|
|||||||||
|
|
|
|||||||||||||||
|
|
|
With the LifeWise and HSA Bank’s Healthcare Savings Account (HSA) program , you purchase a high deductible catastrophic major medical program through LifeWise and set up a HSA with HSA Bank. There are no primary-care gatekeepers on the LifeWise medical plan and you have the freedom to see specialists without referrals via their State wide PPO network. LifeWise offers a choice between a $1,700 and $3,000 individual deductible medical plan ($3,400 and $6,000 family deductible) and you have the option to make contributions to the HSA in amounts equal to the deductible you choose. Benefit Summaries
Rates:
Providers:
Enrollment:
Coverage for individuals and families is available statewide to permanent Washington State residents, except those eligible for Medicare. Eligible family members include you, your spouse, and unmarried children under age 23 who are primarily dependent on you for support. Need Help? 206.448.7878 or 800.987.8199 Enrollment Forms & Instructions Completed enrollment materials must received in our office on or before the 20th of the month will be effective on the first of the following month (e.g., June 20th for July 1st effective date). Applications received on or before the 5th of the month will be effective on the 15th of that month (e.g. July 5th for July 15th effective date).
FAQs – LifeWise
Q. If I live out of the state for part of the year can I still be covered? A. Yes, so long as you are a permanent resident of Washington state. Keep in mind that only emergency or urgent care outside of the state will be covered at the higher benefit level. All non-urgent and non-emergency care outside of the state will be covered at a constant 50% benefit level. Q: Can state residents age 65 or older enroll on a LifeWise individual product? A: Only non Medicare-eligible residents who are 65 years of age or older when their coverage will begin may enroll on one of these individual plans. Please note that people already on an individual plan when they reach age 65 may continue their individual coverage. Q: Are single employee groups eligible? A: Yes. Single employee groups are eligible for LifeWise Individual plans. Q. Are children covered by medical child support orders required to be Washington state residents? A. No. The residency requirement does not apply nor must they complete the Standard Health Questionnaire. And, the nine-month pre-existing condition waiting period will be waived. Please note that these children would receive out-of-area benefits for all services, with the exception of medical emergencies and accidental injuries. Q: Does LifeWise accept applications for effective dates more than one month in the future? A: Yes. Applicants may designate a first-of-the-month effective date of up to three months from the date of application. Q: How do I apply for coverage? A: You will find product information and forms on this Web site. Once you have selected the plan and rates you want, fill out the enrollment application and the Standard Health Questionnaire (if needed). Be sure to include the documentation requested on the application checklist. Q: If I choose a $10,000 deductible plan, can I later change to a $500 deductible plan with the same benefits? A: Yes, but you would have to complete the Standard Health Questionnaire, and acceptance to the new plan will depend on the results of that questionnaire. In addition, the pre-existing condition waiting period will apply because you are moving to a plan offering greater overall benefits and, as with all newly effective contracts, you will have a 12-month waiting period for organ and bone marrow transplant benefits. In all cases deductibles and benefit maximums will start over. Q: If a member currently enrolled in a LifeWise Individual plan applies for a new plan and is not accepted, may he or she retain the existing coverage? A: Yes. Q: The tobacco use section on the application asks whether any tobacco products have been used in the past 12 months. Are nicotine patches considered tobacco products? A: No. Lifewise is asking about tobacco products such as cigarettes, cigars, chewing tobacco and other like products. Q: When does an applicant not need to fill out a Standard Health Questionnaire? A: You don't need to fill one out if you are: Applying for coverage due to relocating within Washington state to an area where your prior health plan isn't offered. Applying for coverage because your health care provider (whom you have seen in the past 12 months) has cancelled from his or her prior insurance, and is contracting with Lifewise. Applying for coverage after exhausting COBRA continuation coverage. A newborn child or newly adopted child of an existing LifeWise individual enrollee. You must apply for coverage within 90 days of relocation, provider cancellation or exhaustion of COBRA in order to have the Standard Health Questionnaire requirement waived. An individual losing group coverage through their employer and is not eligible for COBRA does not have to complete the Standard Health Questionnaire if they’ve had 24 months of uninterrupted active group coverage and apply within 90 days of specific qualifying events. (After June 10, 2004) An individual losing coverage due to the cancellation of their group conversion plan does not have to complete a Standard Health Questionnaire. (After June 10, 2004) Q: Do current LifeWise enrollees have to fill out the Standard Health Questionnaire if they want to switch to another Individual plan? A: Yes. Q: If I have exhausted my state continuation of coverage, must I fill out the Standard Health