What is Individual Health Insurance?
Individual Health Insurance is health coverage that individuals can purchase directly from an insurance company for themselves and their family. Self-employed people and workers at companies that do not offer health benefits may purchase health insurance individually.
Am I eligible for Individual Insurance?
Most people in Washington State are eligible for individual policies.
Can Evergreen pay for my Individual insurance plan?
Evergreen can pay for Individual insurance plans purchased outside of the Health Benefit Exchange only if a person does not qualify for a plan inside the Exchange.
If you currently have an individual policy that does meet our cost-effective criteria, please contact Evergreen to find out whether we can pay your premiums.
How do I apply for an Individual Health insurance Plan?
You can apply online or contact the insurance carrier for an application for an Individual plan.
You should compare benefits and premiums before applying for coverage. The Office of the Insurance Commissioner keeps a complete list of the carriers, the counties they serve, and sample rates. You can also call the Statewide Health Insurance Benefits Advisors' (SHIBA) Consumer Hotline at 1-800-562-6900 to ask for a copy of this publication.
You will need to apply directly with carriers offering individual insurance plans in your county. The open enrollment period to purchase a plan is from November 15, 2014 through February 15, 2015. Outside of open enrollment, a person must experience a "Qualifying Event" in order to immediately enroll in an Individual insurance plan. Qualifying Events are defined as:
- You are no longer eligible for Washington Apple Health (Expanded Medicaid).
- You have given birth to a child, adopted a child, or placed a child up for adoption.
- You lose your health coverage for a reason other than lack of employment.
- You permanently move to a new area where your current plan does not provide coverage.
- Your COBRA coverage ends.
- Your dependent loses their coverage on your employer plan due to their age.
- You get married or enter into a domestic partnership.
- You get divorced or end a domestic partnership.
Currently there are three insurance carriers that are able to accept third-party payment from Evergreen:
If Evergreen informs you that we can pay for an individual plan that you already have, submit your plan information along with application to Evergreen.
- Include documentation of the monthly premium amount. In addition, Evergreen may need the Summary of Benefits for the plan. We will process your application and send a check to your insurance carrier.
- You will also need to enroll in EIP if you are not a current EIP client.
Other important information about Individual Health Coverage
Things you should consider when comparing benefits:
- What does the plan exclude?
- How much are the co-payments and deductible?
- Are there limits on how much you must pay "out of pocket"?
- Are there limits on the number of times you may receive a service?
- Is there a dollar limit on certain benefits – prescription drugs, for example?
- Is your doctor part of the insurance plan’s network?
- Will you be able to choose your primary care doctor and other providers you currently see?
- How will you get access to specialists?