Healthy Life

If you live in Washington, the following health insurance contact information may be helpful to you:

Washington State Office of the Insurance Commissioner

The Washington State Office of the Insurance Commissioner is responsible for regulating all types of insurance sold in the state of Washington, including health insurance policies.

If you are looking for health insurance coverage, the Office of the Insurance Commissioner keeps a list of insurance companies licensed to sell policies in Washington. You can also search for insurance agents on its website.

If you are having trouble resolving a claims dispute with your insurer, you can file a complaint with the Office of the Insurance Commissioner. Find more information about how to file a complaint, or download and print a complaint form here.

Washington State Office of the Insurance Commissioner
5000 Capitol Boulevard
Tumwater, WA 98501
Phone: 800-562-6900
Email: CAP@oic.wa.gov

U.S. Department of Labor

If you get your insurance through your job, your plan is also regulated by the U.S. Department of Labor's Employee Benefits Security Administration (EBSA). They make and enforce the rules that your employer must follow when offering health insurance coverage to employees. For example, your employer cannot single out an individual employee and exclude her from the plan because she (or one of her dependents) has a costly illness. Also, if there are 20 or more employees at your job, you should be offered COBRA continuation coverage when you leave your job. The EBSA works to make sure that all of this happens and your rights are protected.

If you have concerns about your employer's practices in administering your job-based health coverage (for example, if you think you should have been offered COBRA continuation coverage, but were not), contact your regional EBSA office.

U.S. Department of Labor Employee Benefits Security Administration
Seattle District Office
1111 Third Avenue, Suite 860
Seattle, WA 98101-3212
Duane Peterson - Supervisor
Phone: 206-553-4244
Fax: 206-553-0913

Buying Individual Policies in Washington

As a general rule, insurers in Washington are allowed to reject your application for coverage based on your health status. Most applicants will be required to complete a standard health questionnaire designed to determine your health status. There are some individuals who may be exempt from this requirement. For example, individuals who have exhausted all of their COBRA continuation benefits do not need to fill out the questionnaire. For more information, see the questionnaire instructions.

People who are denied coverage from a private insurer have the right to purchase coverage through the Washington State Health Insurance Pool (described below).

Washington State Health Insurance Pool (WSHIP)

WSHIP offers coverage to individuals who are unable to purchase an individual health insurance policy because they have pre-existing health conditions. It also covers "HIPAA-eligible" individuals. You may qualify for coverage as a "HIPAA-eligible" individual if you:

• had at least 18 months of continuous creditable coverage, the last day of which was under a group plan
  AND
  
• you have exhausted all COBRA continuation coverage available to you

If you are not sure whether you are a HIPAA-eligible individual, your insurance agent or the Washington State Office of the Insurance Commissioner can help you find out. For more information about WSHIP, including premium rates, contact WSHIP.

WSHIP
P.O. Box 1090
Great Bend, KS 67530
Phone: 800-877-5187

Washington State Children's Health Insurance Program (SCHIP)

The SCHIP program provides health insurance coverage for children whose family income meets certain guidelines.

SCHIP
Phone: 877-KIDS-NOW

Statewide Health Insurance Benefits Advisors (SHIBA)

SHIBA provides free one-on-one counseling for Medicare beneficiaries with questions about any aspect of Medicare, including the Medicare Part D prescription drug benefit or Medigap coverage.

SHIBA HelpLine
Mailing Address: Office of Insurance Commissioner, P.O. Box 40256, Olympia, WA 98504-0256
Phone: 800-541-7735
Email: SHIBAhelpLine@oic.wa.gov

Washington Medicaid

Medicaid is a government program designed to help the poor and indigent obtain healthcare services. Pregnant women and children under age 19 who meet certain income requirements may be eligible for Medicaid coverage, along with aged, blind, and disabled individuals.

Washington Medicaid
Phone: 800-562-3022

Source : www.healthinsurance.about.com

Why Do I Need Health Insurance?

It is important to get health insurance for yourself and members of your immediate family. Insurance helps to protect you from high health care costs, especially those related to chronic medical conditions or the need for hospitalization.

You should get health insurance for the same reason that you have auto insurance or homeowners insurance - to protect your savings and income.

How Do I Get Health Insurance?

