Frequently Asked Questions
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Individuals and Families
Why do I need health insurance?
Having quality insurance means that you and your family can get the care necessary to stay healthy. And when an accident or illness strikes, a quality health plan can offer protection from huge medical bills
Starting in 2014, if individuals do not have health insurance, they will have to pay a fine of $95, which increases to $325 in 2015 and $695 or 2.5 percent of household income in 2016. For families, the penalty will be $2,085 or up to 2.5 percent of household income.
What is the Washington Health Benefit Exchange?
The Washington Health Benefit Exchange is a public-private partnership with the mission to redefine people’s experience with health care. As part of national health care reform, the Exchange is responsible for Washington Healthplanfinder - an easily accessible, online marketplace for individuals, families and small businesses to compare and enroll in qualified health insurance plans. The Exchange works in close coordination with our state agency partners, including the Health Care Authority (Medicaid), Office of the Insurance Commissioner and Department of Social and Health Services
How was the Exchange created and established?
The Exchange was created in state statute in 2011 (SSB 5445) and was established as a “public-private partnership” separate and distinct from the state. The Exchange complies with open public meetings and public disclosure guidelines, but is not subject to other laws that govern state agencies. In 2012, legislation was passed (ESSHB 2319) that established market rules, requirements for QHPs, essential health benefits and more. The Exchange initially started in the state’s Health Care Authority (HCA) and has transitioned to an independent organization.
How is Washington Healthplanfinder different from websites that sell insurance now?
Washington Healthplanfinder is redefining people’s experience with health care. Unlike other websites that sell one company’s specific health insurance plan, Washington Healthplanfinder is a central location where multiple health insurance companies compete for your business. Depending on how much you earn, you can get access to financial help that lowers the cost of your premiums and copays.
Washington Healthplanfinder also allows you to make side-by-side comparisons of multiple health insurance plans, so you can choose the right plan based on cost, coverage, convenience or any number of factors. Plus, Washington Healthplanfinder gets rid of the fine print and makes it easier to understand what a plan covers and how much it costs. Every plan offered through Washington Healthplanfinder is state-certified, so you can rest assured that you are buying a quality plan from a reliable company.
When can I find coverage through Washington Healthplanfinder?
Washington Healthplanfinder will begin enrolling consumers on October 1, 2013, for health insurance coverage beginning on January 1, 2014.
What if I need coverage now?
If you need coverage before 2014, you may be able to purchase private health insurance by contacting an insurance company or working with an agent or broker. You may also be eligible right now for health coverage under Medicaid. For more information, please visit Washington Connection at www.washingtonconnection.org.
I have insurance through my employer. Will I have to change plans?
Most individuals will be able to stay on their company’s health insurance plan. There is no requirement that you use Washington Healthplanfinder to purchase health insurance.
If I buy a plan on Washington Healthplanfinder, will I still be able to go to my same doctors?
All insurance carriers that offer health plans through Washington Healthplanfinder will be responsible for creating the networks of providers available to their customers. On Washington Healthplanfinder, you’ll be able to sort plans by provider – so you can choose a plan that allows you to continue using your current provider.
What if I’ve never had health insurance before, or have been without coverage for a while?
Washington Healthplanfinder will allow you to find, compare and enroll in a health insurance plan that meets you and your family’s needs, regardless of whether you have a pre-existing medical condition or have been without health insurance before.
How will Washington Healthplanfinder make coverage more affordable?
Residents with incomes of up to $45,960 for an individual and up to $94,200 for a family of 4 will be eligible for savings on their insurance premiums or public programs such as Medicaid. Small businesses who would like to offer health coverage to their employees may be eligible for the Small Businesses Health Care Tax Credit to help cover their monthly premiums. This tax credit is offered through the IRS.
How does the Health Insurance Premium Tax Credit Work?
