Other Health Insurance Options
When Ineligible for WWU Insurance Coverage

 


Affordable Care Act

In March, 2010, Congress passed, and the President signed into law, the Affordable Care Act, which puts in place comprehensive health insurance reform. Starting this year and continuing through 2014, the Affordable Care Act will be implemented, increasing access to affordable care for individuals, families, seniors and businesses. To keep abreast of the changes, visit www.healthcare.gov.

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Who Does this Page Apply to?

This page describes the health insurance options that are available for people who are not eligible for one of the University's health insurance programs such as visitors and family members not eligible for a WWU insurance program.

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

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Common Terms

Premium - The periodic payment required to keep a policy in effect.
Deductible - The portion you must pay before insurance coverage begins.
Co-insurance - The percentage you pay when your health plan pays less than 100% of covered costs. This is sometimes known as “percentage participation." This usually applies after a specified deductible is met.
Co-payment - Your share of a specific health care bill charged at the time of service, usually about $20 for an office visit.

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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 major financial consequences.

Consider which out-of-pocket expenses you are willing to pay. In addition to a monthly premium, you may be responsible for deductible, 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.

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Private Health Insurance Options

Stay on Your Parent's Insurance

Under the Affordable Care Act, if your parent's plan covers children, they may keep you on their health insurance policy until you turn age 26. Contact your parent's health plan to see when this provision takes effect.

Short-term Health Insurance

This type of non-renewable and relatively inexpensive plan provides coverage ranging from 30 days to 6 months. this can be useful if you're in a period of transition, if you are a recent graduate not covered under parent's plan, you do not have access to COBRA rights, or you are visiting WWU from another state or country. There are several companies that offer short-term health insurance in the State of Washington, including Assurant Health.

COBRA for Employees and Dependents

An employee, spouse, and dependent child are eligible for COBRA under these conditions:

  • Voluntary or involuntary termination of employment of covered employee for reasons other than “gross misconduct.”
  • Reduction in the number of hours worked by covered employee falling below the level for health insurance.
  • Employee is enrolled in Medicare.
  • Divorce or legal separation from covered employee.
  • Death of covered employee.
  • Loss of “dependent child” status.

COBRA law applies only to employers that have 20 or more employees. The coverage is identical to whatever the current employees receive. You must pay the COBRA premium to obtain this coverage. See the COBRA web page.

COBRA for Students

Students who are no longer for coverage under their parents' health insurance at age 26 may be eligible for COBRA. There are other categories that may make individuals eligible for 18 to 36 months of COBRA. Special rules may allow extended coverage for an individual who is disabled within the meaning of the Social Security Act. For more information, see the U.S. Department of Labor's FAQs.

Individual Health Insurance

The availability of individual health insurance plans vary by county in Washington State. See the Washington State Office of the Insurance Commissioner's webpage, including these resources and publications:

Western Washington University does not endorse any particular third-party insurance plan option. For your convenience, we've listed a variety of alternative resources for getting online quotes on health insurance coverage:

The premiums depend on 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 see Health Care Plan Considerations above.

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.

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Public Health Insurance Program Options

Washington Health Program

Washington Health is available to anyone who lives in Washington and:

  • Is not eligible for free or purchased Medicare
  • At the time of enrollment is not confined to an institution
  • Is ineligible for coverage under Washington State Health Insurance Pool (WSHIP) or qualifies to bypass the standard health questionnaire under state law.
  • Is not receiving Washington Department of Social Health Services (DSHS) medical assistance (Medicaid) or subsidized Basic Health benefit.

Because Washington Health is not subsidized by the state, there is no income requirement but enrollees must reside in Washington. You can learn more about Washington Health and apply online at www.washingtonhealth.hca.wa.gov.

Washington Basic Health

Basic Health is for Washington State residents who are:

  • Between 0 - 200% of the federal poverty guidelines (FPL),
  • Not eligible for free or purchased Medicare,
  • Not receiving Washington Department of Social Services (DSHS) medical services (Medicaid),
  • Not institutionalized at the time of enrollment; and
  • Not attending school full-time in the United States on a student visa.

The income guidelines are based on the number of people 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. Learn more at www.basichealth.hca.wa.gov.

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 (CSO). If you and/or your family members 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 or "Apple Health Care for Kids" 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 along qualifies as a household of one. Parents can enroll their child on CHIP even if they have no other 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.

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Other Health Care Options

SHIBA HelpLine

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

www.insurance.wa.gov

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. Learn more.

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 here.


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Page Updated 12.05.2013