Overview

The Health Insurance Risk-Sharing Plan (HIRSP) offers health insurance to Wisconsin residents who 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. Applicants are required to meet HIRSP eligibility criteria to qualify.

HIRSP has a six-month waiting period for coverage of services related to pre-existing conditions. If you qualify for HIRSP because you lost your employer-sponsored group health insurance and you meet the requirements in this outline, this waiting period does not apply to you. (Refer to Six-Month Waiting Period for Coverage of Pre-existing Conditions in the Outline of Coverage.

HIRSP covers major medical and prescription drug expenses, subject to pre-existing condition limitations defined in this outline. Policyholders are responsible for paying premium, deductible, and coinsurance amounts as indicated in the HIRSP policy.

HIRSP offers two plans. Plan 1 has two deductible options, and Plan 2 is specifically designed for policyholders who are eligible for Medicare under conditions defined in this outline.

In addition to being responsible for paying the premiums and medical deductibles for the plan you choose, you will also pay a medical coinsurance and a separate drug coinsurance for each prescription. (Refer to HIRSP Plans and Comparison of HIRSP Plans in your Outline of Coverage.

Enrollment in HIRSP is not dependent upon your income or assets. However, if your total annual household income is less than $25,000, you may qualify for reductions in premiums, deductibles, and drug coinsurance under the conditions defined in this outline.

This outline provides general information only. It does not provide a complete description of coverage and does not serve as a legal document. Only the terms of the HIRSP insurance policy constitute a binding agreement between the policyholder and HIRSP. Information contained in this outline is subject to change without notice.