Question 1

Can we shop for better rates, mid-year, outside our current renewal?

Accepted Answer

Yes, you can. Groups can typically shop and change plans mid-year. Most carriers provide full credit for payments made on the existing plan, so switching is usually straightforward. We can offer a no-pressure proposal to explore your options.

Question 2

How do we know what plans/programs for which we are eligible?

Accepted Answer

That’s our job. You are likely eligible for more programs and plans than you’ve seen. We will shop the entire market, including Association Health Plans and Carrier-Direct plans, to compare all options and bring you the best. If your current plan is the best option, we’ll give you our honest opinion.

Question 3

How is PRO different?

Accepted Answer

As a specialized agency, we value personal interactions with clients and their employees. We pride ourselves on responsiveness, creativity, and always prioritizing your best interests over our commission.

Question 4

What are health savings account (HSA) limits for 2025?

Accepted Answer

Single Individual: $4,300

Family (2+ Individuals): $8,550

Catchup Contribution 55+: $1,000

Question 5

What is Apple Health?

Accepted Answer

Apple Health is Washington State’s Medicaid product, which can be enrolled in through the WA Healthplanfinder or the State Health Care Authority.

Question 6

When can I enroll in an individual plan?

Accepted Answer

With a Qualifying Event: 1st of any month (though the Application deadlines are often the 15th of the month prior.)
Without a Qualifying Event: The Individual 'Open Enrollment’ begins November 1, 2025, and ends December 15, 2025, for coverage beginning January 1st, 2026.

Question 7

What is considered a qualifying event?

Accepted Answer

You may qualify to enroll in an individual plan outside the annual Open Enrollment window if you experience any of the following:
Involuntarily lose group/employer coverage
Turn 26 and age out of your parents’ plan
Exhaust your COBRA coverage
Permanently move out of your previous service area
Have a birth or adoption in your family

Question 8

If I have employer-provided coverage, can I still qualify for Apple Health or a subsidy?

Accepted Answer

Possibly, depending on your specific income and the details of your employer plan. If your employer-sponsored plan falls within the range that is considered “affordable,” you will not be eligible for a subsidy through the WA Healthplanfinder/Exchange.

However, there are exceptions. If you qualify financially for Medicaid (Apple Health), you may be able to waive your employer-sponsored plan in favor of Apple Health.

Question 9

Can we give employees a stipend, or pay their individual plan premium?

Accepted Answer

Yes and no. You can give your employees extra income to buy individual plans, but this money is taxable for both the employee and the business. It doesn’t stretch as far as it would if used for a group plan. Carriers prohibit groups from paying for employees’ Individual policies.

Frequently Asked Questions

FAQs