Robert S. Mori, CPA, President    7429 East Heather Way, Everett, WA  98203-5424

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WA State Health Insurance             

 If you've been looking for exceptional healthcare solutions throughout the state of Washington, you've come to the right place. Here at Benefits NW, Inc., we give you countless options when it comes to rates and coverage types for both group plans and individuals. There's no more comprehensive solution to the challenge of providing affordable care to your employees.

All the major carriers are covered here, from Aetna to Blue Shield and many more. You can opt for traditional indemnity coverage or choose something more limited such as a PPO, POS or basic HSA. Whatever your choice, we take pride in providing you with a fluid and speedy interface that can generate quotes and offer up all the latest numbers at the click of a button.

It's essential that you understand the differences between varying types of accounts, and they can differ widely across certain criteria. Some focus more on outpatient care and hospital stays, while others direct their support toward prescriptions, dental and vision costs. Understanding which account offers the best benefits at the best price takes some close inspection and a good sense of your own company's profile.

We can help. If you're looking for substantive advice and the latest news on provider promotions and benefits, we urge you to get in touch with our courteous professionals today. Sometimes all it takes is a single conversation to make sense of this sprawling marketplace. We are available by phone at (877) 455-7591 or by email at marketing@benefitsnw.com.

Which one of the following statements best describe your current status?

"I get health insurance Washington through my job. I have the coverage I need... I think"

Many employers offer a choice of plans. The information provided will help you figure out the plan that's best for you.

"I know I need health insurance, but I'm not sure how to get the most cost effective Washington Medical Insurance."

You're not alone. Many people have questions about how to select a Washington health insurance plan. The information provided will help you find some answers.

"I can't afford Washington health insurance right now. I have too many bills to pay and other things I need to buy."

Washington Health insurance is one of your most important needs. Without it, one serious illness or accident could wipe you out financially. The health insurance insights provided here will help you get the answers you need to make better informed choices about your health coverage.

INsight #1. Answer for: Health Insurance Washington - Why do you need it?

Today, health care costs are by all historical measures extremely expensive and even getting higher. Who will pay for your
bills if you have a major accident or a serious illness? You buy health insurance for
the same reason you buy other kinds of insurance, to have the money in case of a
catastrophe- to protect yourself financially so that an extended illness or a devastating injury with extended time
at the hospital will not bankrupt you. Health insurance protects you and your family
in case you need medical care that is so costly that there would be little chance of ever paying it off. Nobody can predict
the future as to what the cost of medical bills will be for you or for me. In a good
year, your expenses may be low. But if you become ill, your bills may be extreme.
If you have insurance, many of your costs will be covered by the insurance company
or in some instances, your employer and not by you. Health insurance is one of the financial pillars to have to build a solid financial plan.


Insight #2 Answer for: What are the types of Washington health insurance?
here are many different types of Washington health insurance. Each has its positives and negatives.
There is no one "best" plan. The plan that's right for a single person may not be
best for a family with small children. And a plan that works for one family may not be
right for another.

For example, if your family includes just two adults, and have no plans for any more children,
then an individual coverage that doesn't cover maternity could be right and keep the costs down.
On the other hand a young couple who are looking to have children, obviously a plan with maternity coverage would be important.

Because your situation may change, review your Washington health insurance regularly to make sure
you have the protection you need and not paying for protection that you don't need.

Choosing a health insurance plan Washington is like making any other major purchase: You choose the plan
that meets both your needs and your budget. For most people, this means deciding which plan is
worth the cost. For example, plans that allow you the most choices in doctors and hospitals also
tend to be more costly than plans that limit choices. Plans that help to manage the care you receive usually cost you less, but you give up some freedom of choice. However, PPO, POS & HMO plans can give you significant savings if you stay within the provider network or if required go thru a primary care physician and get referrals to specialists.

Cost isn't the only thing to consider when buying health insurance Washington . You also need to consider what benefits are covered. You need to compare plans carefully for both cost and coverage.

