Health Insurance Risk Pools - Resources and Information
Washington Risk Pool - Health Insurance Provided for the Uninsurable
Acronym or name of the risk pool: Washington State Health Insurance Pool or WSHIP.
Regulation establishing risk pool: Washington State Legislature under Washington State Health Insurance Coverage Access Act.
Funding: The programme receives funds from premium payments by members. Funds are also received from assessments on health plans of companies with no tax offset.
Plans offered: There are three medical insurances offered through the WSHIP programme. All are PPO with different types of deductibles.
Plan benefits: Plan 1 is a PPO plan offering deductibles of $500, $1000 and $1500. You pay a coinsurance rate of 20% for inpatient services. For out of network services also the coinsurance rate is 20%. The maximum limit for benefits is $1000 for a deductible of $500, for a deductible of $1000, the out of pocket limit is $1650. The out of pocket limit is $2000 for a deductible of $1500. Under plan 1, you are allowed to choose a doctor and pay a particular percentage of the expenses after paying your deductibles. Benefits are naturally more if you avail of services within the network.
Plan 2 is a supplemental Medicare plan offered to people participating in Medicare Part A and Part B. Annual deductibles do not apply. The applicant has to pay a 20% coinsurance for inpatient services. For out of patient services, the rate of coinsurance is 20% also. For plan 2, the out of pocket limit is $500.
Plan 3 is a PPO plan offering deductibles between $500, $1000, $2500 and $5000. The members are expected to pay a coinsurance of 20% for both in network and out of network services. For $500 deductible, the out of pocket limit is $1000, for a deductible of $ 1000; the out of pocket limit is $1650. The out of pocket limit is $5000 for a deductible of $2500. It is $10000 for deductibles of $5000.
WSHIP plan summary: https://www.wship.org/summary.asp
Maximum benefit limits: The lifetime maximum benefit is $10000000.
Eligibility: (1) The person under 65 and a resident of state of Washington for at 12 months. This is not applicable if you had a previous cover under a separate state risk pool or you were receiving covers under HIPAA. (2) You should provide proof of the fact that you had suitable covers for at least 18 months before your application. (3) The gap in insurance cover should not have been more than 63 days. (4) The person should have been without health cover for at least a period of six months prior to applying for covers. (5) You may not be eligible for any other cover. (6) You must not be a resident of a mental institution. You can provide proof of any one of the following: (a) You have received a notice rejecting your application for insurance because of medical reasons. (b) You were not able to obtain insurance because of a pre existing medical clause.
Enrollment periods: Applications may be made for enrollment in WSHIP at any time of the year but within 63 days of the end of the last cover if the person is applying for HIPAA.
Premium payments: Your age, gender, tobacco usage and plan selection determines the premium you pay.
Premium calculations: The rate capped is between 110% and 150% of the standard rate charged by the leading insurance companies in the state.
Pre existing condition waiting period: A waiting period of 6 months is provided for a person with a pre existing condition. It is waived for a person with HIPAA coverage that was not ended earlier than 63 days prior to the application. The time or duration of the previous coverage is deducted from the waiting period.
Contact information: Washington State Health Insurance Pool. C/O Benefit Management, Inc. Po Box-1090. Great bend, KS 67530. Phone- 18008775187. WSHIP Website.
|Click here for instant free health insurance quotes|
Copyright 2000-2008 QuickHealthInsurance.Com Group, Inc.