About Wisconsin High-Risk Sharing Plan Insurance

The Wisconsin Health Insurance Risk-Sharing Plan (HIRSP) is a member of the National Association of State Comprehensive Health Insurance Plans (NASCHIP). HIRSP operations are administered by the Wisconsin Physicians Service Insurance Corporation. The Wisconsin program is available to residents of all ages. HIRSP made some significant changes to its coverage in January 2010 and, with the passage of the Patient Protection and Affordable Care Act (PPACA) of 2010, other changes may also take place.

History

• The Wisconsin HIRSP Authority was formed in 1979 to "provide access to high-quality, affordable healthcare for all eligible Wisconsin residents." The Authority joined the National Association of State Comprehensive Health Insurance Plans that was formed in 1993 to provide educational resources for states that wished to form plans and to serve as a networking organization for existing plans. The HIRSP Authority, through the NASCHIP, has worked to provide resources for the development of insurance pools mandated by PPACA.

Function

• HIRSP provides insurance to Wisconsin residents who cannot afford private insurance and to those who have lost employer insurance. It also makes insurance affordable for residents who are unable to buy insurance due to pre-existing conditions. Although a six-month waiting period applies for pre-existing conditions, HIRSP guarantees access to health insurance to protect Wisconsin residents against catastrophic illnesses. It has also, since January 2010, paid "first-dollar coverage" of many preventative services, including annual physical exams, select vaccinations, mammograms, routine diagnostic procedures and tests, children's blood lead tests and screenings for depression and alcohol abuse.

Policies

• Policies are structured to meet two income levels and low-income policy holders may also be eligible for "Badgercare," a Medicaid-related supplementary plan. Three levels of premiums relate directly to $1,000, $2,500 or $5,000 deductible limits on policies. HIRSP also offers a Medicare supplement policy for "continuing" members and a Health Savings account program. Coverage is an 80-20 percent split up to $1,000 after deductibles have been met. Premiums are currently lower than private insurance rates. Drugs are covered under a co-pay policy determined by HIRSP formulary. Like Medicare, HIRSP has defined enrollment periods.

Funding

• HIRSP operates on subscriber premiums and federal grants. In 2009, policyholder contributions totaled $84.5 million and federal grants totaled approximately $2.5 million. The plan's total budget was just over $145 million. Other income comes from low-income subsidies and subsidies from providers and insurers. HIRSP operates on a non-profit basis; improved efficiencies made it possible to distribute savings to subscribers in 2009.

Considerations

• The PPACA will have an effect on all state high-risk programs. Aime Goldman, CEO of the HIRSP Authority, says that HIRSP and other states in NASCHIP began meeting with the U.S. Department of Health and Human Resources in 2009 to discuss program efficiencies and have offered to provide an example of a successful state insurance pools as PPACA pools are established.