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. However, the 8% who are the "most costly" to insure may be denied individual coverage due to their health condition. Therefore, people with HIV/AIDS generally cannot get individual coverage.

When applying for an individual policy, you must fill out a Standard Health Questionnaire (SHQ). The SHQ will screen out that 8% of people who will be denied individual coverage.

If you are denied individual insurance, you will be eligible for coverage through the Washington State Health Insurance Pool (WSHIP).

If you currently have an individual policy that does meet our cost-effective criteria, please contact Evergreen for information about whether we could pay your premiums.

How do I apply for an Individual Health insurance Plan?

You may be interested in purchasing your own individual coverage, or you may need to apply in order to qualify for WSHIP. To do so, you will need to apply directly with the carriers offering individual insurance in your county.

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 SHIBA’s Consumer Hotline at 1-800-562-6900 to ask for a copy of this publication.

Here are the five largest companies offering individual insurance policies in Washington State:

• Group Health Cooperative
• KPS Health Plans
• Lifewise Health Plans
• Premera Blue Cross
• Regence Blue Shield of Washington, or Regence of Oregon (for Clark County residents)

When applying for individual coverage, you will also need to fill out a Standard Health Questionnaire (SHQ). Both the insurance application and the SHQ are submitted to the individual insurance company. The SHQ is the same for all health insurers and can be found online.

You can print out applications and the SHQ from insurance websites, or fill both out online. Online applications are generally processed faster than paper ones.

You will not have to complete the SHQ if any of the following are true within the last 90 days:

• You have exhausted your COBRA coverage.
• You have 24 months of continuous coverage on an employer group health plan, but your company is too small to qualify for COBRA.
• You have moved out of your existing plan's service area.
• You are continuing with a doctor who has left your existing plan.

These exceptions may make you eligible for an individual plan, but Evergreen will not be able to pay for this individual plan, as no plans currently available meet our cost-effective criteria.

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 a copy of your insurance card, documentation of the monthly premium amount, and information about the plan's prescription benefits. 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?