Basic Information About Washington Group Health Insurance

In Washington state there are various regulations that relate to individual and group health insurance plans. Washington group health insurance regulations can be learned about in detail by contacting the state insurance regulation department. The basics of this type of insurance are similar in many ways to that of other states. There are two types of group plans -- fully insured and self insured. A fully insured plan means the insurance company accepts the risk and pays the claims. With a self insured plan, the employer is responsible for doing this. You will learn up front whether your group plan is fully insured or self insured as it should be clearly designated.

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One issue that is important to anyone seeking insurance is that of pre-existing conditions. In Washington there are certain rules which apply to this issue. For example, a fully insured plan can exclude these conditions for nine months while a self insured plan can exclude these conditions for twelve months. How long a condition must have existed to be considered pre-existing will vary and should be detailed in your plan. Your insurance administrator can explain more about this issue.

Group health insurance may use one of the following -- an HMO, PPO or POS. These terms are acronyms that you should familiarize yourself with. An HMO stands for health maintenance organization. There are rules and restrictions associated with this type of plan. For example you will have to choose a primary care provider who must refer you in the event you need a specialist. A PPO is similar to an HMO and stands for preferred provider organization. It is, however, less restrictive. A POS plan stands for point of service and is like a combination of an HMO and PPO with certain rules and regulations.

Washington group health insurance can be a complicated subject but employees should understand the basics. You need to know if your employer offers a plan or more than one from which you can choose, how much it costs to participate and all the details of the plan. When you are hired you should receive a detailed explanation of the benefits provided to you. There may be copayments and deductibles you are responsible for paying before your insurance coverage takes effect. When you become insured you will get plenty of information explaining the details of your particular coverage plan.

 


 

 

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