Also known as an Advanced Premium Tax Credit, this tax credit can be used to lower the health insurance premium costs of Washington Healthplanfinder Qualified Health Plans. If you are eligible, this tax credit provides you the option to either reduce the amount of your monthly health insurance premium; or have a lump sum deduction when you file your annual income tax return.
Your Health Insurance Premium Tax Credit is dependent on your household modified adjusted gross income. The household income and tax filing information you provide in your Healthplanfinder application will determine how much tax credit you are eligible for. Any income changes should be reported to Washington Healthplanfinder in order to make a re-determination of your eligibility.
How much will each of the health plans cost?
Specific health insurance plans and pricing that will be offered through Washington Healthplanfinder are currently being submitted to the Exchange and the Washington State Office of the Insurance Commissioner (OIC) for review and will be announced in early fall. To help provide an estimate of what your health insurance premiums may cost, the Exchange has provided a cost-estimate calculator at www.wahealthplanfinder.org that will help individiuals find out if they will be eligible for tax credits to help lower the monthly cost of their insurance premiums.
What if I need help choosing a health plan offered through your site?
Help will be offered online, over the phone and in person for those who need additional assistance choosing and enrolling in a health plan. Stay tuned for more information about our certified “in-person assisters” who will be able to provide in-person assistance in your local community.
How is it funded?
Washington Healthplanfinder is currently funded by two federal Exchange Establishment grants through 2014. However, beginning Jan. 1, 2015, the Exchange is required to be financially self-sustaining. We worked closely with industry experts to formulate a projected operating budget and expected enrollment numbers. The Legislature has passed SHB 1947, which outlines a secure funding source for the Exchange and is most similar to the “Hybrid” funding model our Board presented to the legislature this past December. This bill funds the Exchange by a) allocating premium tax moneys identified for Exchange operations (current state tax) and b) assessments on Qualified Health Plans offered through the Exchange. For more information on SHB 1947, please click here.
What’s coming up next for the Washington Health Benefit Exchange?
- Qualified Health Plans: Insurance carriers have submitted their plans to the Washington State Office of the Insurance Commissioner for approval to be offered through Washington Healthplanfinder. The Office of the Insurance Commissioner has reviewed and approved these health plans and rates, which will be certified by the Washington Health Benefit Exchange Board in August.
- Customer Assistance Program: The Exchange will open its customer support center starting September 3 to start taking questions from consumers. Ten organizations have also been selected to build a network of in-person assistance for residents statewide, and are currently being trained by Exchange staff. Insurance brokers who would like to help residents enroll in health coverage will also be trained in August and September.
- Website Design: Washington Healthplanfinder is working with Deloitte LLP to create the website infrastructure and eligibility system for both commercial and public health plans offered through the site. This is now in the final stages of testing with the federal government.
How can the public get involved?
We work with consumers, community organizations, small businesses, insurance carriers and agents and brokers to gather valuable input on our work. Examples include:
- Consumer Workgroup: The Consumer Workgroup includes community members and organizations seeking to offer input on a variety of issues related to Washington Healthplanfinder. If you are interested in participating, please email us at email@example.com
- Public Comment: All Health Benefit Exchange meetings are open to the public and open for public comment. These include our monthly Board meetings and technical advisory committees on the Role of Agents & Brokers, Plan Management, and Small Business Health Options (SHOP).
- Email Sign-Up: Consumers interested in receiving regular updates from Washington Healthplanfinder may sign up for our electronic mailing list page.
Why should my business use Washington Healthplanfinder?
Washington Healthplanfinder Business, which is available in select southwest Washington State counties, makes it easier to compare and shop for plans all in one place. Business owners will be able to see side-by-side comparisons of state-certified health plans, including the costs, premiums, what is covered, and quality ratings. All plans will cover essential health benefits like visits to the doctor and emergency room, prescriptions, and preventative care. In addition, plans will be offered in four “metal levels” based on the costs covered.
Washington Healthplanfinder also gives employers the freedom to determine their own level of contribution toward their employees’ coverage, and make a single monthly payment rather than payments to multiple plans. Consolidated billing will also be available so employers can provide workers a choice without the hassle of contracting with multiple insurers.