Although there are many names for Washington health insurance plans, we classify them into four main types:

Fee-For-Service (Traditional Health Insurance Washington )
Preferred Provider Organizations {PPO Health Insurance Washington) ***
Point of Service (POS Health Insurance)
Health Maintenance Organizations (HMO Health Insurance)


Please see below for further details about these plan types.

*** In our opinion, the plan type that offers for most people the best combination of freedom and cost containment


Insight #3 Answer for: Where do you get health insurance Washington?

There are two major places to get Washington medical insurance. 1. Group or Employer Sponsored Health Insurance 2. Individual Health Insurance (Generally thru an independent Broker/Agent)

Group/Employer Sponsored Health Insurance

Many Americans get their health insurance through the workplace or are covered as a dependent thru a parent's
workplace. This is called group insurance because a group of employees and their dependents
get coverage all together sponsored by the employer.

Group insurance is generally more comprehensive and have higher maximum limits than individual health insurance. Areas where group health insurance
tends to be more comprehensive include alternative or naturopathic medicine, mental health, maternity, prescriptions, physical therapy & rehabilitation., & rehab.
for substance abuse. You may also get 24 hour nurse & or Mental health assistance.


Some employers offer only one Washington health insurance plan while others (usually larger employer groups) offer a choice of health plans with varying levels of coverage.

What happens if you or your family member leaves the job? Eventually, after terminating from the employer, you will lose your employer-supported group coverage.

It may be possible to keep the same policy for a while, but you will have to pay for it yourself. This will more than likely cost you more than group coverage for the same, or less, protection.

A Federal law makes it possible for People who work in companies with at least 20 employees and terminate employment without cause, may continue their group health coverage for a period of time. under what is called COBRA ( COBRA is an acronym for:Consolidated Omnibus Budget Reconciliation Act of 1985), the law requires that if you work for a business of 20 or more employees and leave your job or are laid off, you can continue to get health coverage for at least 18 months. You will be charged a higher premium than when you were working.

You also will be able to get insurance under COBRA if your spouse was covered but now you are widowed or divorced. If you were covered under your parents' group plan while you were in school, you also can continue in the plan for up to 18 months under COBRA until you find a job that offers you your own health insurance.

Not all employers offer health insurance. You might find this to be the case with your job, especially if you work for a small business or work part-time. If your employer does not offer health insurance, you might be able to get group insurance through membership in a labor union, professional association, club, or other organization. Many organizations offer Washington health insurance plans to members.
Individual Insurance

If your employer does not offer Oregon group insurance, or if the insurance offered is too expensive or too restrictive, you can buy an individual health insurance
policy. Rather than going directly to the insurance carrier, we recommend that you do your shopping thru an independent agent/broker. Why do we recommend
this? It's because typically the rates are the same going thru the broker as the insurance company pays their commissions and you can save an awful lot of time and trouble comparing costs and benefits. Independent agents can tailor a plan to fit your needs. Here, we stress "independent" and not going thru a captive agent to a single insurance carrier or worse yet an
employee of an insurance company. A reputable, independent agent has more allegiance to you and can shop many insurance carriers for you to compare plan
benefits and rates. Depending on the region of the country, you can get a traditional, PPO, POS or HMO plan . But you should compare your options and
shop carefully because coverage and costs vary from company to company. Individual plans may not offer benefits as broad as those in group plans. Also, last but not least, each plan other than a true fee for service will have its list of preferred providers. Although there is much overlap in providers from insurance company to another, there are also wider and narrow networks of physicians and hospital facilities depending on the carrier and the plan itself.

If you get a noncancelable policy (also called a guaranteed renewable policy), then you will receive individual insurance under that policy as long as you
keep paying the monthly premium. The insurance company can raise the cost, but they cannot cancel your coverage. Many companies now offer a conditionally
renewable policy. This means that the insurance company can cancel all policies like yours, not just yours. This protects you from being singled out.
But it doesn't protect you from losing coverage.

Before you buy any Washington health insurance policy, make sure you know what it will pay for...and what it won't.

