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• Kaiser Permanente
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Washington Individual Health Insurance Market & Health Screening

Health screening and the individual market

Application requirements

Most people buying individual health insurance in Washington state will need to complete a standardized health screen questionnaire. If you fail the questionnaire, the insurance company you applied with will automatically send you an application for the Washington State Health Insurance Pool (WSHIP).

Individuals not required to take the health screen

You are not required to fill out the health screen questionnaire when applying for individual insurance if you:

• will exhaust your COBRA coverage or you will lose it because your former employer closed its business.
• have 24 months of continuous coverage through a small employer.
• have moved out of your existing plan's service area within Washington state.
• are staying with a primary care doctor who left your existing plan.
• are losing your coverage with the state Basic Health Plan and you have 24 months of continuous coverage under the plan.
• have received a notice about the discontinuation of your conversion plan. This is a limited benefit policy an individual may have a right to convert to after their group insurance ends.
• are adding a newborn or newly adopted or soon-to-be adopted child to your health plan.

Washington State Health Insurance Pool (WSHIP)

The Washington State Health Insurance Pool (WSHIP) provides health insurance for people who are unable to obtain individual coverage in the private marketplace. This plan provides comprehensive coverage, including a prescription drug benefit. WSHIP bases premiums on age and type of plan selected.

Premiums for WSHIP coverage are higher than commercial health plans. However, WSHIP offers some high deductible plan options with lower premiums.

There are two WSHIP options available for people who are not on Medicare:

• The Standard Plan (Plan 1), which is fee-for-service, allows you to go to the doctor of your choice.
• The Network Plan (Plan 3) uses providers from the First Choice network.

WSHIP also has a separate plan that is only available for people on Medicare (the Basic Plan.) This plan has different eligibility criteria.

WSHIP provides some discount rates to people with low income, people continuously insured with their previous plan, and people who have been in WSHIP for more than three years. For more information about WSHIP, contact the administrator, Benefit Management, Inc., at 1-800-877-5187 or www.wship.org.