Questionnaire? A: Yes. However, in some cases the nine-month pre-existing condition waiting period may be waived. Q. Who reviews the Standard Health Questionnaire sent to LifeWise? A. LifeWise reviews each questionnaire. The questionnaire was developed by the Washington State Health Insurance Pool Board, which sets the rules and procedures to score and evaluate it. Q. Would a different health plan score the Standard Health Questionnaire differently? A. All health plans must score the questionnaire using instructions from the board of the Washington State Health Insurance Pool. Documentation (accompanies application and Standard Health Questionnaire) Q: Do all the family members have to show proof of residency or just the subscriber? A: LifeWise requires proof of residency from the primary applicant. Q: I haven't received a certificate of creditable coverage yet from my former carrier. How does this affect me? A: A carrier must provide a certificate of creditable coverage within 30 days of termination of policy and at no charge to you. If your coverage starts before LifeWise has a copy of your proof of coverage, pre-existing conditions will apply. However, once they receive the document from you, they will apply the proof of coverage retroactively to your coverage start date. Q: What is considered acceptable proof of prior coverage for someone who has just moved from a foreign country? A: LifeWise will evaluate each situation separately. A health card, plan identification card or certificate issued by the national health plan is acceptable proof. Q: When determining an enrollee's age for rate purposes, what is age based on-last birthday (current age) or nearest birthday? A: Current age. Q: Can a separate policy be written for the other family members if one adult smokes? A: Yes. Q: If an applicant is denied enrollment, is he or she told why? A: Yes, if an applicant is determined to be eligible for coverage through the Washington State Health Insurance Pool. LifeWise mails a copy of the questionnaire to the applicant with a letter listing each condition marked and the scores it received within 15 business days of receiving the complete application. Q: If someone is denied coverage by LifeWise and obtains coverage from the WSHIP plan, can he or she ever return to private market coverage? A: Yes. An enrollee on the WSHIP plan may apply for private insurance coverage at any time. However, the person must complete the Standard Health Questionnaire, which determines eligibility for coverage on private plans. Q: If a parent with children applies for coverage and the parent is not eligible based on the answers to the Standard Health Questionnaire, what happens to the eligible children? A: The children may be covered, as long as the parent marked "yes" on the application when answering the question "If one or more family members is not accepted for coverage, I authorize LifeWise to enroll those who are eligible in the program I have selected." The children would automatically become subscribers under separate contracts at the lowest subscriber rate (assuming all children are under 25 years of age). Q: What is the Washington State Health Insurance Pool (WSHIP)? A: The Washington State Health Insurance Pool (WSHIP) was created by the Washington State Legislature. It provides health coverage to Washington residents who cannot find adequate commercial health coverage due to their health conditions, or because they reside in a county where commercial individual coverage is not offered. Q: Is WSHIP the high risk pool? A: WSHIP is sometimes referred to as "the high risk pool," but that label is not correct. WSHIP was created by the Washington State Legislature. It provides health coverage to Washington residents who cannot purchase commercial health coverage due to their health conditions, or because they reside in a county where commercial individual coverage is not offered. Q: How do I contact WSHIP? A: Q: Who can apply directly to WSHIP? A: Only those people who live in counties where no individual insurance is offered may apply directly to WSHIP, or those who have been denied coverage from a private insurer (denial letter from a carrier required) Q: Is there a pre-existing condition waiting period on the LifeWise Individual plans? A: Yes. The pre-existing condition waiting period is nine months. However, under certain circumstances the waiting period may be reduced or waived completely. For details, please contact us. Q: Does an adopted child new to the contract have to fulfill the nine-month pre-existing condition waiting period? A: The adopted child must enroll within 60 days of the adoption to avoid the nine-month pre
Q: What is the difference between a 63-day break-in-coverage as it applies to pre-existing conditions and the 90-day rule in which you don't have to complete the Standard Health Questionnaire? A: If you have a 63-day break-in-coverage, you must complete the Standard Health Questionnaire and your previous coverage will not be credited to the waiting period. If, within the last 90 days, you 1) exhausted COBRA, 2) your provider has left your current plan, or 3) you've moved to an area in Washington where your current coverage is not available, you do not have to fill out the Standard Health Questionnaire. But, if the time lapse is between 64 and 90 days, the prior coverage will not be credited toward your pre-existing condition waiting period. |
|||||||||||||||||||||||||||||||||||||||
|
Home | Associates | Location | Privacy Policy Plaza 600 Building : 600 Stewart Street : Suite 1210 : Seattle, WA 98101 |
|||||||||||||||||||||||||||||||||||||||
