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Washington DC Health Insurance

 

All health insurance policies in Washington DC are considered guaranteed renewable as long as your premiums are paid up to date.  So this means your health insurance can not be canceled because you become sick.

 

Washington DC mandates that health insurance companies cover newborns and adopted children for the first 31 days, on their parent’s policy.  But inversely pregnancy is, and can be considered a pre-existing condition, except on group health policies.

 

Some other mandates under a Washington DC health insurance plan are prostate cancer screenings, treatment for diabetes and annual mammograms.

 

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Washington DC Small Business Health Insurance

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In Washington DC, a group health plan, can not base your health insurance premiums on your health.  This is called non discrimination.  Small Business Health Insurance in Washington DC is also guaranteed issue, meaning that you can not be turn down for coverage.

 

Pre-existing exclusions are limited on the amount of time they can exclude coverage.  Also if you have current coverage, without lapses, that will be credited against your pre-existing period.  Pregnancy is not considered a pre-existing condition on a group health plan.  Washington DC insurance companies use a 6 month look back period, to decide what is pre-existing and what is not.  They can not look back past 6 months.

 

The maximum pre-existing waiting period is 12 months for an employee. If you are a late enrollee your maximum waiting period is 18 months.  Any pre-existing periods must be applied only after written notice.

 

Washington DC does limit the amount of variation between premiums of different group health plans.  Each Small Business Plan will have certain enrollment periods in which employees can sign on to get coverage.  There are limits on the annual increases allowed for small businesses in Washington DC.

 

For additional information about Small Business Health Insurance in Washington DC click here.

 

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Washington DC Individual Health Insurance

 

All Washington DC Health Insurance Policies have to cover disabled children on their parent’s policy into their adulthood.  Genetic information is not able to be considered pre-existing in Washington DC.

 

In Washington DC, insurance companies are able to decide if they want to insure you or not.  They can either rate you up or just refuse coverage.  The exception to this is CareFirst Blue Cross Blue Shield.  This company will sell anyone a Washington DC individual health insurance policy.

 

Washington DC allows health insurance companies to include pre-existing condition exclusions for up to 10 months.  If you are HIPAA eligible you can not have any pre-existing conditions imposed on you.

 

Relative to Pre-Existing Conditions, Insurance companies in Washington DC must give credit to prior credible coverage as long as there was not more than a 63 day lapse in coverage.

 

The rates that an individual pays for a Washington DC Health Insurance Plan are based on age, location, health history, family size, sex etc.  Sadly there is no limit on how much an insurance company can charge and individual for coverage.

 

Healthy Families was a program started not that long ago.  It is designed to provide affordable health insurance for Washington DC low income families.  To see if your family qualifies visit their site.

 

For additional information about Individual Health Insurance in Washington DC click here.

 

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Washington DC Self Employed Health Insurance

 

In Washington DC, self employed people are not able to buy small business health insurance policies.  A Washington DC self employed persons rights are protected under the laws protecting individuals.

 

One benefit for Self Employed people is that they are able to deduct 100% of their health insurance premiums from their taxes!

 

Another option for affordable Washington DC Self Employed Health Insurance is often associations or self employed groups.  Just keep in mind that not all of these groups or associations are regulated by the state.

 

For additional information about Self Employed Health Insurance in Washington DC click here.

 

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Temporary Washington DC Health Insurance

 

Many situations may arise where you find yourself without health insurance, or about to be without health insurance.  These reasons could range from graduating college to being in-between jobs.  Instead of going without health insurance you should look into getting a Washington DC Temporary Health Insurance Policy.  These policies will be cheap, with high deductibles and low coverage, but getting a Washington DC Temporary Health Insurance Policy is much better than going with out health insurance.  It should be noted, that Washington DC temporary health insurance is not guaranteed renewable.

 

For additional information about Temporary Health Insurance in Washington DC click here.

 

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What types of Washington DC Health Insurance are there?

 

HMO- Health Maintenance Organization.  This type of insurance is called managed care.  This means you have certain network of doctors and hospitals in Washington DC that you have to go to for care.  Most Washington DC HMO’s have office visit co-payments that range from $10 to $35, and hospital deductibles that range from $250 to $1,500.  Often the most affordable health insurance plans are HMO’s due to the fact they are managed care.

 

PPO-Preferred Provider Organization.  This type of insurance is also called managed care but it gives the consumer much more freedom; they allow you to visit any doctor or hospital in or out of network.  Most Washington DC PPO’s have an in network and an out of network charge.  If the in network co-insurance is 100% then the out of network co-insurance would be 80%.  If the in network co-insurance is 90% then the out of network co-insurance would be 70%   Typically Washington DC PPO’s offer co-payments for doctor visits as well as hospitalization. 

 

Indemnity Plan - In Washington DC, as health insurance rates continue to rise, many people are finding it more affordable to drop their health insurance and buy a Washington DC Major Medical Health Insurance Plan.  An Indemnity plan can also be called a major medical plan or catastrophic health insurance.  Whatever you call it, typically a Washington DC Indemnity Plan would cover more “major” claims.  An Indemnity plan has an annual deductible and will usually allow you to pick different co-insurance options.  Indemnity plans allow you access to any doctor or hospital, and for this reason they are typically very expensive.

 

Discount Medical Plans – In recent years many Discount Medical Plans have started to surface.  These plans have relatively inexpensive, but consumers must realize that this is not insurance.  All these companies do is to get their customers discounted rates (20-50% off) on certain procedures at certain physicians and hospitals. 

 

Federal Mandated Health Insurance Laws

 

HIPAA

Along with Washington DC Health Insurance Laws, there are Federal Laws that regulate Health Insurance companies.   HIPAA (Health Insurance Portability and Accountability Act of 1996). This act mandated federal standards for individual and group health insurance plans.  Some of the standards that it established were relative to guaranteed renew ability, crediting for prior health coverage and pre-existing condition waiting periods.

 

ERISA

Large corporations do not have health insurance policies.  Typically they are self funded, meaning the corporation pays for all of their employee’s medical bills instead of buying health insurance.  Most of these “self funded” companies are regulated by the federal government under ERISA (Employee Retirement Income Security Act)

 

COBRA

In Washington DC it is mandated, by the state, that all companies that offer a Washington DC Group Health Insurance Policy must also enable their employees to extend their health coverage temporarily; called Cobra.  A Washington DC Cobra Insurance is typically available for a time period of 18 to 36 months.  In Washington DC you are given 60 days to decide if you are going to take Washington DC Cobra Insurance or not.  Once you have passed on the opportunity to take Cobra, you are not eligible to receive it.

 

Cobra Insurance was introduced in 1985.  Cobra stands for Consolidated Omnibus Budget Reconciliation Act.  If you would like more information about your Cobra Insurance options please contact your companies HR department.

 

Often employees are surprised at the cost of a Washington DC Cobra Insurance.  The reason for this is that they are now responsible for 103% (100% of the premium plus a 3% administration fee) of a monthly health insurance premium when they probably only paid 20% while employed. 

 

Whether nor not to take Cobra is an important question, and you should realize there are alternatives to a Washington DC Cobra Insurance Policy.  One should realize what they plan to do in the future.  If you are looking for another job, and it will be a few months before you get a job, it might make sense to look for a Washington DC Temporary Health Insurance Plan.  If you are contemplating working at a consultant, it would be in your best interest to look into a Washington DC Self Employed Health Insurance Policy.   

 

 

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