What is the Washington State Health Insurance Pool (WSHIP)?

WSHIP is a high-risk pool that provides health insurance coverage to people living in Washington State who have been denied individual health insurance. The process of applying to WSHIP can be long and complicated, but Evergreen can help you with each step of the process.

Am I eligible for WSHIP?

If you are a resident of the state of Washington and you have been denied health insurance through an individual carrier, you are eligible for WSHIP. Washington residents living in counties where commercial individual coverage is not available are also eligible.

WSHIP does not offer prescription coverage to new enrollees with Medicare. If you have Medicare and ESRD, you may also be able to obtain medical coverage through WSHIP.

Can Evergreen pay for my WSHIP?

Evergreen can pay for WSHIP's regular medical policies:

• Plan 3, the Network or Preferred Provider Plan, with a $500 deductible
• Plan 1, the Standard Plan, with a $500 deductible, only if your doctor is not on the WSHIP network
• We can also pay for the Basic Plus Medicare plan, however, this plan is closed to new enrollees

A note for people with Medicare, who are not currently in WSHIP's Basic Plus plan:

• Evergreen cannot pay the premiums for the WSHIP Basic Plan, which is the only WSHIP plan open to new enrollees with Medicare. If you are newly eligible for Medicare, or new to Washington State and have Medicare, please see our Medicare Part D page.

How do I apply to WSHIP?

• Complete an application for individual insurance coverage and the SHQ. Our website has more information about individual insurance plans.
• Because of your HIV status, you will then be sent a denial letter based on exceeding the maximum scoring criteria. WSHIP will need this denial letter and score sheet as proof of your eligibility for WSHIP.
• Complete the application for WSHIP, making sure to provide all necessary information and signatures. If you have questions or particular concerns, please ask your case manager or an Evergreen insurance advocate to help you with these applications. We are here to make this process as trouble-free as possible.
• Submit your WSHIP application along with an application to Evergreen. If you are not a current EIP client, you will need to enroll in EIP. We will process your application and send in the WSHIP application along with a check.
• When your denial letter comes in, send it to us as soon as possible. However, we can accept WSHIP applications before the denial letter arrives.
• If you had prior insurance coverage, request a Certificate of Continuous Coverage (CCC) from your previous insurance carrier. This is important, in order to avoid a pre-existing wait period with WSHIP (see below).

Other important information about WSHIP

• WSHIP has a 6 month pre-existing wait period. During this time, you will not have coverage for anything that can be linked to your pre-existing health condition (such as HIV). However, if you had prior insurance coverage within 63 days before applying to an individual policy, you would not have a pre-existing wait period. This is determined by the date of your rejection letter. A Certificate of Continuous Coverage (CCC) from your previous insurance carrier will provide the needed verification.