can be excused from underwriting if you must switch health plans to keep your current doctor. For any new member who has not had prior creditable health insurance coverage, a 9 month exclusionary period can be applied to pre-existing health conditions. If you have been treated, diagnosed or received medical advice for a health condition, your health insurance company can perform a 6 month history check due to the 6 month rule in Washington. However, premiums are not based on an applicant's health condition, age, family size, insurance plan type or location and coverage is granted on a guaranteed issue basis for applicants that meet certain health criteria.

Washington (WA) Small Group Health Insurance Regulations

Any company with 2-50 employees is considered a small group in Washington. A small group cannot be turned down for a group health plan based on the health status of an employee in the group or the health status of the group as a whole. The state of Washington has participation requirements that decide what percentage of eligible employees should enroll in health coverage. 100% participation is required for groups of 2 or 3 and 75% participation for groups of 4-50. Community rating, member's age, family size, and business location are factors that determine a premium's rate. A group that is determined to be high-risk may have to pay a higher premium than a low-risk group. If this occurs, the premium cannot be greater than 375% of the standard premium. Every insurance company in the state must make one standardized plan available, called the "Washington Basic Health Plan." No matter what insurance company you select, the coverage must be the same; however, the rates may vary from one company to the next. For any plan member without creditable coverage that has a pre-existing health condition, the insurance company can add an exclusionary period that lasts 12 months along with a health history check of 6 months.

Washington COBRA and Continuation Coverage

Groups with 20 or more employees are required to follow federal COBRA laws. These regulations allow terminated employees to continue receiving benefits under their previous employer's group health plan for a time span of 18 months. For up to 36 months, eligible dependents may qualify for COBRA coverage. For groups of less than 20, Washington does not have any COBRA laws. However, at the employer's discretion, insurance companies are required to make an option available to set up a continuation plan for employees. In Washington conversion plans are not required, so any person that has lost coverage and is not eligible for individual health insurance must apply for coverage through the Washington high-risk health pool.

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