Wisconsin -WI- Health insurance Coverage and Regulations

Choosing quality medical insurance for you and your family may be an arduous undertaking, but it is one that must be done. Before you do decide what medical insurance coverage to go with for you and your family, you should first go through the needs and the budget of your family. If you are a Wisconsin resident then there are several insurance options for you and your family at both the individual and group level.

Wisconsin regulates the insurance companies and providers of its state through the Wisconsin Office of the Commissioner of Insurance and they legislate which insurance providers can sell plans to individuals and families of the state. Here is a breakdown of some of the different insurance coverage for the state of Wisconsin and how they are regulated:

• Individual: In Wisconsin medical coverage is determined by medical underwriting. Because of this providers have the opportunity to review the past medical history of any individual applicant. Once reviewed, the provider has the option to offer coverage to the individual in full, offer modified coverage to the individual with a plan that may exclude certain coverages using permitted elimination riders, or totally refuse coverage to the individual based on past or current medical history. This rule is in effect even the applicant had prior coverage as Wisconsin regulations do not require that credit be given for past coverage. This means that all applicants are subject to a 24 month exclusionary period on any and all pre-existing conditions. Providers are also allowed by regulators to use an applicant's age, gender, health status, and other various factors when determining individual premium rates.
  
  
• Small Group: The state of Wisconsin defines a small group employer as one with two to 50 employees. In this case, the group of employees must be offered health insurance coverage on a guaranteed issue basis which means that the provider may not deny coverage to the group or any individual of the group based on health history. This rule is pursuant to the Health Insurance Portability and Accountability Act of 1996. However, applicants that had no qualifying coverage prior are subject to a six month look back and a 12 month exclusionary period for conditions that are pre-existing. Because rates for the group are determined by the process of medical underwriting and the providers can use a multitude of determining factor when it comes to the price of premium, the rates for the different members of the group could vary by plus or minus 30 percent of the indexed rate.
  
  
• COBRA and Conversion: Federal regulations state that groups of 20 or more who lose their existing coverage are eligible for COBRA. However Wisconsin has instituted its own mini-COBRA program which allows for groups fewer than 20 that have lost their coverage due to a qualifying event to take advantage of COBRA for an additional 18 month period. To qualify for the Wisconsin mini-COBRA program you must have had at minimum of three months coverage under the group plan being lost. If you do qualify it will be the sole responsibility of you to pay the entire premium in order to stay with the current provider and ensure no loss of benefits. Election for mini-COBRA must take place within 30 days of losing group health coverage. Those who do not qualify for COBRA or mini-COBRA may still be able to obtain health insurance with certain conversion plans.

Life is not always certain. What is certain is the fact that you and your family need to be fully covered with quality medical insurance so that you will always be prepared for whatever life brings you.

Medical insurance quotes

Major Medical Insurance Quotes

Group Health Insurance Quotes