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Washington State Office of the Insurance Commissioner

Who can apply?

In order to receive insurance through the temporary high risk pool program, an individual must meet the following criteria established by law. Eligible individuals must:

  • Be a citizen – an enrollee must be a resident of Washington, a citizen or national of the United States or lawfully present in the United States;
  • Be uninsured -  an enrollee must have not been covered under creditable coverage for the previous 6 months before applying for coverage; and
  • Have a pre-existing condition - an individual must have a qualifying pre-existing condition or a denial letter from an insurance carrier or a letter of acceptance with a reduction or exclusion of coverage for the pre-existing condition. (see list below)

Eligible pre-existing conditions


  • Acute respiratory distress syndrome
  • AIDS / HIV positive, IDS, ARC and other Immune deficiencies
  • Amyotrophic Lateral Sclerosis (ALS)
  • Anemia, chronic fatiguesyndrome
  • Aneurysm
  • Bilateral leg amputation
  • Biliary atresia  
  • Bipolar disorder, schizophrenia
  • Brain injury resulting in a deep or prolonged coma
  • Brain or spinal cord abscess
  • Cancer including lymphoma and leukemia
  • Cerebral palsy
  • Cirrhosis of the liver,
    Hepatitis C
  • Conditions treated by chemotherapy or radiation
  • Congenital brain or spinal cord malformation (e.g. hydrocephalus, spina bifida)
  • Coronary artery disease
  • Crohns Disease or ulcerative colitis
  • Cystic fibrosis
  • Degenerative brain disorder
  • Dermatomyositis
  • Diabetes, sugar in urine
  • Emphysema, chronic lung disease
  • Endocrine  system, gland or hormone disorder
  • Endometriosis
  • Epilepsy
  • Fetal damage resulting from medication use or substance abuse (e.g. fetal alcohol syndrome)
  • Fragile X syndrome
  • Friedreich's Disease
  • Fungal pneumonia
  • Hemophilia
  • Huntington's Disease
  • Chronic kidney disease
  • Lupus
  • Mental retardation
  • MRSA (methicillin resistant staph) infection
  • Mucopolysaccharidoses (e.g. Hunter's or Hurler's syndrome)
  • Multiple Sclerosis
  • Muscular dystrophies
  • Myelodysplastic syndromes (e.g. pancytopenia, aplastic anemia)
  • Necrotizing fasciitis (flesh eating bacterial infection)
  • Nephrotic syndrome
  • Opioid dependency
  • Organ transplants
  • Osteoarthritis
  • Pancreatitis
  • Parkinson's
  • Peritonitis 
  • Phlebitis, blood clot of brain or veins
  • Pregnant (currently)
  • Pulmonary heart disease
  • Rheumatic heart disease
  • Rheumatoid arthritis, ankylosing spondylitis
  • Severe autism
  • Severe burns 
  • Spinal trauma with paralysis, surgery completed or recommended (e.g. fracture of lumbar vertebrae, closed fracture of dorsal vertebra)
  • Stroke, paralysis
  • Subdural hematoma with complications (loss of speech, sight or memory or paralysis
  • Tuberculosis
  • Tumors of the brain or spinal cord
  • Wegener's granulomatosis
  • Other (one or more conditions, with a request to describe)

 

 

 




Updated 10/18/2011

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Need more help? Call our FREE Insurance Consumer Hotline at 1-800-562-6900
or Email us at cap@oic.wa.gov.