Eligibility Requirements for the HIRSP Federal Plan

To qualify for the HIRSP Federal Plan, you must meet all of the requirements under A and at least one of the requirements under B:

A. Base Criteria

1. A resident of Wisconsin
2. A citizen or national of the United States, or lawfully present in the United States
3. Have not had creditable coverage in the six months prior to the HIRSP Federal Plan effective date
4. Not eligible for employer-offered group health insurance coverage
5. Not eligible for comprehensive Wisconsin Medicaid or BadgerCare Plus Standard plan

B. Pre-Existing Condition Criteria

(must have received one of the following based on medical underwriting in the past nine months)

• A notice of rejection from an insurer
• A notice of reduction of limitation on coverage, including restrictive riders
• A notice of reduction of an increase in premium of 50% or more
• Two or more offers for insurance with premiums at least 50% higher than a standard risk would be changed for the coverage
• Tested positive for HIV If you qualify for the HIRSP Federal Plan, you will not be subject to a six-month waiting period of coverage of pre-existing conditions.

If you do not meet the requirements in A and B, you may be eligible for Wisconsin HIRSP.