Depending on your age, job status, and financial condition, there are many ways that you can get health insurance, including:

• Health insurance provided by an employer. Most large companies in the U.S. provide health insurance as an employee benefit. You may be required to pay some portion of the monthly premium, or cost of the health insurance.
• Health insurance that you purchase on your own. If you are self-employed or work for a small company that does not provide health insurance, you will need to buy it on your own.
• Health insurance provided by the government. If you are 65 or older, disabled, or have little or no income, you may qualify for health insurance paid for by the government, such as Medicare and Medicaid.

If you have no health insurance or health insurance that is not adequate, you will be responsible for paying all your health care bills. The Patient Protection and Affordable Care Act signed into law in March 2010 assures that all Americans who need coverage will be able to get health insurance.

Starting in 2014, you will be able to purchase health insurance in a health insurance exchange that will be available in all states. At that time, health insurance companies will not be allowed to impose any pre-existing condition limitations. However, until 2014, the recommendations below will continue to be valid.

• Your state may have a program that pays for part of your monthly health insurance premium, depending on your income and family size.
• Your community may have a free clinic or community health center that will provide healthcare services free of charge or at a reduced fee.

How Do I Choose a Health Plan?

There are many factors to consider when choosing health insurance. These factors may be different if you are choosing one of several employer health plan options or buying your own health insurance.
Employer Health Insurance

If your employer offers health insurance, you may be able to choose among several health insurance plans. Most often, these plans include some type of managed care plan, such as a health maintenance organization (HMO) or a preferred provider organization (PPO). If you choose an HMO, the plan will only pay for care if you use a doctor or hospital in that plan's network. If you choose a PPO, the plan will usually pay more if you get your health care within the plan's network. The PPO will still pay a portion of your care if you go outside the network, but you will have to pay more.

Your employer may offer a number of different health plans that cost more or less depending on the amount of out-of-pocket costs you have each year. These costs may include a copayment each time you see your doctor or get a prescription filled as well as a yearly deductable, which is the amount you pay for healthcare services at the beginning of each year before your health insurance kicks in.

In general, a plan that requires that you use a network provider, has a high deductable, and high copayments will have lower premiums. A plan that allows you to use any provider, has lower deductibles, and lower copayments will have higher premiums.

If you are young, have no chronic disease, and lead a healthy lifestyle, you may consider choosing a health plan that has high deductibles and copayments-you are unlikely to need care and your monthly premiums may be less.

If you are older and have a chronic condition (such as diabetes) that requires many doctor visits and prescription drugs, you may consider a health plan with low deductibles and copayments. You may pay more each month for your share of the premium, but this may be offset by less out-of-pocket costs throughout the year.

To learn more about your health plan options, meet with a representative of your human resources department or read the materials supplied by the health plan. If both you and your spouse/partner work for companies that provide health insurance, you should compare what each company offers and choose a plan from either company that meets your needs.

Private Health Insurance

If you are self-employed, your employer does not provide adequate health insurance, or you are uninsured and do not qualify for a government health insurance program, you can buy health insurance on your own.
You can buy health insurance directly from a health insurance company, such as Blue Cross, through an insurance agent who represents an insurance company, or online from reliable companies (such as ehealthinsurance). Consult with your insurance agent who may be able to help you find health insurance that fits your needs.

Since cost is often the most important factor when choosing a health plan, your answers to the following questions can help you decide which plan to purchase.

• How much is the monthly premium?
• How much will I have to pay before the health plan kicks in?
• How much is the copay for doctor's visits and prescription medications?
• If I choose a PPO, how much will I have to pay if I use doctors or hospitals outside of the PPO's network?
• Is there any limit on how much the health plan will pay for my care in a year - am I protected from large medical costs?

Other factors that may be important to you when choosing health insurance, are:

• What health services are not covered?
• If I have a medical condition (such as diabetes) will the health plan provide coverage immediately or do I have to wait six months or more? Starting in 2014, the health reform legislation will prevent health plans from deny coverage for a pre-existing condition.
• Does the health plan have a drug formulary that includes the medications I use?
• Is my doctor in the health plan's provider network?

Do your homework before you buy any health insurance policy! Make sure that you know what your health insurance plan will pay for... and what it will not.

Source : www.healthinsurance.about.com

Buying private health insurance may save you money.

