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HIRSP offers 3 plan options

• The HIRSP Plan is for an individual who has recently been insured.
• The HIRSP Federal Plan is for individuals who have not been insured for at least six months.
• HIRSP Medicare Supplement Plan is for individuals who are on Medicare because of a disability or for current HIRSP members who turn 65 while enrolled in HIRSP.

Please use the link below to help you compare the plan options.

Compare Plans

• View a Comparison of HIRSP and HIRSP Federal Plans

HIRSP and HIRSP Federal
Documents and Forms

HIRSP Enrollment	HIRSP Federal Enrollment
HIRSP Application for Coverage	HIRSP Federal Application for Coverage
Application for Reduced Premium, Deductible, and Drug Out-of-Pocket Maximum.	No federal subsidy applicable.
Emergency Application For Reduced Premium, Deductible, And Drug Out-Of-Pocket Maximum	No emergency application applicable.
Rate Information HIRSP Premium Rate Tables for effective dates Jan 2012 How to read HIRSP Medicare Supplement Rate Tables: 2012	HIRSP Federal Rate Information HIRSP Federal Rate Tables
HIPAA Authorization Form

HIRSP Coverage	HIRSP Federal Coverage
Outline of Coverage Policy for plans HIRSP 1,000; HIRSP 2,500; HIRSP 5,000. Policy for the HIRSP HSA Plan (PDF) Prior-Approval Requirement Prior Approval Request Form Other information about HIRSP is available under Chapter 149, Wis. Stats. Understanding Your Explanation of Benefits Statement: Sample copy with notations explaining benefit information	HIRSP Federal Plan - Outline of Coverage Policy - HIRSP Federal Plans Learn more about the HIRSP Federal Plan

Pharmacy Information
MedTrak Pharmacy Services For formulary and pharmacy benefit information please visit the HIRSP Pharmacy Benefit Administrator's site: >> MedTrak Pharmacy Services

Privacy Forms
HIRSP Notice of Privacy Practices
Your Right to an Independent Review
HIPAA Authorization Form
HIPAA Privacy Revocation of Authorization Form
HIPAA Privacy Restriction Request Form
HIPAA Privacy Access Request Form
HIPAA Privacy Accounting Request Form
HIPAA Privacy Alternative Communication Request Form
HIPAA Privacy Amendment Request Form
HIPAA Privacy Complaint Form

 
Please Note
HIRSP continues to reimburse agents $40 for approved applications.

Beginning in late 2011, HIRSP will be offering agent certification classes. All agents attending a certification class will be considered HIRSP certified. All HIRSP certified agents will recieve $100 for each approved application versus the current $40 referral fee.

In order to be reimbursed the agent must complete agent section of the HIRSP or HIRSP Federal Application.

About Privacy Forms
For agents to inquire on or track the status of an application, the applicant must first complete this authorization form: HIPAA Authorization Form (PDF)

Application and Privacy authorization forms should be submitted to:

HIRSP
P.O. Box 8961
Madison,WI 53708-8961