Insight #4

Final Tips when shopping for individual insurance:

* Shop carefully. Policies differ widely in coverage and cost. Ask your independent agent to show you policies from several insurers so you can compare them.
* Make sure the policy protects you from large medical costs by having terminology such as "out-of-pocket-maximum.
* Read and understand the policy. Make sure it provides the kind of coverage that's right for you. You don't want unexpected news that the policy won't pay for precedures when you thought they would.
* Check to see that the policy states: the date that the policy will begin paying (some have a waiting period before coverage begins), and what is covered or excluded from coverage.
* Make sure there is a "free look" clause. Most companies give you at least 10 days to look over your policy after you receive it. If you decide it is not for you, you can return it and have your premium refunded.
* Beware of single disease insurance policies. There are some polices that offer protection for only one disease, such as cancer. If you already have health insurance, your regular plan probably already provides all the coverage you need. Check to see what protection you have before buying any more insurance.

Rates can vary depending on the nature of the group and the level of coverage. Typically the older the group, the more number of females are in the group, and the sicker the group, the higher the cost(Older people, females,and sicker people on average need more healthcare).
the least expensive kind. In many cases, the employer pays part or all of the cost. Coverage varies as group plans typically pay anywhere from 50% to 100% of the expenses.


The differences among fee-for-service plans, PPO's, POS's & HMOs, and PPOs are not as clear-cut as they once were. Fee-for-service plans have adopted some activities used by HMOs and PPOs to control the use of medical services. And HMOs and PPOs are offering more freedom to choose doctors, the way fee-for-service plans do. By studying your Washington health insurance options carefully, you will be able to pick the one that provides you with the coverage you need, no matter what it is called.
Managed Care: A Way to Control Costs

Managed care influences how much health care you use. Almost all plans have some sort of managed care program to help control costs. For example, if you need to go to the hospital, one form of managed care requires that you receive approval from your insurance company before you are admitted to make sure that the hospitalization is needed. If you go to the hospital without this approval, you may not be covered for the hospital bill.

The following types of plans are listed in order of those that more restrictive to those that offer more freedom in terms of medical procedures covered and where you can go for services:

Health Maintenance Organizations (HMOs)

Health maintenance organizations are prepaid health plans and are the most restrictive type of plans. As an HMO member, you pay a monthly premium. In exchange, the HMO provides comprehensive care for you and your family, including physicians' visits, hospital stays, emergency care, surgery, lab tests, x-rays, and therapy.

The HMO arranges for this care either directly in its own group practice and/or through physicians and other health care professionals under contract. Usually, your choices of physicianss and hospitals are limited to those that have agreements with the HMO to provide care. However, exceptions are made in emergencies or when medically necessary.

There may be a small copayment for each office visit, such as $15 for a physician's visit or $75 for hospital emergency room treatment. Your total medical costs will likely be lower and more predictable in an HMO than with fee-for-service insurance.

Because HMOs receive a fixed fee for your covered medical care, it is in their interest to make sure you get basic health care for problems before they become serious. HMOs typically provide preventive care, such as office visits, immunizations, well-baby checkups, mammograms, and physicals. The range of services covered vary in HMOs, so it is important to compare available plans. Some services, such as outpatient mental health care, often are provided only on a limited basis.

Many people like HMOs because they do not require claim forms for office visits or hospital stays. Instead, members present a card, like a credit card, at the physician's office or hospital. However, in an HMO you may have to wait longer for an appointment than you would with a fee-for-service plan.

In some HMOs, physicians are salaried and they all have offices in an HMO building at one or more locations in your community as part of a prepaid group practice. In others, independent groups of physicians contract with the HMO to take care of patients. These are called individual practice associations (IPAs) and they are made up of private physicians in private offices who agree to care for HMO members. You select a physician from a list of participating physicians that make up the IPA network. If you are thinking of switching into an IPA-type of HMO, ask your physician if he or she participates in the plan.

In almost all HMOs, you either are assigned or you choose one physician to serve as your primary care physician. This physician monitors your health and provides most of your medical care, referring you to specialists and other health care professionals as needed. You usually cannot see a specialist without a referral from your primary care physician who is expected to manage the care you receive. This is one way that HMOs can limit your choice.

Before choosing an HMO, it is a good idea to talk to people you know who are enrolled in it. Ask them how they like the services and care given.

