Wisconsin Health Insurance

Wisconsin (WI)

Individual Health Insurance Regulations

Medical insurance is essential to protect your family's health against unpredicted events of sickness or injury. Before opting for health coverage, you should go through your family's medical needs and your budget. Being a Wisconsin resident, you can choose from various product alternatives. The Wisconsin Office of the Commissioner of Insurance supervises the legislature under which the Wisconsin health insurers can sell private insurance to individuals and families.
The issuance of medical insurance policies in the State of Wisconsin is determined by the process of medical underwriting. Medical underwriting provides the insurer an opportunity to obtain and evaluate the applicant's prior medical history. Based on the determination of the underwriter, the medical insurance carrier may opt to provide coverage under the terms of the health plan; offer modified coverage, setting specific limitations and exclusions on coverage under the policy; or deny coverage based upon the applicant's medical history. Because Wisconsin insurance regulations do not require that credit for prior coverage be given, all applicants are subject to a 24-month exclusionary period on pre-existing medical conditions. Coverage of health care benefits may also be modified by the permitted use of elimination riders. Credit for prior coverage is not required to be given by the health insurers. An elimination rider is an amendment to the policy which may temporarily or permanently exclude the coverage of specific medical conditions. Insurers are permitted to use an applicant's health status, age, gender and other varying factors when determining individual premium rates.
Search for plans and the costs associated with them using the search box above. We provide individual, family, group and student health plan quotes for you to compare on all states and zip codes. Remember that having coverage leads to a healthier lifestyle as you are able to get regular doctor checkups and therefore a low-cost premium.

Wisconsin (WI)

Small Group Health Insurance Regulations

For purposes of acquiring medical insurance coverage, the State of Wisconsin defines a small group as a group of employees numbering from 2 to 50. Under the Health Insurance Portability and Accountability Act of 1996, medical coverage for groups of this size must be issued on a guarantee issue basis. Guarantee issue coverage prohibits a carrier from declining medical coverage based upon the health history of the group or individual employee. For applicants lacking qualifying prior creditable coverage, insurers are provided with a 6 month look back, 12-month exclusionary period for pre-existing conditions. Premium rates for small group medical coverage are determined by the process of medical underwriting. This process allows the insurance carrier to consider many factors when determining rates, including the overall health of the group. Accordingly, rates may vary by plus or minus 30 percent of the indexed rate.

Wisconsin COBRA and Continuation Coverage

Although groups of 20 or more employees are regulated by federal COBRA regulations, Wisconsin has implemented its own state mini-COBRA regulation. Under the state program, groups of less than 20 employees who, as a result of a qualifying event, have had their group benefits terminated may be eligible for continuation of coverage for an additional 18-month period. To be a qualified recipient for benefits under the mini-COBRA program, you must have had at least 3 months coverage under the group health plan. Coverage and benefits would continue under the employer sponsored plan, cost of which would be at the sole expense of the individual covered under COBRA. Election of these benefits must be made within thirty days of termination from the group health plan. Conversion plans are also available as an alternative to COBRA.