Individual's Frequently Asked Q's

What are Health Savings Accounts and how do they work?

A Health savings account is simply a checking account that allows you to pay for qualified medical expenses on tax advantaged basis.  The account may be established at any bank that provides these types of services. In order to reap the advantages of an H.S.A. you must be insured by a High deductible Health Plan (HDHP) as specified by the IRS.
H.D.H.P.s are available to both groups and individuals and they are simply an insurance plan with a high deductible threshold. The concept is that the premium savings, if deposited into the H.S.A. will provide more control to the insured and encourage wise use of the funds. If they are not “spent” on qualified medical expenses, they may be rolled over from year to year. There are no limits on the amount of funds that can be in an H.S.A. but there are limits on annual contributions.  This graphic will give an overview of how insurance and an H.S.A. work.

Click above to view the HSA diagram

Once I am insured, what if any medical expenses will I be responsible for?

Generally there are four ways that you participate in medical costs.

  1. copays for specific circumstances (office vists, emergency room, pharmacy)
  2. Deductible… this is your responsibility before the insurer participates.
  3. Co-Insurance.. once the deductible has been met, most insurers pay a specific percentage of the costs. (70/80/90) You would be responsible for the balance generally up to a specific out of pocket limit.
  4. Uncovered expenses.  All insurers will provide you with an agreement, the insurance policy, which details what non-covered expenses are

How are rates for individual plans determined?

IIn Washington, rates for individual health insurance are based on the age of the applicant.  Rates can be higher if the applicant uses tobacco products, but can not be increased or decreased based on the health of the applicant.

If I cannot qualify for an individual plan due to health reasons what are my options?

Washington provides a “carrier of last resort” for folks who cannot qualify under individual plans.  The benefits are excellent although costs are high due to the nature of this pool of insureds.

What are temporary insurance products?

These are designed to provide short term coverage to individuals who are between jobs,  students, those on a probationary period with their new employer etc. They are relatively inexpensive and purchased for a specific time period.  They generally do not include coverage for pre-existing health conditions.

What about pre-existing health conditions?

Washington State has specific protection for consumers leaving one plan and transferring to another. Under most circumstances, if the coverage is like-kind, and there is not a prolonged break in coverage (more than 90 days) the waiting periods are waived.

What if I have been uninsured for an extended period?

There is a 9 month waiting period for existing health conditions.

What is the best plan for me?

Many folks wish to obtain catastrophic coverage only to lower monthly costs. Others wish to provide greater “up-front” benefits so their out of pocket cost for medical care will be limited. In either case, we can assist you in obtaining the product that best fits your needs and budget.

How are my claims paid?

Most plans now are of the PPO variety. (Preferred provider Organization) When you seek the care from a member provider (hospital, chiropractor, physician, pharmacy) they will agree to bill your insurance company for you, AND agree to the fee schedule set by the insurer.

What is an explanation of benefits?

This is the statement that you receive from your insurer once a claim has been acted on. We refer to them as EOB’s. They will tell you how the claim was processed and what responsibility is yours.

Quick Links:
Washington Insurance Commissioner
Medicare Information
Lifewise Health Plan
Premera Blue Cross
Mutual of Omaha
Washington Health Insurance Pool
Washington Dental Service
Assocatiation of Wahington Business
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