Applications

• HIRSP Application for Coverage
• Application for Reduced Premium, Deductible, and Drug Out-of-Pocket Maximum.
• Emergency Application For Reduced Premium, Deductible, And Drug Out-Of-Pocket Maximum

Federal Application

• HIRSP Federal Application for Coverage
  No federal subsidy applicable.
  No emergency application applicable.

• HIPAA Privacy Authorization for Use or Disclosure Form

• 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
  
  
• Learn more about the HIRSP Federal Plan