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Wisconsin Health Insurance Information


Updated September 09, 2008

If you live in Wisconsin, the following health insurance contact information may be helpful to you:

Wisconsin Commissioner of Insurance

The Wisconsin Commissioner of Insurance is responsible for regulating all types of insurance sold in the state of Wisconsin -- including health insurance policies.

If you are looking for health insurance coverage, the Commissioner of Insurance keeps a list of insurance companies licensed to sell policies in Wisconsin. You can search this list for insurance companies or agents.

If you are having trouble resolving a claims dispute with your insurer, you can file a complaint with the Commissioner of Insurance. Their site has a complaint form for you to fill out and print.

Wisconsin Office of the Commissioner of Insurance
125 South Webster Street
Madison, Wisconsin 53703-3474
Phone: 608-266-3585 (Madison) or 800-236-8517 (statewide)
Fax: 608-266-9935

COBRA Continuation Coverage - U.S. Department of Labor

If you get your insurance through your job, your plan is also regulated by the U.S. Department of Labor's Employee Benefits Security Administration (EBSA). They make and enforce the rules that your employer must follow when offering health insurance coverage to employees -- for example, your employer cannot single out an individual employee to exclude her from the plan because she (or one of her dependents) has a costly illness.

Also, if 20 or more employees are at your job, you should be offered COBRA continuation coverage when you leave your job. If you elect COBRA, you will continue with your current coverage, but can be charged up to 102% of the total cost of the plan premium. This is likely to be significantly higher than the amount you paid while in the plan because employers often subsidize the cost of insurance premiums for employees and their dependents. Your COBRA continuation coverage will last from 18 to 36 months depending on why you lost your coverage. For more information about COBRA coverage, contact the EBSA.

The EBSA works to make sure that your rights are protected. If you have concerns about your employer's practices in administering your job-based health coverage -- for example, if you think you should have been offered COBRA continuation coverage, but were not, or if you feel that you were wrongly terminated from your health plan -- contact your regional EBSA office.

U.S. Department of Labor Employee Benefits Security Administration
Chicago Regional Office
200 West Adams Street, Suite 1600
Chicago, IL 60606
Steve Haugen - Director
Phone: 312-353-0900
Fax: 312-353-1023

Buying Individual Policies in Wisconsin

As a general rule, insurers in Wisconsin are allowed to reject your application for coverage based on your health status. However, you may qualify for coverage as a "HIPAA-eligible" individual if you:

  • had at least 18 months of continuous creditable coverage, the last day of which was under a group plan AND
  • you have exhausted all COBRA continuation coverage which was available to you.

People who are HIPAA-eligible are guaranteed the right to buy an individual policy from a private insurer. You can also buy insurance through Health Insurance Risk Sharing Plan(described below). If you are not sure whether you are a HIPAA-eligible individual, your insurance agent or the Wisconsin Office of the Commissioner of Insurance can help you find out.

Wisconsin Health Insurance Risk Sharing Plan (HIRSP)

HIRSP offers coverage to individuals who are unable to purchase an individual health insurance policy because they have pre-existing health conditions. It also covers "HIPAA-eligible" individuals, as described above. For more information about the program, including premium rates, contact HIRSP.

Phone: 866-445-8491 or 304-558-8264

Badger Care Plus - the State Children's Health Insurance Program

Badger Care Plus provides health insurance coverage for all children, regardless of their family income. Children from families with higher incomes may be required to pay premiums or co-pays. Families earning less than 100% of the Federal Poverty Level are exempt from out-of-pocket costs.

Badger Care Plus
Phone: 800-362-3002
Email: DHFSBadgerCarePlus@dhfs.wisconsin.gov

Wisconsin State Health Insurance Assistance Program (SHIP)

SHIP provides free one-on-one counseling for Medicare beneficiaries with questions about any aspect of Medicare, including the Medicare Part D prescription drug benefit, or Medigap coverage.

Phone: 866-456-8211 or 888-758-6047 (TTY)

Wisconsin Medicaid

Medicaid is a government program designed to help the poor and indigent obtain healthcare services. Pregnant women and children under age 19 who meet certain income requirements may be eligible for Medicaid coverage, along with aged, blind, and disabled individuals.

Wisconsin Medicaid
Phone: 800-362-3002

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