Washington Health contracts with Community Health Plan of Washington to provide reduced-cost health care coverage to qualified Washington State residents.
Monthly premiums are based on your age, the age of each family member applying for coverage, the annual benefit limit you choose, if you use tobacco products, and your county of residence.
Community Health Plan Clinic and Affiliates
|Annual Benefit Limit||Health 75 - $75,000
Health 100 - $100,000
|Health 75 - $75,000
Health 100 - $100,000
|Total maximum amount the plan will pay per person in any calendar year|
|Annual Deductible||$500 per member/$1,500 per family||$1,000 per member/$3,000 per family||The amount you pay every year before the plan pays for covered services|
|Annual Out-of-Pocket Maximum
(Deductible does not apply)
|$3,000 per member/$9,000 per family||$5,000 per member/$15,000 per family||The set limit after which your plan pays 100% of the allowable charge|
|Coinsurance||30%||50%||Percentage of allowed charges you pay after you meet the deductible|
Washington Health offers two options – Health 75 and Health 100. You choose the annual coverage that best meets the needs for you and your family. Washington Health provides the same benefits regardless of the option you select.
Washington Health has partnered with Community Health Plan of Washington to provide coverage to all counties throughout the state. Their extensive network includes over 2,000 primary care providers, 13,500 specialists, 540 primary care sites, and over 100 hospitals.
Still want more choices?
Washington Health is about choice – offering discounts and low copays if you choose to receive care and prescription drugs from a Community Health Plan clinic. But choosing your own doctor is important too – so you are able to select from thousands of doctors in the Community Health Plan network while still maintaining a low deductible and coinsurance. Ultimately, you have the choice to see any provider accepting your health plan. You may pay a higher coinsurance and are subject to balance billing.
Any choice you make connects you to great basic coverage such as:
- Routine office visits and immunizations
- 24-hour nurse line
- Preventive screenings like mammograms and PAP smears
- Prescription drugs
- Emergency room and hospital care
- Diagnostic imaging and lab work
- Help with chronic illness
See a detailed list under Benefits and Services.
How Washington Health works
Washington Health is available to anyone who lives in Washington and:
- Is not eligible for free or purchased Medicare.
- At the time of enrollment, is not confined to an institution.
- Is ineligible for coverage under the Washington State Health Insurance Pool (WSHIP) or qualifies to bypass the standard health questionnaire under state law.
- Is not receiving medical assistance (Medicaid) or subsidized Basic Health benefit.
Your Monthly Premium
Once enrolled in Washington Health, you’ll get a bill for your monthly premium about six weeks before the month covered for that payment. For example, the bill for December coverage is sent in mid-October and payment is due November 5. Your monthly premium payment must be received by the fifth of the month prior to the coverage month. If you do not pay your premium when due, you will lose your coverage for at least one month. Partial payment or checks that cannot be processed for any reason will be considered nonpayment.
If you are covered through a home care agency or a financial sponsor, Washington Health will bill them directly. You may be required to contribute toward your monthly premium through them. Contact your representative for more information.
Each Washington Health member is responsible for the cost of their health care coverage. Cost sharing comes in the form of copays, coinsurance, and deductibles. In addition, each member will have an out-of-pocket maximum. (See definitions and examples.)
How the health plans work
Primary Care Providers
As a Washington Health Member, you need to choose a primary care provider (PCP). Your PCP is your main health care provider and can refer you to specialists if necessary. Everyone in your family can choose his or her own PCP. If you don’t choose a PCP, Community Health Plan of Washington will choose one for you. Visit Community Health Plan of Washington’s online provider directory for a list of PCPs.
A specialist is a health care provider other than your PCP who offers a specific kind of medicine—a surgeon, a physical therapist, or a mental health counselor, for example. Your PCP will provide you with a written referral to a specialist covered by Community Health Plan if you need to see one. Specialist care is covered only when you’ve been referred by your PCP.
You may choose to see a women’s health care specialist in the Community Health Plan network without a referral from your PCP.
In an emergency, you may receive Washington Health benefits for care without prior PCP approval. However, you must report this to your primary care provider or health plan within 24 hours or as soon as possible.
In-network and out-of-network
Although you may visit any provider you wish, your costs will vary based on if the provider is in-network or out-of-network. You will receive in-network care from a Community Health Plan of Washington clinic or from a primary care provider, specialist, primary care site, or hospital that is contracted with Community Health Plan of Washington. Out-of-network care is received from primary care providers, specialists, primary care sites, and hospitals which are not contracted with Community Health Plan of Washington. If you receive care from an out-of-network provider, and do not have a referral from your primary care provider, be prepared to pay additional costs for the services received.
Any care not approved by your health plan is not covered under Washington Health. If you receive care that is not covered under Washington Health, you must pay the entire cost for those services.
Once you are enrolled in Washington Health, you need to let Washington Health know when you move or have any family changes.