Your Rights under Wisconsin Health Insurance Law

(Copyright 2005 All Rights Reserved)

Wisconsin Individual Health Insurance:

In Wisconsin, your access to individual health insurance may depend on your health status, but once you have health insurance, it cannot be canceled because you or anyone in your family becomes sick. Individual health insurance is guaranteed renewable, unless the insurance carrier cancels the plan.

Low or moderate household incomes may be eligible for free or subsidized health insurance coverage for all members of the family through a Wisconsin sponsored Individual health insurance program. If your children are 18 years old or younger and are considered low income based on Wisconsin guidelines, you may be able to purchase individual health insurance through the Wisconsin sponsored health insurance plan or receive assistance paying for private health insurance. All states take part in the federally sponsored program that provides health insurance for children or expectant mothers and are considered low income.

If you enroll in the Wisconsin Comprehensive Health Insurance Plan and are not HIPAA eligible, you will face a pre-existing condition removal period.

If you move away from Wisconsin, you may not be able to buy individual health insurance in another Wisconsin unless you are HIPAA eligible.

Under Wisconsin law, newborns and adopted children are automatically covered under the health plan of the parents and are fully insured for the first 31 days, if the plan covers dependents.

If you have had difficulty obtaining affordable individual health insurance because of your health condition, you may also be eligible for a Wisconsin sponsored Health Insurance Plan.

Eligibility for Medicaid in Wisconsin is based on your household income. People with high medical expenses may also qualify for Medicaid.

To find out more visit the Wisconsin Department of Insurance website is HTTP://WWW.STATE.WI.US

Wisconsin Group Health Insurance:

Coverage under your group health plan cannot be denied or limited, nor can you be required to pay more, because of your health status. All group health plans in Wisconsin must limit refusal due to pre-existing conditions.

If you have to take leave from your job due to illness, the birth or adoption of a child, or to care for a seriously ill family member, you may be able to keep your Wisconsin group health insurance coverage for a limited time, of up to 12 weeks. Your employer must continue your health benefits. However, you will have to continue paying your share of the premium.

Wisconsin group health insurance plans cannot apply a pre-existing condition refusal period for pregnancy, newborns, or newly adopted children, children placed for adoption, or genetic information. Increased premiums can be assessed on new groups if employees enrolling have any of the above. Existing groups may have their premiums increased to offset any extraordinary medical expenses the group may incur.

With few exceptions, small employers cannot be turned down for group health insurance in Wisconsin. They can also require you to contribute a minimum percentage of your workers premiums.

If you are self-employed and buy your own self-employed health insurance in Wisconsin, you are eligible to deduct 100% of the cost of your premium from your federal income tax.

If you lose your Wisconsin group health insurance and meet other qualifications, you will be HIPAA eligible. You can buy an Wisconsin individual health insurance policy.

If you have a legal dependent or disabled child, that dependent or child may remain covered under your fully insured Wisconsin group health plan after he or she reaches the age at which dependent coverage is usually terminated for as long as the person remains dependent.

To help you find the best health insurance company check out the complaint ratio. Click here for the instruction sheet on " How to find an insurance company complaint ratio".

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