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Wisconsin Health Insurance

Being the earning member of your family, you are morally obligated to provide a secured future to your loved ones. Health insurance is expensive, therefore, you must assess your overall financial resources and the risks associated with the lack of proper health coverage. More than 47 million Americans are uninsured, majority of whom are working families. The rising healthcare costs force these families, especially children, into financially-crippling circumstances in the event of an illness or injury. However, for those families who are not covered under their employers’ health group plan, there are low-priced state sponsored health insurance programs.

Wisconsin was ranked at 17th spot in the 2008 Healthiest States List of United Health Foundation. In 2007, the state was at 12th and 10th position in 2006. The major challenges of Wisconsin include high geographic disparity, high prevalence of binge drinking and low public health funding. The state of Wisconsin, having the population of more than five million people, offers both private-market and public health insurance alternatives. The private-market health insurance consists of various types of health plans including family, Medicare supplemental, short-term, student, group and dental. In addition, the state and federal government sponsored programs provide subsidized health coverage to the uninsurable residents of Wisconsin who meet specific eligibility requirements.

The Wisconsin Office of the Commissioner of Insurance protects the insurance consumers against unfair practices by regulating all kinds of insurance sold through private-market health insurers as well as public health coverage programs. However, nearly 8.5% uninsured Wisconsin residents continue to be a major concern for the state’s lawmakers. Approximately, 36.2% uninsured Wisconsin citizens come under the above 200% FPL bracket, according to the Censor Bureau’s 2007 and 2008 Current Population Survey.

Health insurance is one thing that you cannot afford to survive without. When purchasing health coverage, it is prudent to contact a licensed health insurance agent/broker to avail the benefits of health insurance alternatives.

Below is the guidelines for applying for and obtaining individual health insurance in the state of Wisconsin. These regulations apply to all insurance companies offering individual or family health insurance in Wisconsin:

Medical Underwriting	Yes
Pre-Existing Condition Exclusion Period	24 months
Look Back Period	No Limit
Look Back Standard	Prudent person
Mandatory Benefits	Cancer screening for women including breast and cervical cancer screening, reconstructive surgery after mastectomy, direct access to OB/GYNs, OB/GYNs as Primary Care Providers
Market Rate Restrictions	None
Guaranteed Issue Options	None

Below is the guidelines for small group health insurance in the state of Wisconsin. These regulations apply to all insurance companies offering small group health insurance in Wisconsin:

Small Group Size	2-50
Employee Qualifications	Owner can count as an employee
Guaranteed Issue	Yes
Premium Rating Factors	Rate Bands
Rate Adjustment Factors	30%
Look-Back Period	6 months
Pre-existing condition exclusionary period	12 months
Mandatory Benefits	Same as individual

Below are the COBRA guidelines for small groups in the state of Wisconsin. For employer groups of more than 20 employees, refer to the federal COBRA guidelines:

Mini-Cobra Option	Yes
Eligible Group Sizes	2-19
Extension of Benefits Period - Standard	18 months
Extension of Benefits Period - Disabled	18 months
Maximum Premium Increase	100%
State Legislation Reference	Regulation 632.897 Wisconsin Continuation Law
Additional Notes	To be eligible for Wisconsin continuation coverage, you must have been continuously covered under your policy for at least 3 months.

There are several state sponsored health insurance programs in the State of Wisconsin to assist those without insurance in obtaining adequate coverage.

Some states offer special state sponsored health insurance plans for qualified persons that are not eligible for individual health insurance due to pre-existing medical conditions. The guidelines for enrollment in these programs vary by state. The high-risk pool in the State of Wisconsin is summarized in the chart below:

Plan Name	High Insurance Risk-Sharing Plan (HIRSP)
Website	http://www.hirsp.org/
Phone Number	800-828-4777
HIPPA Eligibility Required?	Yes
Available Carriers	NA
Pre-Existing Condition Waiting Period	6 months
Enrollment Periods	Currently Open to New Enrollment
Premium Limits	No more than 200% of standard rate
Lifetime Maximum Benefit	$1 million
Special Notes	To qualify for the coverage, you must not be eligible for employer-offered group health insurance, comprehensive Wisconsin Medicaid services, or BadgerCare Plus.

Through shared funding from the federal government, the State of Wisconsin provides health insurance for uninsured children that meet certain eligibility guidelines. A summary of this program is outlined in the chart below:

Program Name	BadgerCare Plus
Website	http://www.badgercareplus.org/
Phone Number	800-362-3002
Apply Online	Yes
Age Limits	Under 19
Insurance Carrier	Varies
Length of Coverage	Subject to Periodic Eligibility Review
Residency Requirements	Wisconsin resident, U.S. citizen, legal immigrant
Other Eligibility Requirements	All children without access to health insurance are eligible. Parents and Caretakers up to 200% of the FPL
Pre-Existing Condition Exclusions	None
Cost	$0 or minimal cost of sharing

Medicaid is a state program partially funded through the federal government. Qualification guidelines, as well as the types of people that are eligible, will vary by state. The chart below provides a summary of the Medicaid programs in the State of Wisconsin:

Governing Agency	Wisconsin Department of Health Services
Website	http://dhs.wisconsin.gov/MEDICAID/
Phone Number	800-362-3002
Residency Requirements	Wisconsin residents, U.S. citizen, documented immigrant
Federal Poverty Line Income Limits	Children ages 0-5 150% FPL Children ages 6-19 100% FPL Pregnant women 250% FPL Medically needy individuals up to 83% FPL Medically needy couples up to 61% FPL

Wisconsin Health Care Options Matrix™ Guide

Provided by the Foundation for Health Coverage Education, the guide is a quick reference guide prepared by the non-profit Foundation for Health Coverage Education that outlines Wisconsin’s public and private health care choices for individuals and groups with various demographic profiles.

Family Health Insurance Guide by HealthInsuranceFinders.com

The guide created by HealthInsuranceFinders.com provides useful information regarding health insurance coverage such as individual/family health insurance, group health insurance, separate child health insurance and state-sponsored programs that are available for low to middle income families.

Wisconsin: At-A-Glance

Provides exclusive health data of the Wisconsin state. Statehealthfacts.org, a project of the Henry J. Kaiser Family Foundation, is designed to provide free, up-to-date, and easy-to-use health data on all 50 states.