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
Wisconsin Health Insurance Risk Sharing Plan (HIRSP)
HIRSP, created in 1979, offers health insurance to Wisconsin residents who either are unable to find adequate health insurance coverage in the private market due to their medical conditions or who have lost their employer-sponsored group health insurance.
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 3 different deductible options and is designed for individuals not eligible for Medicare. Plan 2 is a Medicare supplemental plan.
Plan Benefits
Plan 1 is a standard PPO plan offering deductibles of $1,000, $2,500 and $5,000 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. The maximum out-of-pocket limit for the $5,000 deductible plan is $6,000 for the individual plan and $12,000 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 $500 for the individual plan and $1,000 for the family plan.
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 Plus
- 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 the selected HIRSP plan.
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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