HIRSP Federal Plan - Noncovered Services

The following is a partial list of treatments, services, supplies and expenses that HIRSP Federal Plan does not cover.

  • Cosmetic treatments
  • Custodial care
  • Eyeglasses
  • Hearing aids
  • Charges for produres or services that are determined as not medically necessary and appropriate
  • Expenses incurred for procedures or services that are of questionable medical value, experimental or investigative (except drugs for the treatment of HIV infection)
  • Infertility, impotence and sterilization services or drugs
  • Healthcare services performed by members of your immediate family or anyone else living with you
  • Routine dental care
  • Any services covered by any other policy of healthcare insurance

Refer to the HIRSP Federal policy for a full listing of covered/noncovered services, exclusions, conditions and limitations.

Provider Network and Your Coverage

Health Care Services Provided In Wisconsin.
If you receive health care services described in this section from a health care provider in Wisconsin, that health care provider must be a Wisconsin Medicaid-certified health care provider.
HIRSP will pay benefits up to the HIRSP allowed amount. You are responsible for any applicable deductible and coinsurance amounts.

Health Care Services Provided Outside of Wisconsin.
If you receive health care services described in this section from a health care provider outside of Wisconsin who is not Wisconsin Medicaid-certified, HIRSP will pay benefits for those health care services up to the HIRSP allowed amount. You are responsible for any amounts billed over the HIRSP allowed amount. The billed amount you are responsible for may be as much as, if not more than, 40% of the provider’s charge for those health care services. Also, you are responsible for any applicable deductible and coinsurance amounts.