Washington State High Risk Insurance

High-risk health insurance in the state of Washington is available through the nonprofit Washington State Health Insurance Pool. State residents rejected for medical reasons can use the program to obtain individual health insurance. It was created under the 1987 Health Insurance Access Act and amended in 2000 in response to the state's health insurance market in the late 1990s.

Non-Medicare Eligibility

• WSHIP applicants must be Washington state residents, be ineligible for Medicare and be rejected for individual health insurance or live in a county where individual health insurance is unavailable. Dependents are eligible if they are unmarried and younger than 19. Children older than 19 are eligible if disabled.

  Applicants are ineligible if they terminated WSHIP coverage in the past year (unless they picked up continuing coverage and then were dropped for any reason other than not paying monthly premiums), are prison inmates, received $2 million in benefits, are covered under a duplicate program or became eligible for medical assistance on July 1, 2008 or later.

Medicare Eligibility

• Eligibility for Medicare recipients includes Washington state residency, enrollment in Medicare Parts A and B and evidence of medically-based rejection, increased premiums, restrictive riders or pre-existing condition limitations on a Medigap insurance policy (or no access to either comprehensive Medigap coverage or reasonable selection of Medicare Advantage plans).

Available Non-Medicare Plans

• Available WSHIP plans for those not on Medicare include preferred providers that pays 80 percent of network provider charges and 60 percent of out-of-network provider charges and the standard plan that pays 80 percent for both network and out-of-network providers. Both have a range of deductibles and co-pays for prescription drugs.

  The HSA-qualified preferred provider plan features a high deductible and can be combined with a federal health savings account. It includes a $3,000 deductible for medical costs and prescription drugs plus annual limits on out-of-pocket expenses.

  Two other plans are limited preferred provider A and B. The first features the same 80/60 coverage as the preferred provider plan plus a set deductible and co-pays for prescription drugs subject to an annual maximum.

  The second features no maternity coverage a $2,000 annual maximum for prescription drugs.

Available Medicare Plans

• Applicants covered by Medicare Parts A and B can apply for the basic plan that serves as a Medigap policy, paying those costs not covered by Medicare. It does not pay for prescription drugs except for costs not covered by Medicare Part B. If you have a reasonable choice (as defined by guidelines) of Medicare Advantage Plans in your county, you are not eligible for WSHIP.

Enrollment

• Washington State Health Insurance Pool applications are available on the agency's website (www.wship.org). Include the rejection notice from a health insurance provider, including the Standard Health Questionnaire scoring sheet. If you received reduced Medigap coverage, attach the insurance provider's letter of explanation. Consulting an insurance agent to fill out the paperwork is encouraged. Direct questions to the agency's customer service department at [phone]. Grievance procedures for rejected applications are included in the application packet.