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How to Apply

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.

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Save Time. Apply Online!

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.

Applications

• Apply Online!
  
  
• HIRSP Application for effective dates 1/1/12
  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 Federal Certified agent in your county.

Additional applications:

• Application for Reduced Premium, Deductible, and Drug Coinsurance this subsidy application applies if your household income is less than $34,000
  
  
• Emergency Application for Reduced Premium, Deductible, and Drug Coinsurance
  
  
• Authorization Form

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.

Mail to HIRSP
Attn: Member Services Administration
1751 W Broadway
PO Box 8961
Madison, WI 53708-8961

HIRSP Fax: (608) 243-6136

If you have questions about your application call HIRSP customer service at:

Phone:
1-800-828-4777 or 1-608-221-4551

Member Service Hours (CST):
Mon-Thurs: 7:00am - 7:00pm, Fri: 7:00am - 4:30pm

Where to Get an Application
Applications and information can be obtained from one of the following:

• HIRSP Customer Service by calling (800) 828-4777 or
  (608) 221-4551,
  
• or by writing to:
  HIRSP, P.O. Box 8961, Madison WI 53708-8961
  
• this Web page
  
• Your insurance agent.

Please Note

The new HIRSP Federal Plan may offer better health insurance options than HIRSP.

Enrolling in Wisconsin's HIRSP now will prevent you from enrolling in the Federal Plan. We want you to be aware of the Federal program so that you can make a fully informed decision before you enroll in HIRSP. Read more...