| |
Eligibility
You must be a resident of Washington State in order to apply
for individual coverage in Washington. Each insurance carrier
will require proof of residency, such as a copy of your valid
driver's license, voter registration card, or a utility bill.
You
may not be eligible for individual coverage if you are age
65 or over. Coverage would be limited to Medicare Supplement
programs. You will not be eligible for individual coverage
if you are currently entitled to Medicare due to a disability.
Enrolling
Children
The insurance carriers we work with define a child as one
who is under the age of 23. If your child is 23 or older,
that child will need to complete his or her own application
for coverage, separate from your application.
Required
Health Questionnaire
The State has a standard health questionnaire that is used
by all insurance carriers. Each of your health conditions
that you note on the questionnaire carries a certain "weighting"
which has been set by the State's Office of the Insurance
Commissioner. Even if you currently have health conditions,
you may still qualify for individual coverage. A health questionnaire
must be completed for each family member applying for coverage,
and must have all questions answered.
Health Questionnaire Waiver
There are a few instances where a health questionnaire is
not required:
You have relocated within Washington State within the
last 90 days and your prior health plan is not available
in your new location.
Your provider has left your prior plan's network within
the last 90 days and is in the new carrier's network.
Your prior plan must have been an individual plan, not
a group plan.
You have fully exhausted your COBRA coverage within the
last 90 days.
You have a COBRA-qualifying event but your employer has
fewer than 20 employees (and therefore cannot offer COBRA)
AND you have had 24 months of continuous comprehensive
coverage (all group plans combined) before enrolling in
the individual plan.
In addition, you will not need to fill out a health statement
for a newborn or a newly adopted child if you are adding
that child to your existing plan within 60 days of the
birth or adoption.
Pre-existing Condition Waiting Periods
Individual plans have a 9-month pre-existing condition waiting
period. While you will be covered for all other conditions
from the first day of your coverage, pre-existing conditions
will not be covered until you have been covered on the plan
for a full 9 months.
If
you are currently on a health plan that is considered "creditable
coverage," the time you have been on that plan will
count toward your 9 month pre-existing condition period.
Currently
Pregnant
On the last section of the health questionnaire, you will
need to note that you are pregnant, and your due date. There
are no "health points" added for being pregnant,
so this will not lessen your chances for obtaining coverage.
However, you need to know that pregnancy is considered a
pre-existing condition, and is subject to the plan’s
9-month pre-existing condition waiting period. If you are
currently on a health plan that is considered "creditable
coverage," the time you have been on that plan will
count toward your 9 month pre-existing condition period.
If not, your new individual plan will cover only prenatal
care, not your delivery charges.
Submission
Deadlines
The carriers have deadlines for submitting enrollment paperwork.
They are not able to alter these deadlines.
If
you mail in your application, all enrollment materials must
be postmarked to the carrier by the 20th of the month prior
to your enrollment date. For example, if your materials
are postmarked by October 20th, coverage could begin on
November 1. However, if after October 20th, your coverage
could not begin until December 1.
If
you are enrolling online, you need to enroll on or before
the 20th of the month prior to your requested enrollment
date.
Lifewise
also allows you to submit your application via mail or online
by the 5th of the month in order to enroll on the 15th of
that same month.
Initial
Payment
When you receive your coverage notice from the insurance
carrier, you will be told whether your application has been
accepted. If they have accepted your application, they will
send you a bill for your first month’s premiums, including
an initial due date.
Thereafter,
they will ask you to pay for coverage by the 1st of the
month for which you are covered.
If Denied Coverage
If one insurance company denies you coverage because of
the answers you provided on your health questionnaire, it
is likely that all carriers will deny you coverage. That
is because all the insurance carriers in the state of Washington
use the same health underwriting questionnaire and follow
the same scoring guidelines.
But there is
another plan that you can enroll under! For anyone denied
coverage due to health, you may apply for coverage under
the Washington State Health Insurance Pool (WSHIP). The
cost for the WSHIP plans is higher than an individual plan
available in the open market, but WSHIP guarantees that
they will accept you.
WSHIP will also
add you onto their plan back to the date you were trying
to obtain coverage under an individual plan. For instance,
if you sent in an application timely to LifeWise for an
October 1 effective date, and you were denied coverage,
you can send that notice to WSHIP and they will provide
coverage back to October 1st, even though they would have
received the enrollment form after October 1st.
Learn
more about the WSHIP
plan.
Back To Top
|
