Wisconsin has had a high-risk health insurance plan in place since 1979. This plan, called HIRSP, allows people who do not qualify for ordinary health insurance because of pre-existing conditions or financial problems to get health insurance. People who have had health insurance in the last six months may be insured via Wisconsin HIRSP; those who have not had any insurance in six months or more must use the federal HIRSP plan.
Waiting Period
There is a six-month waiting period after you apply for HIRSP coverage if you have a pre-existing condition. During this period, your HIRSP insurance will not cover any of your health care costs. The waiting period does not apply if you are applying for HIRSP coverage because you lost your employer-sponsored coverage, and there is no waiting period for drug coverage. HIRSP defines a pre-existing condition as any diagnosed physical or mental health condition that has required treatment in the past six months.
Eligibility Requirements
Wisconsin offers HIRSP insurance to all residents who meet four eligibility requirements. In addition to being a Wisconsin resident, you must be under the age of 65 unless you are not eligible for Medicare. You also must not be eligible for employer-sponsored group health insurance and must not be eligible for other low-income health insurance plans such as Medicaid or Badger Plus. You also must meet specific eligibility requirements for people who lost their health insurance or people who have pre-existing conditions.
Pre-Existing Conditions
If you have a pre-existing medical condition, you must meet one of several conditions for eligibility. You may qualify for HISRP if you qualify for disability payments through Medicare, if you test positive for HIV or have received a notice of cancellation, rejection, reduction or limitation of coverage or notice of increase in premiums of 50 percent or more. In addition, you must wait six months after applying for your coverage to begin.
Loss of Insurance
If you have lost your employer-sponsored health insurance,you must wait until your COBRA benefits expire before you can apply for HISRP insurance. You must have had insurance for at least 18 continuous months, counting the period in which you used COBRA insurance and must apply for HIRSP insurance within 63 days of losing your COBRA benefits. You must submit proof of insurance when you apply for HIRSP.
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