WWU employees and their dependents who lose eligibility to participate in a WWU medical plan should first consider exercising their right to insurance continuation through COBRA before exploring the options described on this page.

Health Care Plan Considerations

Be sure to understand the differences between comprehensive and catastrophic health insurance plans.  The distinction is important relative to a policy holder's ability to change health insurance plans and not be penalized for a pre-existing condition such as cancer or serious injury.

Comprehensive insurance usually has higher premiums than catastrophic insurance, and:

• The deductible must be less than $1,500 (as required by Washington State Law); and,
• Time spent under a comprehensive health insurance plan is credited towards the pre-existing condition waiting period (generally up to nine months).  This is called "creditable coverage."

Catastrophic insurance usually has lower premiums than comprehensive insurance, and:

• The deductible per medical occurrence is $1,500 or more; and,
• If you move to another health insurance plan that has a pre-existing condition waiting period, you will be responsible for the entire cost of care for any pre-existing conditions during the pre-existing condition waiting period - generally up to nine months.  This can have financial consequences.

Consider which out-of-pocket expenses you are willing to pay.  In addition to a monthly premium, you may be responsible for deductibles, co-insurance and/or co-payments (called "out-of-pocket expenses" or "cost sharing").  Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs) and traditional fee-for-service insurance plans all administer cost sharing differently.

Private Health Insurance Options

Short-term Health Insurance

This type of non-renewable and relatively inexpensive plan provides coverage ranging from 30 days to six months.  This can be useful if you are in a job transition, you do not have access to COBRA rights or you are visiting WWU from another state or country.

The following companies offer short-term health insurance in Washington State:

• Grad Med Program
• Fortis
• Liberty (Currently only available for out-of-state residents)

Professional Associations

Many professional and fraternal associates offer health insurance to their members.  Associates plans vary widely in the way that benefits are administered.  Be sure to educate yourself about the provisions of coverage.  Some association plans have a very limited and restricted payment schedule.  You are responsible for all costs above the scheduled amount.

Individual Health Insurance

The available of individual health insurance plans vary by county in Washington State.  The cost of premiums depend upon your age and level of cost-sharing for the plan.  Legislation passed in March 2000 requires most individuals to pass a health screening questionnaire to qualify for individual coverage.  The health plan you choose will send you an application packet with the health screening questionnaire.

If you qualify for private insurance, there may be a pre-existing condition waiting period of up to nine-months for any health condition you had in the previous six months.  This depends on whether and for how long you have been covered by a comprehensive insurance plan immediately prior to beginning an individual health insurance plan.  Remember, catastrophic coverage is not deemed comprehensive coverage.

If you do not "pass" the health screening, you will automatically become eligible for health insurance through the Washington State Health Insurance Pool (WSHIP), however, you may still have a pre-existing condition waiting period. 

Public Health Insurance Program Options

Washington Basic Health

Basic Health is for Washington State residents who are:

• not eligible for free or purchased Medicare and,
• not institutionalized at time of enrollment and,
• within the income guidelines of 200% Federal Poverty Level (FPL).

The income guidelines are based on the number of persons in your family.  Be sure to count all of your family members, even those you don't intend to cover, because family size is used to determine your monthly premium.  Family members include you, your spouse, children, and/or legal dependents including those who are disabled or full-time students under the age of 23.  You currently have to register for Basic Health and may be placed on a waiting list.

Medicaid

Medicaid provides health insurance to some people with low incomes who meet certain criteria.  In Washington State, these criteria are: pregnant women, children, disabled individuals, persons over the age of 65, refugees and aliens.  Medicaid eligibility is complex.  If you think you may be eligible for Medicaid coverage you should meet with a representative of the Department of Social and Health Services at a local Community Service Office.  If you and/or family member have very high medical expenses, speak with a CSO representative to determine if you qualify for Medicaid through a spend-down process.

Children's Health Insurance Program (CHIP)

CHIP is for children up to 19 years of age who qualify by income (up to 250% of the federal poverty level).  Income levels are based on family (household) size.  A young person living alone qualifies as a household of one.  Parents can enroll their child on CHIP even if they have other or no health insurance.

Washington State Health Insurance Pool (WSHIP)

This state-instituted health insurance program is designed to provide health insurance for a small percentage of the population who otherwise are medically uninsurable because of pre-existing health problems.  Before you can apply for WSHIP, you must have a letter of denial from a private health insurance company.

Other Healthcare Options

Community Clinics offer health care on a sliding fee schedule.  Contact a SHIBA HelpLine representative for a list of Community Clinics in your area at:

SHIBA HelpLine

(800) 397-4422

TDD: (360) 664-3154

This is a statewide network of volunteers trained by the Washington State Office of the Insurance Commissioner to assist, educate and advocate for consumers about health insurance and health care access issues.  The service is free.

Washington State Office of the Insurance Commissioner

The Insurance Commissioner's Office has responsibility for regulating all insurance business in Washington under the authority granted by the insurance laws of this state.  Learn more at www.insurance.wa.gov.