Washington Basic Health

By Author: Michale Simson
Total Articles: 5
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Basic Health is a state-sponsored program providing low-cost health care coverage through private health plans. If you qualify, this is a great plan with fantastic benefits. An overview of the plan is below.
Cost:
Monthly premiums are based on age, income, family size, and health plan chosen
No co-payments for preventive care services
Low co-payments on some services
Very low deductibles
20% coinsurance on some services
Low out of pocket maximums
Choice of Provider:
Select your own doctor or other provider affiliated with the health plan you choose.
Choice of health plans in most counties.
Decide on the health plan that offers the best value, location, and providers for you.
Benefits:
Doctor and hospital care, including preventive care
Emergency services
Prescription drugs
All health plans in Basic Health offer the same basic benefits, but monthly premiums, providers, and some details of coverage vary (such as which prescription drugs or preventive services are covered).
The amount the state contributes to your monthly ...
... premium depends on:
Your age
Your income
The number of people in your family
The health plan you choose
Eligibility:
Basic Health is for Washington State residents who are:
Within Basic Health's Income Guidelines (See bottom of page for income chart)
Not eligible for free or purchased Medicare
Not institutionalized at the time of enrollment
Not attending school full-time in the United States on a student visa
Your Monthly Premium:
Once enrolled in Basic Health, you'll get a bill for your monthly premium about six weeks prior to the month covered by that payment. (For example, the bill for December coverage is sent in mid-October; payment is due November 5.) Your monthly premium payment must always be received by the fifth of the month prior to the coverage month. If you do not pay your premiums when due, you will lose your coverage for at least one month, so it is important that you pay each monthly premium on time. Partial payment or checks that cannot be processed for any reason (for example, checks returned for non-sufficient funds or no signature) will be considered nonpayment.
How the health plans work:
The health plans require each Basic Health member to select a primary care provider (PCP). To receive benefits, you must receive care from your health plan's authorized providers. Your PCP may provide or coordinate your care. Each covered family member may have a different PCP. If you don't choose a PCP, your health plan may choose one for you. You may change your PCP during the year. Contact the health plan for more information on changing a PCP or for a current list of providers.
In an emergency, you may receive Basic 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 addition, women may self-refer to a plan-designated women's health care professional for medically necessary services or medically appropriate follow-up for maternity care, routine gynecological exams, and reproductive care. Check with your health plan for details.
Any care not approved by your health plan is not covered under Basic Health. If you receive care that is not covered under Basic Health, you must pay the entire cost for those services.
Important!
Once you are enrolled in Basic Health, you need to let Basic Health know when you have any changes in family status or income. These changes may affect your monthly premium. If you do not keep income current, the state may require you to repay the state-paid portion of your premium.
Income bands effective July 1, 2008 - June 30, 2009
Download Income Bands Chart (97K PDF)
Use your family's gross monthly income (before taxes and other deductions) and the number of people in your family to determine your income band on the income table in the linked PDF above. If you fall within one of these income bands, you may be eligible for Basic Health. If your income is above these bands, you may not be eligible for Basic Health at this time.
The number of persons in your family means you, your spouse, children, and/or any legal dependents, including those who are disabled or full-time students under age 25, even if they're not living at home. Be sure to count all family members, even those you don't want to enroll, because family size is used to determine your monthly premium.
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