Questions to Ask About an HMO

* Are there many physicians to choose from? Do you select from a list of contract physicians or from the available staff of a group practice? Which physicians are accepting new patients? How hard is it to change physicians if you decide you want someone else? How are referrals to specialists handled?
* Is it easy to get appointments? How far in advance must routine visits be scheduled? What arrangements does the HMO have for handling emergency care?
* Does the HMO offer the services I want? What preventive services are provided? Are there limits on medical tests, surgery, mental health care, home care, or other support offered? What if you need a special service not provided by the HMO?
* What is the service area of the HMO? Where are the facilities located in your community that serve HMO members? How convenient to your home and workplace are the physicians, hospitals, and emergency care centers that make up the HMO network? What happens if you or a family member are out of town and need medical treatment?
* What will the HMO plan cost? What is the yearly total for monthly fees? In addition, are there copayments for office visits, emergency care, prescribed drugs, or other services? How much?


Point of Service (POS)

The Point of Service Plan offers the cost containment and ease of use benefits of the HMO with some of the freedom of a a PPO plan. Usually, most preventive care is covered along with physicians visits, hospital stays, emergency care, surgery, lab tests and therapy. YOu get the ease of use of a membership card so that you do not have to handle bills for office visits and hospital stays.


Like the HMO, the member needs to see a primary care physician for most needs and then if a specialist is necessary, that primary care physician make referrals to other providers and specialists in the plan. But in a POS plan, members can refer themselves outside the primary network and still get some coverage. If the physician makes a referral outside the primary network, the plan pays all or most of the bill. If you refer yourself to a provider outside the primary network and the service is covered by the plan, you will have to pay the co-insurance.

POS plans can either be prepaid in arrangements or be fee-for-service

* Are there many primary care and specialist physicians to choose from? Who are the physicians in the POS network? Where are they located? Which ones are accepting new patients? How are referrals to specialists handled?
* What hospitals are available through the POS? Where is the nearest hospital in the POS network? What arrangements does the POS have for handling emergency care? Is this worldwide?
* What services are covered? What preventive services are offered? Are there limits on medical tests, out-of-hospital care, mental health care, prescription drugs, or other services that are important to you?
* What will the POS plan cost? How much is the premium? Is there a per-visit cost for seeing POS physicians or other types of copayments for services? What is the difference in cost between using physicians in the POS network and those outside it? What is the deductible and coinsurance rate for care outside the primary network? Is there a limit to the maximum you would pay out of pocket?


Preferred Provider Organizations (PPOs)

The preferred provider organization is a combination of traditional fee-for-service and managed care plans. In our opinion, they are the best of both worlds and have become the most popular type of plan. There are a designated number of primary care and specialist physicians and hospitals to choose from. When you use those providers (sometimes called "preferred" providers, other times called "network" providers), most of your medical bills are covered.

When you go to physicians in the PPO, you present a membership card and do not have to fill out forms. Usually there is a small copayment for each visit. For some services, you may have to pay a deductible and coinsurance.

PPO plans allow you to see certain specialists direct without a primary care physician referral while other specialists may require a referral from a physician. You may still want to have a primary care physician in a PPO since these physicians are lower in cost than going to specialists for your care. Most PPOs cover preventive care. This usually includes visits to the physician, well-baby care, immunizations, and mammograms.

In a PPO, you can use physicians who are not part of the plan and still receive some coverage. At these times, you will pay a larger portion of the bill yourself (and also fill out the claims forms). Some people like this option because even if their physician is not a part of the network, it means they don't have to change physicians to join a PPO.
Questions to Ask About a PPO

* Are there many physicians to choose from? Who are the physicians in the PPO network? Where are they located? Which ones are accepting new patients? How are referrals to specialists handled?
* What hospitals are available through the PPO? Where is the nearest hospital in the PPO network? What arrangements does the PPO have for handling emergency care?
* What services are covered? What preventive services are offered? Are there limits on medical tests, out-of-hospital care, mental health care, prescription drugs, or other services that are important to you?
* What will the PPO plan cost? How much is the premium? Is there a per-visit cost for seeing PPO physicians or other types of copayments for services? What is the difference in cost between using physicians in the PPO network and those outside it? What is the deductible and coinsurance rate for care outside of the PPO? Is there a limit to the maximum you would pay out of pocket?


