• Eligibility
• Applying for coverage
• Effective Dates of Coverage
• Credit for Prior Coverage & HIPPA Eligibility
• Completing the Health Questionnaire
• Maternity

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

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 Northwest Insurance Services  prior to the 15th of the month for an effective date of the 1st of the next month. 
  Incomplete applications may cause delays in your effective date.
  
  Send all Enrollment Materials to:
  
  Regence Blue Shield
  PO Box 91053
  1800 Ninth Ave 
  Seattle, WA 98111-9153

Back to the top

Effective Dates of Coverage

• 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.

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.

• 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.

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:

1. 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.
   
   
    
2. 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.
   
   
    
3. 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.
   
    
4. If you are a current Regence BlueShield subscriber on a closed individual product you do not need to complete the Standard Health Questionnaire for Washington State.

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