Washington State Health Insurance


Washington State

Individual Health Insurance Regulations

Medical insurance is necessary to protect your family's health against unfortunate circumstances of sickness or injury. Before opting for health coverage, you need to go through your family's medical needs and your budget. Being a Washington resident, you can choose from various product alternatives. The Washington State Office of the Insurance Commissioner supervises the regulations under which the Washington health insurers can sell private health insurance to individuals and families.
Medical underwriting is permitted by insurance companies offering individual health insurance in the State of Washington. Persons enrolling in a new health plan must complete an application that contains questions pertaining to health history. The insurance companies use a point system to calculate risk factors. Applications that achieve more than 325 points can be declined coverage. Persons that are reapplying for coverage because they are relocating to a new area in the state in which their previous insurance company does not offer coverage are exempt from the point rating system and do not need to answer health questions when applying for coverage with a new insurance company. You are also exempt from underwriting if you need to change health plans to keep your current doctor. A 9-month exclusionary period applies to pre-existing medical conditions for any new member that does not have prior creditable health coverage. A 6-month prudent person rule allows the insurance companies to look back at your health history to see if you have received treatment, been diagnosed, or received advice for a medical condition. Premiums not based on health status, based on age, family size, plan type and geography. Coverage is guaranteed issue for persons that meet specific health criteria.
Search for plans and the costs associated with them using the search box above. We provide individual, family, Medicare supplemental, group and student health plan quotes for you to compare on all states and zip codes. Remember that having coverage leads to a healthier lifestyle as you can get regular doctor checkups and therefore an affordable premium.


Washington State

Small Group Health Insurance Regulations

A small group in Washington is defined as any company with 2-50 employees. Any company falling into this classification may not be turned down for a group health plan based on the health status of the group or any employee that wished to be enrolled in the employer's health plan. There are many participation requirements that determine what percentage of eligible employees must enroll for coverage. Groups of 2 or 3 require 100% participation and groups of 4-50 require a minimum 75% participation. Premiums are based on a community rating, age of plan members, family size, and business location. Groups that are classified as high-risk may be charged a higher premium than other lower risk groups, but that premium may not exceed 375% of the standard premium. All insurance companies must offer 1 standardized plan, called the Washington Basic Health Plan. The coverage must be identical, regardless of which insurance company you select, but the rates may be different from one carrier to the next. A 9-month exclusionary period with a 6 month look-back is permitted on pre-existing conditions for any plan member that does not have adequate creditable coverage.


Washington State COBRA and Continuation Coverage

Groups of 20 or more employees must abide by federal COBRA regulations which allow terminating employees to continue coverage under the group health plan for a period of 18 months. Some qualified dependents may be eligible for up to 36 months of COBRA coverage. Washington does not have a state COBRA law that applies to groups of less than 20. However, insurance companies must give employers the option to set up a continuation option for employees, which is done solely at the employer's discretion. There are no conversion plans required in Washington, so any person that is losing their coverage and are not eligible for individual medical insurance will need to apply for coverage under the state high-risk health pool.