You can apply for HIRSP using the HIRSP online application or contacting HIRSP directly or through an insurance agent licensed in Wisconsin. Parents or legal guardians may apply on behalf of dependents.
If you are unable to view or open the PDF documents, you will need to download the Free Adobe Reader software.
There are benefits to submitting enrollment applications using the online system, or by fax. The benefits include; expedited enrollment, improved accuracy (i.e. typed vs. hand written information), and reduced cycle time. You may enjoy the convenience and benefits the online system has to offer.
Before applying, see if you qualify for Medicaid or BadgerCare Plus Standard Plan. If you qualify for BadgerCare Plus Standard Plan or Medicaid, you will be ineligible for HIRSP.
NOTE: If you are eligible due to loss of employer-offered group health coverage, you do not need to submit proof of medical condition.
HIRSP Certified Agent, if you would like assistance completing your application, you may want to work with a HIRSP Certified agent in your county.
Application for Reduced Premium, Deductible, and Drug Coinsurance
this subsidy application applies if your household income is less than $34,000
for Reduced Premium, Deductible, and Drug Coinsurance
Mail or fax your completed application and relevant documentation to the address below.
If paying via direct bill please also mail your initial payment to the address below.
Attn: Member Services Administration
1751 W Broadway
P.O. Box 8961
Madison, WI 53708-8961
HIRSP Fax: 1-608-243-6136
If you have questions about your application call HIRSP customer service at:
1-800-828-4777 or 1-608-221-4551
Member Service Hours:
Monday through Thursday 7:00 a.m. to 5:00 p.m. and Friday 8:00 a.m. to 4:30 p.m. (CT)
Where to get an application
Applications and information can be obtained from one of the following: