Washington Risk Pool - Health Insurance for the Uninsurable
Risk Pool Name / Acronym
Washington State Health Insurance Pool / WSHIP
Insurance Regulation Establishing Risk Pool
Washington State Legislature
Washington State Health Insurance Coverage Access Act
Washington State Health Insurance Pool (WSHIP)
The Washington State Health Insurance Pool (WSHIP), created by the Washington State Legislature, offers individual health insurance coverage to Washington residents who got rejected for coverage due to medical reasons.
Funding
Premiums are collected from person insured by WHIP, but those funds are not substantial to operate the program, so there are also assessments of insurance carriers.
Plans Offered
There are three medical insurance plans available through the WSHIP program. All plans are PPO plans with a variable of deductibles.
Plan Benefits
Plan 1 is a standard PPO plan offering deductibles of $500, $1,000.00 and $1,500. For most in-patient covered medical services, the WSHIP member is required to pay a 20% coinsurance. For most out-patient covered medical services, the WSHIP member is required to pay a 20% coinsurance. The maximum out-of-pocket limit, including deductible, is $1,000 for the $500 deductible, $1,650 for the $1,000 deductible and $2,000 for the $1,500 deductible. Plan 1 allows you to see any doctor you choose while paying a fixed percentage of medical expenses in addition to your annual deductible; however, your out-of-pocket costs may be lower if you receive services from a provider who is part of the First Choice Network.
Plan 2 is a supplemental Medicare eligible plan or the basic plan available to individuals participating in Medicare Part A and Part B. An annual deductible does not apply. For most in-patient covered medical services, the WSHIP member is required to pay a 20% coinsurance. For most out-patient covered medical services, the WSHIP member is required to pay a 20% coinsurance. The maximum out-of-pocket limit for plan 2 is $850. This plan does not provide prescription drug coverage except supplemental benefits for medications covered under Medicare Part B.
Plan 3 is a PPO Plan offering a variable of deductibles, including $500, $1,000, $2,500 and $5,000 deductibles. For most in-patient covered medical services, the WSHIP member is required to pay a 20% coinsurance. For most out-patient covered medical services, the WSHIP member is required to pay a 40% coinsurance. The maximum out-of-pocket limit, including deductible, is $1,000 for the $500 deductible, $1,650 for the $1,000 deductible, $5,000 for the $2,500 deductible and $10,000 for the $5,000 deductible.
Maximum Benefit Limits
Individual lifetime maximum benefit is $2,000,000 per WSHIP member.
Eligibility
- You are a resident of the State of Washington, and one of the following
- You must provide evidence of rejection for medical reasons, a requirement of restrictive riders, an up-rated premium, or a pre-existing conditions limitation on a Medicare supplemental insurance policy, or live in a Washington state county where individual health benefit plans are not offered
- You reside in a county of Washington State that does not have individual health insurance available from one of the association health insurance companies
- You are eligible for coverage under federal HIPAA regulation
- You must not be eligible for a group health plan; Medicare or Medicaid
- You must not have lost your most recent coverage for non-payment of premium
- You must have exhausted your COBRA coverage if it was made available to you
- You must not have terminated coverage in WSHIP within the last 12 months
- You are not an inmate of a public institution
- You have not already been paid $2,000,000 in benefits by WSHIP
- You are not enrolled in a public program which duplicates benefits provided by WSHIP
Enrollment Periods
You may apply for WSHIP at anytime or within 63 days of the termination date of your previous group health coverage if you are applying under the HIPAA eligibility category.
Premium Payments
Premiums for WSHIP are determined by plan selection and age. WSHIP offers various payment options, including monthly bank account withdrawal, or quarterly, semi-annual and annual payments.
Premium Calculations
Premiums are determined by reviewing similar health plans available in Washington State that are available to standard eligible persons. WSHIP premiums are capped between 110 and 150 percent of that rate.
Pre-Existing Condition Waiting Periods
There is six month waiting period on pre-existing conditions unless you provide proof your prior creditable coverage that terminated no later than 63 days preceding the date of your WSHIP application. The length of time that this previous medical insurance coverage was in effect will apply to the six month waiting period.
Washington State Health Insurance Pool Contact Information
Washington State Health Insurance Pool
C/O Benefit Management, Inc.
P.O. Box 1090
Great Bend, KS 67530
Phone: 1-800-877-5187
WSHIP Website
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