History and Purpose
WSHIP is the high risk health insurance pool for the state of Washington. It serves as a safety net for individuals who have been denied health insurance coverage because of their medical status or are unable to obtain comprehensive coverage.
WSHIP was established under the Washington State Health Insurance Access Act of 1987 (RCW 48.41), which was substantially amended in 2000 after the state’s individual insurance market had collapsed in 1999 as a result of guaranteed issue enacted in 1994. The following description of the Pool is based on the act as amended, which describes legislative intent as:
- To provide access to health insurance coverage to all residents of Washington who are denied health insurance.
- To provide a mechanism to ensure the availability of comprehensive health insurance to persons unable to obtain such insurance coverage on either an individual or group basis directly under any health plan.
The statute has been amended several times since 2000. Most recently, the statute was amended in 2013 to address provisions of the Affordable Care Act (ACA) that take effect on January 1, 2014 that prohibit carriers from denying individual coverage due to pre-existing conditions.
The modifications to WSHIP’s statute effective January 1, 2014 include: 1) elimination of the Standard Health Questionnaire; 2) changes to WSHIP’s eligibility criteria for its non-Medicare plans; 3) a requirement to discontinue WSHIP non-Medicare plans on December 31, 2017; and 4) a directive for the Board to revisit its study of eligibility completed in 2012 with another review of the populations that may need ongoing access to coverage through the Pool, for submission to the Governor and Legislature in November 2015.
WSHIP’s non-Medicare plans are currently closed to new enrollment but WSHIP continues to provide coverage to individuals who were enrolled in those plans prior to December 31, 2013 and have elected to keep their WSHIP coverage. By law, WSHIP’s non-Medicare plans will be discontinued on December 31, 2017.
WSHIP’s Medicare-eligible plan (Basic) continues to be open to new enrollment. This plan provides supplemental coverage to individuals enrolled in Medicare and unable to obtain comprehensive supplemental coverage.