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Numerous state and federal laws make it easier for people with pre-existing conditions to get or keep health insurance, or to change from one health plan to another. A federal law, known as the Health Insurance Portability and Accountability Act (HIPAA) sets national standards for all health plans. In addition, states can pass different reforms for the health insurance plans they regulate (fully insured group health plans and individual health plans), so your protections may vary if you leave Washington. Neither federal nor state laws protect your access to health insurance in all circumstances. So please read this guide carefully.

The following information summarizes how federal and state laws do — or do not — protect you as a Washington resident.

How am I protected?
In Washington, as in many other states, your health insurance options are somewhat dependent on your health status. Even if you are sick, however, the laws protect you in the following ways.

• Coverage under your group health plan (if your employer offers one) cannot be denied or limited, nor can you be required to pay more, because of your health status. This is called nondiscrimination.

• All health plans in Washington must limit exclusion of pre-existing conditions. There are rules about what counts as a pre-existing condition and how long you must wait before a new health plan will begin to pay for care for that condition. Generally, if you join a new plan your old coverage will be credited toward the pre-existing condition exclusion period, provided you did not have a long break in coverage.

• Your health insurance cannot be canceled because you get sick. All health insurance is guaranteed renewable.

• If you leave your job, you may be able to remain in your old group health plan for a certain length of time. This is called COBRA continuation coverage or state continuation coverage. It can help when you are between jobs or waiting for a new health plan to cover your pre-existing condition. There are limits on what you can be charged for this coverage.

• If you lose your group health insurance and meet other qualifications, you can buy a conversion policy. This is an individual health plan from the company that insured your employer group. You cannot be denied coverage because of your health status, and you will not face a new pre-existing condition exclusion period. There are limits on what you can be charged for a conversion policy.

• You can be turned down for an individual health plan because of your health status, age, or any other factor that might predict your use of health services. If you have health problems, you may qualify for health insurance from the Washington State Health Insurance Pool (WSHIP).

• If you are federally eligible, you can buy an individual health policy from an insurer.

• If you are buying an individual or small group health plan, you cannot be charged more for your health insurance due to your health status. This is called adjusted community rating.

• If you, as an individual, family, or employer, cannot afford health insurance, you may be able to purchase a managed care plan through the Washington Basic Health Plan program.

• If you are a small employer buying a group health plan, you cannot be turned down because of the health status, age, or any other factor that might predict the use of health services of those in your group. All health plans for small employers must be sold on a guaranteed issue basis.

• If you are a small employer buying a group health plan, you cannot be charged more due to the health status of those in your group. This is called adjusted community rating.

• If you have low or modest household income, you may be eligible for free or subsidized health coverage for yourself or members of your family. The Washington State Basic Health Program offers subsidized health coverage to individuals and families. Basic Health offers no cost coverage for children under age 19 when eligible families sign up through Basic Health. This coverage is the same as Healthy Options for kids through Medicaid and is called Basic Health Plus. The Washington Medicaid program offers free health coverage for pregnant women, families with children, elderly and disabled individuals with moderate to low incomes. Finally, the WSHIP offers premium subsidies to enrollees age 50 and older who have low to modest incomes. (See Chapter 5.)

• If your children are 18 years old or younger, do not have health insurance and do not meet other Medicaid type qualifications, you may be able to buy insurance for them through the Basic Health program.