Author: Richard H. Adler 

The Washington State Insurance Commissioner's Office has enacted significant rule changes which will dramatically restrict health care insurers from denying coverage to patients and consumers because of pre-existing conditions. WAC 284-10-050.

Between July 1, 1994, and September 30, 1994, Washington State residents will be able to apply for health care coverage without a health care screening or a pre-existing condition waiting list. This "window of opportunity" is opening because, as part of the state's short-term health care reform laws, the pre-existing condition exclusions will change for all health care plans in Washington.

During these three months, enrollment will be open for both group and individual plans offered by all health care insurers. If someone has applied in the past for health insurance and was rejected because of a pre-existing health problem, that same person can reapply during this time and is guaranteed acceptance by the health care insurer. Additionally, recent insureds with health problems may also benefit from the changes. Enrollees in the midst of a year-long wait for coverage of pre-existing conditions will see their wait periods evaporate on July 1, 1994.

After this three month window of opportunity closes, a modified rule takes effect on October 1, 1994. New applicants will still be able to obtain coverage despite their pre-existing condition; however, they may be required to wait three months before the condition is covered.

The rules which take effect July 1, 1994, do the following:

• Prohibit any carrier from excluding or denying coverage based upon a pre-existing condition. See WAC 284-10-050(2)(3).


• Define "pre-existing condition" as "any health condition, illness, or injury which existed at any time prior to the effective date of health plan coverage." See WAC 284-10-050(1).


• Establish a one-time open enrollment period from July 1, 1994, to September 30, 1994, allowing people previously excluded from coverage due to pre-existing conditions to enter the health care system without further delay. See WAC 284-10-050(2).


• Provide immediate coverage for both new applicants and existing policy holders. The rules state that exclusions in existing policies cannot be enforced. See WAC 284-10-050(2)(3).


• After the one-time enrollment period, health care insurers must accept anyone regardless of their health condition and may impose no more than a three month waiting period before covering pre-existing conditions. See WAC 284-10-050(3).


• Prohibit new rate classes for new applicants. See WAC 284-10-050(4).

Without a doubt, these new laws represent significant changes. Now is the opportune time to so advise patients, colleagues, associates, and friends. To assist you in this endeavor, you are welcome to copy and re-distribute this article.

Very truly yours,
ADLER GIERSCH, P.S.

Richard H. Adler
Attorney at Law