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Washington Health Insurance

Having a suitable health insurance always takes precedence when it comes to protecting your family against unexpected events. Purchasing health coverage is costly and requires a thorough review of all future risks and its influence on your financial health. In the U.S., nearly 47 million people are uninsured, majority of whom are working families who are susceptible to the possibility of huge medical bills due to the absence of proper health coverage. For those families who are not covered by their employers’ group plan, there are low-cost state sponsored health insurance programs that provide insurance to the medically-uninsurable individuals.

In 2008, Washington stood at the 10th place on the Healthiest States List as issued by the United Health Foundation. The state was on 12th and 15th position in 2006 and 2007 respectively. Many factors that have contributed to the improved Washington’s health score include low prevalence in smoking, low percentage of children under 18 in poverty, low infant mortality rate and decreasing uninsured population. The Washington state, with more than six million residents, offers both private-market and public health insurance alternatives. The private-market health insurance consists of various types of health plans including family, Medicare supplemental, short-term, student, group and dental. Additionally, the state and federal government sponsored programs provide economical health coverage to the uninsurable citizens of Washington who meet specific eligibility requirements of age and income.

The Washington State Office of the Insurance Commissioner manages and administers all kinds of insurance sold through private-market health insurers as well as public health coverage programs. However, due to high geographic disparity with the state, approximately 11.7% of the population is still uninsured. According to the Censor Bureau’s 2007 and 2008 Current Population Survey, roughly 40.7% of uninsured residents come under the above 200% FPL category.

On the whole, Washington State’s health system is robust, providing better healthcare access to its citizens. If you are a resident of the Washington state in need of suitable health coverage, contact a licensed health insurance agent/broker to the avail the suitable health insurance options and their benefits.

Individual/Family Health Insurance

Below is the guidelines for applying for and obtaining individual health insurance in the state of Washington. These regulations apply to all insurance companies offering individual or family health insurance in Washington:

Medical Underwriting


Pre-Existing Condition Exclusion Period

9 months

Look Back Period

6 months

Look Back Standard

Prudent person

Mandatory Benefits

Cancer screening for women including breast cancer screening, direct access to OB/GYNs, eating disorder parity, maternity care

Market Rate Restrictions


Guaranteed Issue Options


Small Group Health Insurance

Below is the guidelines for small group health insurance in the state of Washington. These regulations apply to all insurance companies offering small group health insurance in Washington:

Small Group Size


Employee Qualifications

Two employees must work 30 hrs/week for coverage
Owner can count as an employee with proprietor

Guaranteed Issue


Premium Rating Factors

Adjusted Community Rating

Rate Adjustment Factors

Modified Community Rate

Look-Back Period

6 months

Pre-existing condition exclusionary period

9 months

Mandatory Benefits

Same as Individual

State Cobra Variations for Small Groups

Below are the COBRA guidelines for small groups in the state of Washington. For employer groups of more than 20 employees, refer to the federal COBRA guidelines:

Mini-Cobra Option


Eligible Group Sizes


Extension of Benefits Period - Standard


Extension of Benefits Period - Disabled


Maximum Premium Increase


State Legislation Reference


Additional Notes


State Sponsored Health Insurance Programs

There are several state sponsored health insurance programs in the State of Washington to assist those without insurance in obtaining adequate coverage.

High-Risk Pools

Some states offer special state sponsored health insurance plans for qualified persons that are not eligible for individual health insurance due to pre-existing medical conditions. The guidelines for enrollment in these programs vary by state. The high-risk pool in the State of Washington is summarized in the chart below:

Plan Name

Washington State Health Insurance Pool (WSHIP)


Phone Number


HIPPA Eligibility Required?


Available Carriers

Benefit Management, Inc., (BMI)

Pre-Existing Condition Waiting Period

6 months

Enrollment Periods

Currently Open to New Enrollment

Premium Limits

No more than 150% of standard rate

Lifetime Maximum Benefit

$2 million

Special Notes

To qualify for the coverage, you should be a Washington state resident; you must have been rejected for coverage by an insurance carrier; you are not eligible for Medicare coverage.

Children’s Health Insurance Program

Through shared funding from the federal government, the State of Washington provides health insurance for uninsured children that meet certain eligibility guidelines. A summary of this program is outlined in the chart below:

Program Name

Apple Health for Kids


Phone Number


Apply Online


Age Limits

Under 19

Insurance Carrier

Depends on community of residence

Length of Coverage

Annual income eligibility review

Residency Requirements

Washington resident, U.S. citizen, legal immigrant

Other Eligibility Requirements

The child should not be eligible for Medicaid, and the family income should be between 200 and 250% of FPL.

Pre-Existing Condition Exclusions



The premiums are $15 per child, with a family maximum of $45 per month.


Medicaid is a state program partially funded through the federal government. Qualification guidelines, as well as the types of people that are eligible, will vary by state. The chart below provides a summary of the Medicaid programs in the State of Washington:

Governing Agency

Department of Social and Health Services


Phone Number


Residency Requirements

Washington resident, U.S. citizen, qualified immigrants

Federal Poverty Line Income Limits

Child age 0-19: 200% FPL
Pregnant woman: 185% FPL
Parent: 50% FPL with resource test

Additional Resources

Washington Health Care Options Matrix™ Guide

Provided by the Foundation for Health Coverage Education, the guide is a quick reference guide prepared by the non-profit Foundation for Health Coverage Education that outlines Washington’s public and private health care choices for individuals and groups with various demographic profiles.

Family Health Insurance Guide by

The guide created by provides useful information regarding health insurance coverage such as individual/family health insurance, group health insurance, separate child health insurance and state-sponsored programs that are available for low to middle income families.

Washington: At-A-Glance

Provides all-inclusive health data of Washington state. is a project of the Henry J. Kaiser Family Foundation and is designed to provide free, up-to-date, and easy-to-use health data on all 50 states.