Written by a parent, not a doctor. Nothing here is medical advice.

Childhood Cancer Lantern
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Washington program

Help paying your work-plan premium (Premium Payment Program)

Once someone in the family has Apple Health, the state can pay you back for an approved private premium when keeping that plan saves it money.

What it is

Once someone in the family has Apple Health, the state can pay you back for an approved private premium when keeping that plan saves it money.

Once someone in the family has Apple Health, the state can check whether paying you back for a private premium costs it less than paying for care directly. It reviews the actual policy and premium; approval is not automatic, and high-deductible plans are excluded.

Eligibility rules
  • Someone in the family must already have Apple Health; there is no separate income test.
  • Eligible policies: a qualifying employer or COBRA plan, or certain individual plans bought through the Washington exchange without premium tax credits. Exclusions apply.
  • The state compares the premium, cost sharing and administration against what Apple Health would otherwise pay.
What you get
  • Reimbursement of a qualifying premium after approval.
  • Ask HCA whether premium for family members without Apple Health can be included; that was not verifiable from the published rule.
Processing
  • HCA lists up to 30 days after all required paperwork is received. An application does not guarantee reimbursement.
If you decide to apply
  1. After Apple Health approval, call HCA’s Premium Payment Program.
  2. Submit the signed intake form and the IRS W-9 from the official page.
  3. Keep premium receipts and follow the reimbursement deadlines.

HCA Premium Payment Program, 800-562-3022 ext. 15473 · official page · Official page ↗

Before joining
  • Ask the oncology team and HCA how claims and approvals would work under the new arrangement.
Good to know

Joining moves your child from an Apple Health managed-care plan to fee-for-service: a different Apple Health office handles payment and approvals. It does not make your child uninsured. Have the oncology team check providers, prescriptions and approvals before switching. The high-deductible exclusion is about reimbursement only; it does not affect free Apple Health as second insurance.

Other details
  • Apple Health eligibility itself continues; only the billing arrangement changes.

Federal background: Help paying an employer health-plan premium.

Official sources
Ask your social worker

“If our child is approved for Apple Health, is it worth asking the state to reimburse our work-plan premium, and what would change about how the hospital bills us?”

Why I’m asking: We want to reduce premiums without interrupting treatment.

More background and detailed requirements

How this could help

You keep the approved private insurance and Apple Health. If HCA approves the cost comparison, it can reimburse qualifying premiums; family members without Apple Health can sometimes be included when cost-effective. This can reduce the monthly cost of keeping your existing doctors and insurance.

HCA must approve an eligible comprehensive plan and cost-effectiveness. The rule excludes high-deductible plans. Some qualifying employer, COBRA and exchange policies can qualify; exclusions apply, including exchange premium-tax-credit plans.

What to know before you apply

  • Someone in the family must have Apple Health before applying.
  • The current program page says processing may take up to 30 days after all required paperwork is received. Keep premium-payment records and follow reimbursement deadlines.
  • Joining PPP ends Apple Health managed-care enrollment and uses fee-for-service. Confirm the new provider billing and authorization arrangements before the change. Apple Health eligibility itself continues.

Your next steps

  1. Contact the Premium Payment Program at 800-562-3022, extension 15473.
  2. Submit the signed intake form and IRS W-9 requested on the official program page.
  3. Ask the oncology team and HCA how claims and authorizations would work with the proposed coverage arrangement.

no separate income test: the child must have Apple Health under the categorically needy, medically needy or alternative benefit plan rules

A qualifying employer or COBRA plan, or certain individual plans purchased through the Washington exchange without premium tax credits; exclusions and cost-effectiveness rules apply.

the state compares the premium, cost sharing and administration against what Apple Health would otherwise cost

Additional program information and published rules

Who does what

The three parts, side by side. The agency decides; nobody on this page does.

You

File form HCA 13-705 with the premium amount and proof of enrolment, then send receipts on time.

Your social worker

The hospital financial counselor or the Apple Health caseworker helps with the form and the cost figures.

The care team

Confirm the current cancer team, pharmacy, scheduled care and authorizations under the proposed fee-for-service arrangement.

Who decides
The Health Care Authority, on a cost comparison.
Ask the agency
“Could the Premium Payment Program reimburse our insurance premium, and would joining change how my child’s care is authorized?”

How to apply

First step: Contact the Premium Payment Program at 800-562-3022, extension 15473.

  1. Contact the Premium Payment Program at 800-562-3022, extension 15473.
  2. Submit the signed intake form and IRS W-9 requested on the official program page.
  3. Ask the oncology team and HCA how claims and authorizations would work with the proposed coverage arrangement.

Official application / program page ↗

Where it starts: Use the official HCA Premium Payment Program page for the current intake packet, HCA 13-705 application and requested W-9. Call 800-562-3022 ext. 15473 for help.

What to gather

  • The premium amount and who it is paid to
  • Proof your child is enrolled in the plan
  • Receipts for premiums you have paid

How long: HCA says processing may take up to 30 days after it receives all required paperwork.

What a yes looks like

An approval with the premium amount and start date, plus confirmation that Apple Health medical claims will use fee-for-service.

What a no looks like, and the next move

If the no is about cost, ask for the comparison in writing and whether the above-average premium route applies.

Watch out

  • PPP enrollment ends integrated Apple Health managed care and uses fee-for-service for the child's Apple Health medical coverage. Confirm providers and upcoming treatment approvals before the change. High-deductible plans are excluded. Proof of premium payment is due by the end of the third month after the last coverage month.
  • HCA must approve the actual plan and cost comparison. Keeping an employer plan does not by itself establish eligibility.

The numbers and the rules

The arcane layer, kept on purpose. Checked September 15, 2026.

What it is worth

Washington’s Premium Payment Program can reimburse an approved private insurance premium when someone in the family already has Apple Health and keeping the private plan saves the state money.

Covers: Reimbursement of approved private-insurance premiums · Possible inclusion of other family members when cost-effective

Legal protection: The work plan and its network stay in place

What it costs the family: There is no application fee. Premium reimbursement requires approval and documentation; do not assume every premium is reimbursable.

The eligibility facts, as published

Income
no separate income test: the child must have Apple Health under the categorically needy, medically needy or alternative benefit plan rules
Insurance status condition
An eligible comprehensive employer plan (including qualifying COBRA) or qualifying individual exchange policy without tax credits. High-deductible plans and individual plans bought outside the Washington exchange are excluded; other exclusions and limited grandfathering rules apply.
Cost test
the state compares the premium, cost sharing and administration against what Apple Health would otherwise cost
Delivery system
PPP is exempt from integrated managed care. Enrollment starts only after applicable managed-care enrollment ends; HCA pays covered medical claims through fee-for-service.
Residency
Washington

Decisions this site cannot make: Cost-effectiveness determination

Expect friction on: Changing from integrated managed care to fee-for-service · Confirming the current providers and treatment approvals · Sending premium receipts on time

The trap: PPP enrollment ends integrated Apple Health managed care and uses fee-for-service for the child's Apple Health medical coverage. Confirm providers and upcoming treatment approvals before the change. High-deductible plans are excluded. Proof of premium payment is due by the end of the third month after the last coverage month.

Where I read this

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