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A health plan inspired by student life
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ISHIP Medical Loss Ratio
Commonly asked questions
What is Medical Loss Ratio (or 80/20 rule)?
The Affordable Care Act is the law that governs healthcare in the United States.
Part of the law says that no more than 20% of premiums (the amount you pay for your health plan) can be spent on:
- Salaries
- Sales
- Advertising
- Other administrative costs
The law requires LifeWise Assurance Company (LWAC) to spend at least 80% of premiums it receives on health care services and improving health care quality, such as:
- Doctor bills
- Hospital bills
- Efforts to improve patient safety
These requirements are referred to as “80/20 rule” or the “Medical Loss Ratio” standard. It is intended to ensure consumers get good value for their health care dollars.
If LWAC doesn’t meet the 80/20 rule in a plan year, we must refund a portion of your premium (an amount of money called a rebate).
What year is in question?
In the 2022 calendar year, LWAC did not meet the 80/20 rule.
What is counted in the 80/20 calculation?
- Total incurred claims LWAC paid during the year, plus (+) expenses for activities that improve health care quality
divided by (÷)
- Total premium paid to LWAC, minus (-) federal and state taxes, licensing, and regulatory fees
What addresses were used to send the checks?
Rebate checks were sent to member addresses on file as of July 20, 2023.
When will checks be sent?
Rebate checks should be mailed by September 18, 2023.
What if a check needs to be reissued?
Call customer service at 800-971-1491. They can stop payment on the original check and reissue a new check for the member.
What happens to checks that are returned or not cashed?
If the check is not cashed:
- After 180 days, checks are held in in our Unclaimed Property Compliance System. Members may ask to have the check reissued by calling customer service at 800-971-1491.
- After 3 years, funds are considered unclaimed property. They are sent to the State of Washington Department of Revenue. To claim the funds at this point, the member should contact the Department of Revenue.
For Providers
Visit our Provider website to check patient eligibility, claim status, submit prior authorization requests, and find other helpful resources.
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For Administrators
Log in to view student enrollment, eligibility, and more.
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Customer Service
800-971-1491
TDD / TTY: 711
5 a.m. to 8 p.m. Pacific, Monday to Friday
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Mailing Address
LifeWise Assurance Company
PO Box 33940
Seattle, WA 98133-0940
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Claims Submission
PO Box 91059
Seattle, WA 98111-9159
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Office Location
7001 – 220th St SW, Building 1
Mountlake Terrace, WA 98043
8 a.m. to 5 p.m. weekdays.
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