Fee-for-Service (Traditional)

This is the traditional kind of health care policy. Insurance companies pay fees for the services provided to the insured people covered b y the policy. This type of Washington health insurance offers the most choices of physicians and hospitals. You can choose any physician you wish and change physicians any time. You can go to any hospital in any part of the country.

With fee-for-service, the insurer only pays for part of your physican and hospital bills. This is what you pay:

* A monthly fee, called a premium.
* A certain amount of money each year, known as the deductible, before the insurance payments begin. In a typical plan, the deductible might range from $250 to $10,000 for a single person and a family deductible of two or three times the single deductible. when at least three two people in the family have reached the individual deductible. The deductible requirement applies each year of the policy. Also, not all health expenses you have count toward your deductible. Only those covered by the policy do. You need to check the insurance policy to find out which ones are covered.
* After you have paid your deductible amount for the year, you share the bill with the insurance company. For example, you might pay 20 percent while the insurer pays 80 percent. Your portion is called co-insurance.

To receive payment for fee-for-service claims, you may have to fill out forms and send them to your insurer. Sometimes your physician's office will do this for you. You also need to keep receipts for drugs and other medical costs. You are responsible for keeping track of your medical expenses.

There are limits as to how much an insurance company will pay for your claim if both you and your spouse file for it under two different group insurance plans. A coordination of benefit clause usually limits benefits under two plans to no more than 100 percent of the claim.

Most fee-for-service plans have an "out-of-pocket maximum," the most you will have to pay for medical bills in any one year. You reach the out-of-pocket maximum when your deductible and co-insurance total reach a certain amount. It may be as low as $1,000 or as high as $20,000. Then the insurance company pays the full amount in excess of the out-of-pocket maximum for the items your policy says it will cover. The out-of-pocket maximum does not include what you pay for your monthly premium.

Some services are limited or not covered at all. You need to check on preventive health care coverage such as immunizations and well-child care.

There are two kinds of fee-for-service coverage: basic and major medical. Basic protection pays toward the costs of a hospital room and care while you are in the hospital. It covers some hospital services and supplies, such as x-rays and prescribed medicine. Basic coverage also pays toward the cost of surgery, whether it is performed in or out of the hospital, and for some physician visits. Major medical insurance takes over where your basic coverage leaves off. It covers the cost of long, high-cost illnesses or injuries.

Some policies combine basic and major medical coverage into one plan. This is sometimes called a "comprehensive plan." Check your policy to make sure you have both kinds of protection.
What Is a "Customary" Fee?

Most insurance plans will pay only what they call a reasonable and customary fee for a particular service. If your physician charges $1,000 for a hernia repair while most physician's in your area charge only $600, you will be billed for the $400 difference. This is in addition to the deductible and coinsurance you would be expected to pay. To avoid this additional cost, ask your physician to accept your insurance company's payment as full payment. Or shop around to find a physician who will. Otherwise you will have to pay the rest yourself.
Questions to Ask About Fee-for-Service Insurance

* How much is the monthly premium? What will your total cost be each year? There are individual rates and family rates.
* What does the policy cover? Does it cover prescription drugs, out-of-hospital care, or home care? Are there limits on the amount or the number of days the company will pay for these services? The best plans cover a broad range of services.
* Are you currently being treated for a medical condition that may not be covered under your new plan? Are there limitations or a waiting period involved in the coverage?
* What is the deductible? Often, you can lower your monthly Washington health insurance premium by buying a policy with a higher yearly deductible amount.
* What is the coinsurance rate? What percent of your bills for allowable services will you have to pay?
* What is the maximum you would pay out of pocket per year? How much would it cost you directly before the insurance company would pay everything else?
* Is there a lifetime maximum cap the insurer will pay? The cap is an amount after which the insurance company won't pay anymore. This is important to know if you or someone in your family has an illness that requires expensive treatments.