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Wisconsin Health Insurance

 

All health insurance policies in Wisconsin are considered guaranteed renewable as long as your premiums are paid up to date.  So this means your health insurance can not be canceled because you become sick. 

 

Wisconsin mandates that health insurance companies cover newborns and adopted children for the first 60 days, on their parent’s policy.  But inversely pregnancy is, and can be considered a pre-existing condition, except on group health policies.  Annual mammograms for women are also mandated in Wisconsin.

 

The Wisconsin Health Insurance Risk Sharing Plan (HIRSP) is a high risk pool.  This is made up of people in Wisconsin that have been refused coverage under a private health insurance policy because of their health.

 

Individuals will have pre-existing exclusions of up to 6 months.  HIPAA eligible people will not have any pre-existing exclusions.  HIRSP premiums can not be more than 100% higher than what a healthy person would pay in Wisconsin for an individual policy.

 

The Wisconsin Department of Insurance has put together some frequently asked Questions about WI health insurance and if you would like to view them click

Here.

 

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Wisconsin Small Business Health Insurance

 

In Wisconsin, a group health plan, can not base your health insurance premiums on your health.  This is called non discrimination.  Small Business Health Insurance in Wisconsin is also guaranteed issue, meaning that you can not be turn down for coverage.

 

Pre-existing exclusions are limited on the amount of time they can exclude coverage.  Also if you have current coverage, without lapses, that will be credited against your pre-existing period.  Pregnancy is not considered a pre-existing condition on a group health plan.

 

When deciding what is pre-existing, Wisconsin small business health insurance companies will look back over the last 6 months of your health history.  Any treatments or diagnosis that they find will be considered pre-existing.

 

The maximum pre-existing waiting period is 12 months for an employee. If you are a late enrollee your maximum waiting period is 18 months.  Any pre-existing periods must be applied only after written notice.

 

Wisconsin doe’s limit the amount small businesses can be charged for monthly insurance premiums, and also how much rates can go up every year at renewal.  For companies with more than 50 employees there are no limitations.

 

For additional information about Small Business Health Insurance in Wisconsin click here.

 

                            Request a Wisconsin Small Business Health Insurance Quote

 

 

 

Wisconsin Individual Health Insurance

 

All Wisconsin Health Insurance Policies have to cover disabled children on their parent’s policy into their adulthood.

 

In Wisconsin, insurance companies are able to decide if they want to insure you or not.  They can either rate you up or just refuse coverage.  Also Wisconsin does not mandate what you buy, so insurance companies are able to design specific policies for specific consumers, rather than make insurance companies offer similar policies.

 

Wisconsin allows health insurance companies to include pre-existing conditions that are limited to 24 months or also elimination periods that eliminate any coverage for a pre-existing condition for the life of the policy.

 

Small business insurers have to give you credit for continuous coverage, but Wisconsin Individual Health Insurance Companies do not have to credit pre-existing condition exclusions with prior coverage.

 

The rates that an individual pays for a Wisconsin Health Insurance Plan are based on age, location, health history, family size, sex etc.  Sadly there is no limit on how much an insurance company can charge and individual for coverage.

 

For additional information about Individual Health Insurance in Wisconsin click here.

 

                            Request a Wisconsin Individual Health Insurance Quote

 

 

 

Wisconsin Self Employed Health Insurance

 

Self Employed people in Wisconsin are not allowed to buy small business health insurance plans.  Therefore they are eligible to buy Wisconsin individual plans.  So self employed people’s rights are protected under individual health insurance laws and regulations.

 

Another option for affordable Wisconsin Self Employed Health Insurance is often associations or self employed groups.  Just keep in mind that not all of these groups or associations are regulated by the state.

 

One benefit for Self Employed people is that they are able to deduct 100% of their health insurance premiums from their taxes!

 

For additional information about Self Employed Health Insurance in Wisconsin click here.