For some consumers, buying health insurance is the only health coverage option. However, even if you have health insurance from your employer, private insurance may still be an option to save money. With health insurance premiums increasing every year and employers passing more of the costs onto their employees, your company's health insurance may not be the best deal.
According to the Kaiser Family Foundation, the average American worker contributes $779 for an individual health plan and $3515 for a family health plan. Since this is an average, some employees may be paying much more.

Shop Online for a Better Health Insurance Premium

Shop around online and see if you can find a private insurance policy that provides you with the coverage you need but is less expensive than the premium you pay at work.

A good place to start is the website of the Foundation for Health Coverage Education. This organization provides an interactive "Health Insurance Eligibility Quiz" to help you find affordable health insurance options in your state. After answering five questions about your household, the site provides you with a customized profile that includes the public and private health plans in your state for which family members in your household may qualify.

Another place to seek information for health plan options in your area is ehealthinsurance. This online company provides information and access to 1000s of health insurance plans and is licensed in all 50 states and the District of Columbia. Even if you don't buy insurance through them, ehealthinsurance is a good place to search for a health plan and get a sense of how many plans are available in your state and how much they cost.

How Buying a Private Plan May Help

Nearly 30% of people who work in small companies that offer health care coverage pay more than half of their monthly health insurance premium as a payroll deduction.
Since the average premium for a family is more than $13,000, many employees could be paying more than $6,500 each year. Some of these employees may do better buying their own insurance. For example:

Doug Jones works for a small company that offers a PPO health insurance plan (with a yearly deductible of $1500) for employees and their family. Because of the recent down turn in the economy, Doug's company increased his share of the monthly premium to 60%, which costs Doug almost $700 each month.

Doug's wife works part time as a librarian and has no health insurance benefit. The Joneses have two children ages 7 and 10. All four family members are in good health and have a healthy lifestyle.

If Doug's company was located in the northern suburbs of New York City, his health plan choices would be limited and a comparable plan to the one he has at work would cost him more than $1,000 a month - not a good option for Doug!

If Doug's company was located in northern Ohio, his selection of affordable health plans would be considerably better with more than 100 health plan options. Depending on how much of a deductible, copayment, or coinsurance he is willing to pay, he can find a plan for himself and his family for considerably less than what he pays at work.

Planning on Switching? Be Careful!

Even if it is less expensive, dropping your job-based coverage and switching to a private plan that you buy may not be the best option for you. Health insurance you get from your employer has some very important protections that may not be available (depending on the state you live in) if you buy private insurance.
These include:

• Guaranteed issue - If your employer offers health insurance, you (along with all employees) must be accepted for coverage, regardless of your health status.
• Guaranteed renewability - Your employer (or health plan) cannot cancel your insurance if you become sick.
• Portability - If you had health insurance (either private or from another employer) before enrolling in your current job-based coverage, your new health insurer must reduce any preexisting condition waiting times by the amount of time that you were covered on your previous plan.
  
  For example, if your new health plan has a 6-month waiting period before covering your treatment of high blood pressure and you had health insurance coverage for the past 12 months, you would be fully covered for your high blood pressure when you start your new plan.
• COBRA - If you are laid off from your job and your former employer has more than 20 employees, the company is required by a 1986 federal law (known as COBRA) to offer you the option to pay for an extension of your health insurance coverage for at least 18 months. COBRA is not available if you have a private health insurance plan.

Health Reform Changes

The Patient Protection and Affordable Care Act signed into law in March 2010 addresses access to health insurance coverage and assures that all Americans who need coverage will be able to get health insurance. It is not clear how the legislation will impact the cost of health insurance, especially premiums and out-of-pocket expenses. It is likely the costs will continue to increase for the foreseeable future.

Starting in 2014, you will be able to purchase health insurance in a health insurance exchange that will be available in all states. At that time, health insurance companies will not be allowed to impose any pre-existing condition limitations. However, until 2014, the recommendations above will continue to be valid.

Understand Your Options

You also need to make sure that you fully understand the benefits and limitations of the private plan compared to your employer-based plan. Are the benefits the same? If the private health insurance is a managed care plan (such as a PPO or HMO), are your doctors in the network?

If you apply for private health insurance, do not cancel any health insurance coverage you currently have until you receive an approval letter and insurance policy, or contract from the health plan you selected.,

Before you make any commitment, carefully review the new insurance policy.

Source : www.healthinsurance.about.com