Wisconsin Risk Pool - Health Insurance for the Uninsurable

Risk Pool Name / Acronym
Wisconsin Health Insurance Risk Sharing Plan / HIRSP

Insurance Regulation Establishing Risk Pool
Wisconsin Legislature
Wisconsin Act 27

Funding

The Wisconsin Risk Pool is partially funded by the premiums that are collected Association health insurance carriers are assessed for net losses in proportion to the share of total health insurance premiums they received in Wisconsin the preceding year.

Plans Offered

HIRSP offers two medical insurance plans. Plan 1 is a PPO Plan with 2 different deductible options and is designed for individuals not eligible for Medicare. Plan 2 is a Medicare supplemental plan plan.

Plan Benefits

Plan 1 is a standard PPO plan offering deductibles of $1,000 and $2,500 per year. For most in-patient covered medical services, the HSRIP member is required to pay a 20% coinsurance. For most out-patient covered medical services, the HSRIP member is required to pay a 20% coinsurance. The maximum out-of-pocket limit for the $1,000 deductible plan is $2,000 for the individual plan and $4,000 for the family plan. The maximum out-of-pocket limit for the $2,500 deductible plan is $3,500 for the individual plan and $7,000 for the family plan.

Plan 2 is specifically designed for those individuals who are enrolled in Medicare Part A, B and D and offers a $500 deductible. No coinsurance on this plan. The maximum out-of-pocket limit for Plan 2 is $1,000.

Outline of Coverage for HIRSP Plans

Maximum Benefit Limits

The maximum lifetime benefit for all HIRSP plans is $1,000,000.

Eligibility

• You must be a resident of Wisconsin
• You may not be eligible for employer-sponsored group health insurance
• You are not eligible for Wisconsin Medicaid or BadgerCare
• You are eligible for Medicare because of a disability
• You have tested positive for HIV
• Or, in the past nine months, you received a notice of rejection from 2 or more insurers, a notice of cancellation, a notice of significant reduction of coverage, a notice of an increase in your premium of 50% or more, or two or more offers for insurance with premiums at least 50% higher than what you would be charged for a standard individual policy with substantially the same coverage and deductibles as HIRSP
• Or, you have lost your employer-sponsored group health insurance
• You did not voluntarily cancel your coverage
• You exhausted your continuation coverage under your employer-sponsored group health insurance, including state continuation coverage or COBRA coverage
• Including this employer-sponsored group health insurance, you have had continuous insurance coverage for at least 18 months with no gap in coverage greater than 63 days
• You applied to HIRSP within 63 days of losing your employer-sponsored group health insurance
• You are not eligible for Medicare

Enrollment Periods

Once your application has been approved, your coverage will be made effective on the date your application was received with all required documentation. You may select a different effective date as long as it is not further than 60 days from the date that you submit your application.

Premium Payments

Monthly premiums for HIRSP are based on age, gender and geographic area.

Premium Calculations

Premiums are determined by reviewing similar health plans available in the state of Wyoming that are available to standard eligible persons. Wisconsin Risk Pool premiums are capped 200 percent of that rate.

Pre-Existing Condition Waiting Periods

There is a 6 month waiting period for pre-existing medical conditions. This waiting period will be waived if you are eligible for coverage under federal HIPAA regulations.

Wisconsin Health Insurance Risk Sharing Plan Contact Information

HIRSP
1751 W. Broadway
P.O. Box 8961
Madison, WI 53708-8961
Phone: 1-800-828-4777

HIRSP Website

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