Penelope
Diamond Member
- Jul 15, 2014
- 60,260
- 15,767
- 2,210
Is this what you want?? It would be like qualifying for disability and there was a cap on it.
How does this help someone who does not qualify for a high risk pool, but is working a min wage job (as you know WI has not raised its min wage, for say someone having a baby, or some with asthma, someone who just lost their job. WI is not a state that we want to be like, like Texas.
Medical Conditions
If you have meet one of the following requirements, you are able to receive coverage through HIRSP. Those with pre-existing conditions are subject to a six month waiting period for benefits related to their condition only. Applicants with medical conditions must be residents of Wisconsin for at least three months as of your effective date in the high risk pool, except for those who have been enrolled in another state high risk pool for one year and apply within 45 days of your plan’s end. Applicants must be able to document one of the following criteria:
§ Medicare eligible due to a disability
§ HIV-positive
§ Received one of the following from insurance companies in the past 9 months:
§
§ Rejection notice from one or more insurers
§ Benefit termination notice
§ Notice of reduction or limitation of coverage, including restrictive riders
§ Notice of premium increase of at least 50 percent
§ Two or more insurance quotes with premiums at least 50 percent higher than a standard comprehensive policy similar to HIRSP coverage
HIRSP Plans
Like a private insurer, HIRSP offers plans in deductibles of $1,000 to $7,500, with monthly premiums varying based on age and tobacco use. All comprehensive plans provide 80 percent coverage for medical care after deductible, with out-of-pocket limits that vary with each deductible. Prescription drugs are included for a copay with each tier, starting at $5 for Tier 1. There are also Health Savings Account plans for those who want a federally qualified high deductible plan. HSAs include all benefits in the deductible, offering no services for a copay. Coverage is also 80 percent after deductible with HSA plans.
HIRSP Benefits
HIRSP plans cover any services viewed as medically necessary and appropriate according to their company policy. This includes preventive services and many other types of care that and individual may need based on their age, gender, health status, and lifestyle traits that may put them at risk. Preventive care is covered at 100 percent for any plan member in need of routine exams, immunizations, screenings, or any other appropriate service. Prescription drugs can be filled through a HIRSP contracted pharmacy. Prior Approval may be needed for certain services, with the exception of those on the HIRSP Medicare Supplement plan. Many benefits including those listed below are covered by HIRSP plans.
§ Preventive care
§ Physician office visits
§ Prescription drugs
§ Home health care
§ Surgical services
§ Anesthesia
§ Radiology
§ Laboratory and X-ray
§ Skilled nursing services
§ Annual physical exam
§ Hospice care
§ Pap test and pelvic exam
All care can be obtained through a certified Medicaid provider anywhere in Wisconsin. To locate a certified provider, call 800-828-4777.
Health Insurance Risk Sharing Plan | Wisconsin Health Insurance
How does this help someone who does not qualify for a high risk pool, but is working a min wage job (as you know WI has not raised its min wage, for say someone having a baby, or some with asthma, someone who just lost their job. WI is not a state that we want to be like, like Texas.
Medical Conditions
If you have meet one of the following requirements, you are able to receive coverage through HIRSP. Those with pre-existing conditions are subject to a six month waiting period for benefits related to their condition only. Applicants with medical conditions must be residents of Wisconsin for at least three months as of your effective date in the high risk pool, except for those who have been enrolled in another state high risk pool for one year and apply within 45 days of your plan’s end. Applicants must be able to document one of the following criteria:
§ Medicare eligible due to a disability
§ HIV-positive
§ Received one of the following from insurance companies in the past 9 months:
§
§ Rejection notice from one or more insurers
§ Benefit termination notice
§ Notice of reduction or limitation of coverage, including restrictive riders
§ Notice of premium increase of at least 50 percent
§ Two or more insurance quotes with premiums at least 50 percent higher than a standard comprehensive policy similar to HIRSP coverage
HIRSP Plans
Like a private insurer, HIRSP offers plans in deductibles of $1,000 to $7,500, with monthly premiums varying based on age and tobacco use. All comprehensive plans provide 80 percent coverage for medical care after deductible, with out-of-pocket limits that vary with each deductible. Prescription drugs are included for a copay with each tier, starting at $5 for Tier 1. There are also Health Savings Account plans for those who want a federally qualified high deductible plan. HSAs include all benefits in the deductible, offering no services for a copay. Coverage is also 80 percent after deductible with HSA plans.
HIRSP Benefits
HIRSP plans cover any services viewed as medically necessary and appropriate according to their company policy. This includes preventive services and many other types of care that and individual may need based on their age, gender, health status, and lifestyle traits that may put them at risk. Preventive care is covered at 100 percent for any plan member in need of routine exams, immunizations, screenings, or any other appropriate service. Prescription drugs can be filled through a HIRSP contracted pharmacy. Prior Approval may be needed for certain services, with the exception of those on the HIRSP Medicare Supplement plan. Many benefits including those listed below are covered by HIRSP plans.
§ Preventive care
§ Physician office visits
§ Prescription drugs
§ Home health care
§ Surgical services
§ Anesthesia
§ Radiology
§ Laboratory and X-ray
§ Skilled nursing services
§ Annual physical exam
§ Hospice care
§ Pap test and pelvic exam
All care can be obtained through a certified Medicaid provider anywhere in Wisconsin. To locate a certified provider, call 800-828-4777.
Health Insurance Risk Sharing Plan | Wisconsin Health Insurance
