Health Insurance Risk Pools - Resources and Information
Wisconsin Risk Pool - Health Insurance Provided for the Uninsurable
Acronym or name of the risk pool: Wisconsin health insurance risk sharing plan or HIRSP.
Regulation establishing risk pool: Wisconsin Legislature.
Funding: It is partially funded by payment of premiums from the participants. Plans are funded through assessment of insurance companies that are assessed for losses in proportion to the total premiums received by them.
Plans offered: Two medical plans are offered by HIRSP. The plan 1 is a PPO plan with two different deductibles. It is specifically designed for people who are not eligible for Medicare. Plan 2 is a medical supplemental plan.
Plan benefits: The plan 1 is a PPO plan with individual deductible of $1000 and $2500. You pay a coinsurance rate of 20% for inpatient services. For out of network services also the coinsurance rate is 20%. The maximum limit for benefits is $3500 for the $2500 plan and $7000 for the family plan.
Plan 2 is particularly meant for those people who cannot afford Medicare part A, B and D. It offers a deductible of $500. No coinsurance is to be paid for this plan. The maximum limit for benefits is $1000.
HIRSP coverage outline: http://www.hirsp.org/pdfs/outline.pdf
Maximum benefit limits: The lifetime maximum benefit for all plans is $1000000.
Eligibility: (1) You must have been a resident for state of Wisconsin. (2) You should provide proof of the fact that you had suitable covers for at least 18 months before your application and you must apply for the cover within 63 days of termination of the previous cover. (3) You may not be eligible for any other cover. (4) You must not be a resident of a mental institution. (5) You have received a notice rejecting your application for insurance because of medical reasons. (6) You were not able to obtain insurance because of a pre existing medical clause. (7) You must be eligible for Medicare due to a disability. (8) You have tested positive for HIV. (9) You should have completed your coverage under COBRA. (10) You did not cancel your cover voluntarily. (11) You may not be eligible for Wisconsin Medicaid or Badger Care.
Enrollment periods: When your application is approved, your cover becomes effective the day you made your application. A different date might be opted for but it must be within 60 days of your application.
Premium payments: Your age, gender, tobacco usage and plan selection determines the premium you pay.
Premium calculations: The rate capped is at 200% of the standard rate charged by other plans.
Pre existing condition waiting period: A waiting period of 6 months is provided for a person with a pre existing condition.
Contact information: HIRSP, 1751 W. Broadway. P.O. Box 8961. Official Website.
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