Standard Health Questionnaire

Standard Health Questionnaire (SHQ)

The Standard Health Questionnaire (SHQ) is used by insurance carriers to determine eligibility of people who apply for private, individual medical coverage. Carriers are required by law to use this questionnaire and its scoring system if they sell plans for which you can be rejected based on your health. You may only be rejected for coverage if you score 325 or more points. If you are rejected, you are automatically eligible for coverage from WSHIP.  WSHIP was created by the Washington legislature to offer health insurance to residents who are rejected for individual coverage.  WSHIP is also responsible for the form and content of the questionnaire and for recertifying it every 36 months to ensure that it meets the requirements of state law.  WSHIP does not administer or score the questionnaire; the carrier provides and scores the applicant’s questionnaire.

Exemptions. Some individuals are exempt from taking the questionnaire and cannot be rejected by carriers if they meet other requirements of the plan. These exemptions are determined by the legislature and not by WSHIP. They are listed at the beginning of the questionnaire. WSHIP does not advise on whether or not an applicant qualifies for an exemption.

How does the SHQ work? The questionnaire contains a list of medical conditions and each condition is assigned a point value. You are asked to mark any condition you have been diagnosed, treated, medicated, and/or monitored for within the timeframe specified. Your total score will be used by the carrier to determine eligibility for coverage.

How are the points determined? The point value assigned to each condition is determined by an independent consulting actuary and based on actual claims data for Washington state. If a condition has higher points than another condition, it means the costs of treating that condition were higher for the population as a whole. Everyone is scored the same number of points for the condition.

Can the score be appealed? You may appeal to the carrier (and then to WSHIP) if you believe your questionnaire was not scored correctly or timely. WSHIP does not accept appeals disputing the number of points assigned to a particular condition.

Who to contact with questions. Contact your agent or the carrier if you have questions about whether you are required to fill out the questionnaire, how to fill out the questionnaire or how your questionnaire was scored. See our “Frequently Asked Questions About the Standard Health Questionnaire” document for more information.

Samples of the questionnaire and scoring system are provided below for informational purposes only. Do not fill out this questionnaire or send to WSHIP.  The Standard Health Questionnaire will be included as part of the insurance carriers' application.  If required, you will submit your completed questionnaire directly to the carrier.

October 1, 2009 Recertified Standard Health Questionnaire and Related Materials
The Standard Health Questionnaire has been recertified and modifications were approved by the Board of Directors of WSHIP May 21, 2009, for coverage on or after October 1, 2009.