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Washington State Office of the Insurance Commissioner

Frequently asked questions

Q. How can I apply?

A. Applications are available at www.wship/PCIP-WA or by calling the plan toll-free at 1-877-505-0514. If you apply by the 15th of the month, and you are accepted, coverage will begin on the 1st of the next month.

Q. How is the new plan different from Washington's current high risk pool, the Washington State Health Insurance Pool (WSHIP)?

A. There are four key differences:

    1. You must be uninsured for at least six months to be eligible for the new plan and WSHIP has no such requirement.
    2. The new plan has no waiting period before coverage for pre-existing conditions begins and WSHIP has a six month pre-existing waiting period.
    3. The new plan includes a list of pre-existing conditions that automatically qualify you for the new plan. To qualify for WSHIP you must be rejected for individual coverage.
    4. The new plan is funded by premiums and federal dollars. WSHIP is funded by premiums and an assessment on the health insurers in Washington state.

If you'd like more information, here's a side by side comparison of the state and federal programs (PDF).

Q.  Who is eligible for the new plan?

A.  To be eligible, you must have been uninsured for at least the last six months.You also need to be meet the criteria for having a pre-existing condition and be a U.S. citizen or individual residing here legally and a Washington State resident.

Q. Can I apply for coverage if I have COBRA and it's about to run out?

A. No, even if your COBRA or other continuation of coverage is about to run out, you won’t meet the requirement to be uninsured for at least the last six months.

Q.  If my health conditions are not included on the application’s “Eligible Pre-existing Medical Conditions List,” could I still qualify?  How are other conditions considered in determining my eligibility?

A. You may still qualify for PCIP-WA if your conditions are not on the list. Make sure to mark “Other” at the bottom of the Eligible Pre-existing Medical Conditions List and write in all health conditions you have.  Attach a letter from your doctor confirming these conditions or a copy of a signed prescription form that contains your full name and exact diagnosis codes.

An enrollment specialist will check the diagnosis codes on the Standard Health Questionnaire (SHQ) database to establish a SHQ condition score for each diagnosis that you list.

If the combined SHQ score is over 121 you qualify for PCIP-WA coverage.

Q. Can I list more than one condition under “other”?

A. Yes.  Remember to submit the required documentation for each condition.

Q.  The application says that I must be without “substantial health coverage (known as Creditable Coverage)” for at least six months.  What does that mean?

A.  If you are covered by a health insurance plan, you probably do not qualify for PCIP-WA.  However, certain limited types of insurance do not qualify as “creditable coverage” (substantial health coverage) and do not disqualify you from the plan.  If you have a question about whether your coverage meets this definition, please call us at 1-877-505-0514.

Q. Why did Washington state decide to run its own program instead of letting the federal government run the plan?

A. The key benefit to running our own program, along with our current high risk pool, the Washington State Health Insurance Pool is that we maintain local control and can modify the plan to meet the specific needs of Washington residents.

Q. How many other states are running their own programs?

A. 29 states and the District of Columbia are running their own programs. See a map of states

Q. How are the rates determined?

A. Rates for the Pre-existing Condition Insurance Plan cannot be more than the average rate in Washington State’s  individual market for comparable coverage. See rates

Q. How much is the federal government giving Washington state for this program?

A. Based on current estimates, Washington state will receive $239 million from the federal government to fund the program.

Q. If I enroll in this program and congress repeals health care reform what will happen to my benefits?

A. Funding for the Pre-existing Condition Insurance Plans was appropriated in 2010. To end the program, congress would have to pass legislation to repeal funding. Passage would require a 2/3rds majority vote and the Presidents signature.

Q. Why is the program temporary? What happens when it ends in 2014?

A. The Pre-existing Condition Insurance Plan was designed to provide temporary coverage to people struggling to find health insurance. In 2014, the full benefits of federal health reform take effect and insurance companies can no longer deny people coverage because of a pre-existing condition.

 

 

 

 

 




Updated 01/25/2012

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