Why are you only offering coverage options in select southwest Washington counties?
The Exchange was made aware that the insurance carriers that have filed to participate in Washington Healthplanfinder Business will not provide us with adequate coverage options to offer health plans statewide starting Oct. 1, 2013. Based on this information, the Exchange Board recently took action to approve the debut of Washington Healthplanfinder Business in select southwest Washington counties beginning Oct. 1, 2013.
The counties will be serviced by Kaiser Foundation Health Plan of the Northwest. Rather than delay Washington Healthplanfinder business, this new approach allows us to continue our commitment to providing health coverage options for Washington’s small businesses starting 2014. Changes to the small business market will have no effect on the market for individuals and families, which has seen great participation from health plan carriers.
What if I have questions or need help?
Washington Healthplanfinder provides personalized support for your small business to help answer questions as you choose the best coverage for you and your employees. You can also still work with an agent or broker to find plans and enroll through the website.
Will I still be able to use my agent or broker to get health insurance?
Yes, you will be able to continue using your agent and broker as long as they have been certified by the Washington Health Benefit Exchange to sell health plans through Washington Healthplanfinder. Agents and brokers must also be certified by respective health insurance carriers to sell specific health plans, just as they do today.
Do I have to get insurance for my employees? What happens if I do not cover my employees?
If you have fewer than 50 full time employees, you are not required to provide them with health insurance coverage. However, good benefits can help recruit and retain good employees. And, the tax credits offered through Washington Healthplanfinder will help put affordable health coverage within reach.
Can I use Washington Healthplanfinder if my company has more than 50 employees?
Employers with more than 50 employees may be eligible to purchase coverage through Washington Healthplanfinder in 2016.
What if I am self-employed?
Because a small business is defined as having up to 50 employees, self-employed individuals may purchase health insurance through Washington Healthplanfinder Business or through the individual market on Washington Healthplanfinder.
What is Washington Healthplanfinder Business?
Washington Healthplanfinder Business, which is available in select southwest Washington State counties, will enable small businesses with up to 50 employees to offer a choice of quality health plans and choose their level of contribution toward an employees’ coverage. Employers will be able to make a single monthly payment to Washington Healthplanfinder rather than to multiple plans. If eligible, the Exchange will provide small businesses with exclusive access to a small business health care tax credit from the IRS that will provide a 35 percent tax credit on health premiums, with the credit increasing to 50 percent in 2014.
What are the requirements for small businesses participation?
To participate, businesses may have up to 50 employees, be based in or have an employee worksite in Washington State, and achieve minimum group participation rates. Participation rates include 100 percent for businesses with two to four employees and 75 percent for businesses with five to 50 employees.
Who is eligible for the small business tax credit?
Starting in 2014, Washington Healthplanfinder Business will provide exclusive access to the small business tax credit, which is offered through the IRS. To be eligible, small employers must have 25 employees or less and contribute at least 50 percent of the total premium cost for employee health coverage. In 2014 and beyond, the maximum tax credit available is 50 percent of employer premium payments for small businesses (or 35 percent for tax-exempt businesses). The amount of the tax credit varies depending on the number of employees and average FTE annual income. The maximum credit is available for employers with 10 or fewer employees with average annual wages of $25,000 or less.
How can I enroll my current clients in Washington Healthplanfinder?
If producers have been appointed by insurance carriers to sell Washington Healthplanfinder Qualified Health Plans and have completed required training courses through the Exchange, they may enroll existing clients in the system. Clients will need to select you as their agent or broker through the Washington Healthplanfinder system. Once they have completed this step, you will be notified on your producer dashboard and can guide them through the application process.
How can I get involved?
Producers can attend our monthly Agents & Brokers Technical Advisory Committee for more information. Meeting information can be found at: http://wahbexchange.org/committees/agents-brokers-tac/ . For additional questions, please contact: firstname.lastname@example.org