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(Available to Washington State Residents Only)
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Regence BlueShield Frequently Asked Questions
Eligibility
To be eligible for Regence BlueShield coverage you must reside in the Washington State Regence BlueShield service area at least 30 days prior to application
(see map). Proof is required.
- Must reside in Regence BlueShield Service Area (see map)
- Must reside in the service area 30 days prior to application
- Proof of Washington State Residency
- Valid Washington State Driver's License or Identification Card
- Current Utility Bill with name and address
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Applying for Coverage
To apply for coverage with Regence BlueShield you must provide the following:
- Completed and signed Enrollment Application
- Completed and signed Standard Health Questionnaire for Washington State where applicable (see Completing the Health Questionnaire)
- Proof of Washington State Residency
- Valid Washington State Driver's License or Identification Card
- Current Utility Bill with name and address
- Certificate of Creditable Coverage from prior carrier (see Credit for Prior Coverage & HIPPA Eligibility) where applicable.
- All enrollment materials should be submitted to Regence Blue Shield prior to the 20th of the month for an effective date of the 1st of the next month. Regence BlueShield requires all application materials postmarked to their office on or before the 20th of the month.
Incomplete applications may cause delays in your effective date.
Please submit all enrollment materials to:
Regence Blue Shield
P.O. Box 1107
1602 21st Ave
Lewiston, ID 83501
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Effective Dates of Coverage
- Applications must be POSTMARKED to Regence BlueShield by the 20th of the month to be considered for an effective date of the first of the next month.
- Accepted applications will be notified of their effective date of coverage and the total premium due for the first period of coverage. Once payment is received, the coverage will be activated.
- Declined applications will be eligible for the Washington State Health Insurance Pool. Information about enrolling in the Washington State Health Insurance Pool will be sent to the declined applicant.
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Credit for Prior Coverage & HIPPA Eligibility
Credit for Prior Coverage
The nine-month waiting period for pre-existing conditions will be shortened one day for each day you had creditable coverage under another health plan, provided:
- You were enrolled in comprehensive group or individual coverage at any time during the 63-day period immediately preceding the date of application and the benefits under your previous health plan were equivalent to or greater than the Regence BlueShield plan you are applying for:
OR
- You and your dependents are seeking coverage because of a change of residence within Washington State and your current medical coverage is not offered in the new area and application is made within 90-days of relocation and you were enrolled at any time during the 63-day period immediately preceding the date of application for comprehensive coverage;
OR
- You or your dependents are seeking coverage because your current health care provider is no longer part of your current carrier's provider network and is part of the Regence BlueShield Selections Network and application is made within 90 days of your provider leaving your current carrier's provider network and you were enrolled at any time during the 63-day period immediately preceding the date of application for comprehensive coverage.
HIPPA Eligibility
The nine-month waiting period for pre-existing conditions will be waived if you are eligible as defined by 2741(b) of the Federal Health Insurance Portability and Accountability Act (HIPPA) of 1996 (42 U.S.C. 300gg-41(b)).
A HIPPA Eligible individual is defined as someone:
- Who has at least 18 months of prior creditable coverage
- Whose most recent prior creditable coverage was under a group health plan, government health plan, or church plan and was not terminated for fraud or nonpayment of rate
- Who is not eligible for coverage under a group plan, Medicare A or B, or Medicaid and does not have other health coverage, and;
- Who elected and exhausted any COBRA continuation or similar state extension of coverage, which they were offered.
If you meet the requirements for any of the conditions listed under Credit for Prior Coverage & HIPPA eligibilty, pre-existing condition waiting periods will be credited upon receipt of a Certificate of Creditable Coverage from your prior insurance carrier. A Certificate of Creditable Coverage will be issued to you by your prior insurance carrier upon termination of your plan. Please contact your prior insurance carrier for more information.
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Completing the Health Questionnaire
You DO NOT need to complete the Standard Health Questionnaire for Washington State if you are in any one of these three circumstances:
- You have moved from one part of Washington State to another part of Washington State and
- Had medical insurance with a health insurance carrier before moving, and
- The same health insurance carrier does not offer health insurance where you live now and
- You are applying for insurance with a new insurance carrier and
- You have applied to the new insurance carrier no more than 90 days from the time that you moved.
- Your doctor or other care provider cannot treat you because they have stopped being a part of your insurance carrier's provider network for your individual health plan and
- Your are applying for individual insurance with an insurance carrier, that does include the same care provider in its provider network and
- You have seen the same care provider during the 12 months before the provider left your insurance carrier's network and
- You are applying to the new insurance carrier within 90 days from the day your care provider left your current insurance carrier's network.
- You are applying for medical insurance because you have used up all of the time on your COBRA (group continuation) coverage, and
- You have applied for individual insurance with a new insurance carrier within 90 days from the date that the group continuation coverage ended.
Please note, to receive credit for prior coverage, you must apply within 63 days of losing coverage. If you are applying after the 63rd day, but before the 90th day of losing coverage, you will be subject to a 9 month pre-existing condition waiting period. Please refer to
Pre-Exisitng Condition Waiting Period & Policy Exclusions for more information.
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Within the rules described below, you have lost or will be losing your group coverage.
In order for this exception to apply, you must be applying for coverage because your
employer normally employs fewer than 20 employees (as determined under federal
rules known as "COBRA") and is not, therefore, required to offer you "COBRA"
coverage. In addition,
- (a) you must submit your application to the carrier within the
period beginning 90 days before the "qualifying event," and ending 90 days after the
qualifying event (as defined under "COBRA");
- (b) you had at least 24 months of continuous group coverage immediately prior to the "qualifying event"; and
- (c) the effective date of the individual coverage must be on, or within 90 days after, the date of
the "qualifying event."
Under "COBRA," a "qualifying event"
means any of the following
events that causes a loss of health coverage: death of the employee; a reduction in
hours or a termination of employment (other than by reason of gross misconduct); the
divorce or legal separation from the covered employee; the employee becoming entitled
to Medicare; a dependent child ceasing to be a dependent child under generally
applicable requirements of the health plan; and a bankruptcy filing by an employer from
whose employment the employee retired at any time.
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Maternity
Maternity related care that will be subject to the nine-month pre-existing condition waiting period, but is not limited to:
- Delivery
- Pregnancy Termination
- Complication of Pregnancy
- Postnatal Care
- Newborn Care
The nine-month pre-existing condition waiting period is waived for prenatal care for the initial and subsequent exams and periodic visits.
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E-mail us for more information and a free quote or CALL TOLL FREE
1-800-875-4490 (in the U.S.)
or 1-253-854-0199 (outside the U.S.)
Fax: 1-253-896-9411
Mailing address: Maddock & Associates, 1407 Willow Road E, Suite C, Tacoma, WA 98424
Serving all of Washington at 800-875-4490, Seattle at 206-682-1628,
Bellevue at 425-454-6834, Kent at 253-854-0199 and Tacoma at 253-572-3291.
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