 

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Wisconsin Temporary Health Insurance

 

Many situations may arise where you find yourself without health insurance, or about to be without health insurance.  These reasons could range from graduating college to being in-between jobs.  Instead of going without health insurance you should look into getting a Wisconsin Temporary Health Insurance Policy.  These policies will be cheap, with high deductibles and low coverage, but getting a Wisconsin Temporary Health Insurance Policy is much better than going with out health insurance.  Unlike all other policies in Wisconsin, temporary health insurance is not sold on a guaranteed renewable basis.

 

For additional information about Temporary Health Insurance in Wisconsin click here.

 

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What types of Wisconsin Health Insurance are there?

 

HMO- Health Maintenance Organization.  This type of insurance is called managed care.  This means you have certain network of doctors and hospitals in Wisconsin that you have to go to for care.  Most Wisconsin HMO’s have office visit co-payments that range from $10 to $35, and hospital deductibles that range from $250 to $1,500.  Often the most affordable health insurance plans are HMO’s due to the fact they are managed care.

 

PPO-Preferred Provider Organization.  This type of insurance is also called managed care but it gives the consumer much more freedom; they allow you to visit any doctor or hospital in or out of network.  Most Wisconsin PPO’s have an in network and an out of network charge.  If the in network co-insurance is 100% then the out of network co-insurance would be 80%.  If the in network co-insurance is 90% then the out of network co-insurance would be 70%   Typically Wisconsin PPO’s offer co-payments for doctor visits as well as hospitalization. 

 

Indemnity Plan - In Wisconsin, as health insurance rates continue to rise, many people are finding it more affordable to drop their health insurance and buy a Wisconsin Major Medical Health Insurance Plan.  An Indemnity plan can also be called a major medical plan or catastrophic health insurance.  Whatever you call it, typically a Wisconsin Indemnity Plan would cover more “major” claims.  An Indemnity plan has an annual deductible and will usually allow you to pick different co-insurance options.  Indemnity plans allow you access to any doctor or hospital, and for this reason they are typically very expensive.

 

Discount Medical Plans – In recent years many Discount Medical Plans have started to surface.  These plans have relatively inexpensive, but consumers must realize that this is not insurance.  All these companies do is to get their customers discounted rates (20-50% off) on certain procedures at certain physicians and hospitals. 

 

Federal Mandated Health Insurance Laws

 

HIPAA

Along with Wisconsin Health Insurance Laws, there are Federal Laws that regulate Health Insurance companies.   HIPAA (Health Insurance Portability and Accountability Act of 1996). This act mandated federal standards for individual and group health insurance plans.  Some of the standards that it established were relative to guaranteed renew ability, crediting for prior health coverage and pre-existing condition waiting periods.

 

ERISA

Large corporations do not have health insurance policies.  Typically they are self funded, meaning the corporation pays for all of their employee’s medical bills instead of buying health insurance.  Most of these “self funded” companies are regulated by the federal government under ERISA (Employee Retirement Income Security Act)

 

COBRA

In Wisconsin it is mandated, by the state, that all companies that offer a Wisconsin Group Health Insurance Policy must also enable their employees to extend their health coverage temporarily; called Cobra.   Wisconsin Cobra Insurance is typically available for a time period of 18 to 36 months.   In Wisconsin you are given 60 days to decide if you are going to take Wisconsin Cobra Insurance or not.  Once you have passed on the opportunity to take Cobra, you are not eligible to receive it.

 

Cobra Insurance was introduced in 1985.  Cobra stands for Consolidated Omnibus Budget Reconciliation Act.  If you would like more information about your Cobra Insurance options please contact your companies HR department.

 

Often employees are surprised at the cost of a Wisconsin Cobra Insurance.  The reason for this is that they are now responsible for 103% (100% of the premium plus a 3% administration fee) of a monthly health insurance premium when they probably only paid 20% while employed. 

 

Whether nor not to take Cobra is an important question, and you should realize there are alternatives to a Wisconsin Cobra Insurance Policy.  One should realize what they plan to do in the future.  If you are looking for another job, and it will be a few months before you get a job, it might make sense to look for a Wisconsin Temporary Health Insurance Plan.  If you are contemplating working at a consultant, it would be in your best interest to look into a Wisconsin Self Employed Health Insurance Policy.   

 

 

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