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HIRSPvsHIRSP-Federal-Plan-Comparison

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Dear,

If you have a pre-existing health condition, you may be eligible for comprehensive coverage
under the Health Insurance Risk-Sharing Plan (HIRSP) or the new HIRSP Federal Plan.

Both plans offers comprehensive medical and pharmacy benefits including coverage of brand
name drugs and mental health coverage. Prescription drug co-payments can be as low as $5
for generic drugs. Beginning January 1st, there will be no cost to you for your annual physical
and other preventive services that will help you maintain good health. Until then, HIRSP and
HIRSP Federal members receive $150 of first-dollar coverage for these services.

The new HIRSP Federal Plan provides medical and drug coverage for treatment of your pre-
existing conditions on day one of your coverage – there are no waiting periods. HIRSP
Federal offers four different plan options, each with different premiums and cost-sharing. In
order to qualify for HIRSP federal, you cannot have had health insurance in the last six months.

If you have recently lost your insurance coverage and do not qualify for the HIRSP Federal
Plan, you may still qualify for HIRSP. HIRSP offers premium discounts and cost-sharing
subsidies to individuals whose annual household income is below $33,000. For example, a 25
year old male with an annual income of less than $10,000 would only pay $89 per month for a
$2,500 deductible insurance plan through HIRSP. Please note: under some circumstances,
HIRSP applies a six month waiting period for medical treatment related to pre-existing
conditions. The waiting period does not apply to prescription drugs.

Attached to this letter are several documents that will help you decide if HIRSP or HIRSP
Federal Plan is right for you. These resources include a side-by-side comparison of HIRSP and
the HIRSP Federal Plan, including the eligibility criteria, frequently asked questions, and HIRSP
and HIRSP Federal Plan rate tables.

For more information about HIRSP, please call 1.800.828.4777 or for the HIRSP Federal Plan,
please call 1.888.253.2698 or visit www.hirsp.org for information on both plans.

Sincerely,



Amie Goldman
CEO
                            HIRSP State and Federal Plan Comparison
Eligibility

              Description                                       HIRSP                             HIRSP Federal
Base Criteria                                    Wisconsin Resident for at least 3        Wisconsin Resident
(You must meet all of the base eligibility       months.
criteria within the plan you choose.)
                                                 Under 65 years of age.                   Not Eligible for Medicare.

                                                 Not eligible for employer-offered        Not eligible for employer-offered
                                                 group health insurance coverage          group health insurance coverage
                                                 Not eligible for comprehensive           Not eligible for comprehensive
                                                 Wisconsin Medicaid or BadgerCare         Wisconsin Medicaid or
                                                 Plus Standard Plan.                      BadgerCare Plus Standard Plan.
                                                                                          Are a citizen or national of the
                                                                                          United States or are lawfully
                                                                                          present in the United States.
                                                                                          Have not had creditable coverage
                                                                                          in the six months prior to the
                                                                                          HIRSP Federal effective date.

Medical Uninsurability Criteria                  Received in the past nine months one     Received in the past nine months
(If you meet the base criteria, you must         of the following based on medical        one of the following based on
meet at least one of the medical
                                                 underwriting:                            medical underwriting:
uninsurability criteria to be eligible for the
HIRSP Federal Plan. To be eligible for                 A notice of rejection from an         A notice of rejection from
HIRSP you must meet one of the medical                    insurer;                                an insurer;
uninsurability criteria or the loss of                 A notice of reduction of              A notice of reduction of
employer-sponsored coverage criteria.)
                                                          limitation in coverage,                 limitation in coverage,
                                                          including restrictive riders;           including restrictive riders;
                                                       A notice of an increase in            A notice of an increase in
                                                          premium of 50% or more;                 premium of 50% or more;
                                                       Two or more offers for                Two or more offers for
                                                          insurance with premiums at              insurance with premiums
                                                          least 50% higher than a                 at least 50% higher than a
                                                          standard risk would be                  standard risk would be
                                                          charged for the coverage.               charged for the coverage.

                                                 Tested positive for HIV.                 Tested positive for HIV.
                                                 Eligible for Medicare due to a           N/A
                                                 disability.

Loss of Employer-Sponsored                       Lost employer-offered group health       N/A
Coverage Criteria                                insurance and meet all of the
(To be eligible for HIRSP you must meet          following requirements:
one of the medical uninsurability criteria or          Did not voluntarily cancel
the loss of employer-sponsored coverage
criteria.)
                                                         your coverage.
                                                       Exhausted available
                                                         continuation coverage
                                                         (COBRA or state
                                                         continuation) under your
                                                         employer-offered group
                                                         health insurance.
                                                       Have had continuous
                                                         insurance coverage for at
                                                         least 18 months with no gaps
                                                         in coverage greater than 63
                                                         days.
                                                       Are not eligible for Medicare.

                                                                   2
  .
  Cost

       Description                                HIRSP                                 HIRSP Federal
Plan Options                   Major Medical Plans:                             Major Medical Plans:
                               HIRSP 1,000/2,500/5,000                          HIRSP Federal
                                                                                500/1,000/2,500/3,500
                               Health Savings Account (HSA) Plans:
                               HIRSP 2,500 HSA and HIRSP 3,500 HS

Premiums                       State law requires premiums to cover 60% of      See rate tables for details.
                               plan costs. See rate tables for details.

Annual Medical Deductible      Major Medical Plans:                             Major Medical Plans:
                               $1,000/$2,500/$5,000                             $500/$1,000/$2,500/$3,500

                               HSA Plans:                                       NOTE: Members in the federal pool with
                               $2,500/$3,500 combined medical and               effective dates between August 1, 2010
                                                                                and December 1, 2010 will have their
                               pharmacy deductible
                                                                                deductibles reduce by 50% for calendar
                                                                                year 2010.

Annual Medical Coinsurance     Major Medical Plans:                             Major Medical Plans:
                               20% of allowed amount up to $1,000 out-of-       20% of allowed amount up to
                               pocket.                                          $1,000 out-of-pocket.

                               HSA Plans:
                               20% of allowed amount after deductible is met,
                               up to $2,100 out-of-pocket.

Medical Out-of-Pocket          Major Medical Plans:                             Major Medical Plans:
Maximum (total annual          $2,000/$3,500/$6,000                             $1,500/$2,000/$3,500/$4,500
medical deductible and
coinsurance payments for       HSA Plans
covered services)              $4,600/$5,600 (medical and pharmacy)

Family Medical Out-of-Pocket   Major Medical Plans:                             Major Medical Plans:
Maximum (all family members    $4,000/$7,000/$12,000                            $3,000/$4,000/$7,000/$9,000
must be on the same plan)
                               HSA Plans:
                               $9,200/$11,200 (medical and pharmacy)

Drug Co-pay                    Major Medical Plans:                             Major Medical Plans:
                               $10 Tier 1/$40 Tier 2                            $10 Tier 1/$40 Tier 2

                               HSA Plans:
                               100% up to the deductible amount and then
                               20% of allowed amount after deductible is met.

Annual Drug Maximum Out-of-    Major Medical Plans:                             Major Medical Plans:
Pocket                         $2,000                                           $500/$1,000/$2,500 deductible
                                                                                plans = $2,000 drug out-of-
                               HSA Plans:                                       pocket maximum
                               $4,600/$5,600 (medical and pharmacy)
                                                                                $3,500 deductible plan = $1,450
                                                                                drug out-of-pocket maximum




                                                       3
  Coverage Limitations

             Description                                HIRSP                              HIRSP Federal
  Pre-Existing Waiting Periods            Individuals who qualify for HIRSP       There is no pre-existing waiting
                                          under the medical uninsurability        period for individuals eligible for the
                                          criteria are required to serve a six-   HIRSP Federal Plan.
                                          month waiting period for medical
                                          coverage of pre-existing conditions.
                                          The waiting period does not apply to
                                          prescription drug coverage.
                                          Individuals who qualify for HIRSP
                                          due to loss of employer-offered
                                          coverage are not required to serve
                                          a waiting period.



  Medical Benefits
  The following is a list of selected services covered under HIRSP and the HIRSP Federal Plan. For a full
  listing of covered benefits please see the HIRSP policy.

                Description                                          HIRSP and HIRSP Federal
Alcoholism, Drug Abuse and Nervous or              Deductible/Coinsurance
Mental Disorders
Ambulance Services                                 Deductible/Coinsurance

Autism Services                                    Deductible/Coinsurance
Cardiac Rehabilitation Services                    Deductible/Coinsurance
 (up to 48 sessions)
Chiropractic Services                              Deductible/Coinsurance

Diagnostic Radiology Services                      Deductible/Coinsurance
 (PET Scans, MRIs, MRAs)
Durable Medical Equipment                          Deductible/Coinsurance

Emergency Services                                 Deductible/Coinsurance

Genetic Testing                                    Deductible/Coinsurance

Home Health Care                                   Deductible/Coinsurance
  (up to 40 visits Home Health service visits
  per year)
Hospice Care                                       Deductible/Coinsurance

Hospital Services                                  Deductible/Coinsurance

Medical and Surgical Services                      Deductible/Coinsurance

Office Visits and Consultations                    Deductible/Coinsurance

Pain Management Services                           Deductible/Coinsurance

Preventive Care                                    $150 of first dollar coverage. Remaining services covered subject
                                                   to deductible/coinsurance.


                                                           4
 Radiation and Chemotherapy                     Deductible/Coinsurance
  Services
 Single Kidney Transplants and Dialysis         Deductible/Coinsurance: Continually payable up to $30,000 per
 Treatments                                     year beyond the $500,000 transplant maximum benefit. Dialysis
                                                treatment counts towards the $30,000 each year is not covered
                                                under the $500,000 transplant benefit.
 Skilled Nursing Care Facility                  Deductible/Coinsurance
    (up to 30 days per confinement)
 Therapies (OT,PT, Respiratory, Speech)         Deductible/Coinsurance

 Transplants                                    Deductible/Coinsurance up to a $500,000 Lifetime Maximum Benefit

 X-ray and Lab Services                         Deductible/Coinsurance
 Maximum Lifetime Benefit                       $2 Million Combined Medical and Drug


    Prescription Drug Benefits
        Description                             HIRSP                                   HIRSP Federal
Prescription Drugs            Tier 1 (mainly generics) $10 copay            Tier 1 (mainly generics) $10 copay
                              Tier 2 (mainly brands) $40 copay              Tier 2 (mainly brands) $40 copay
                              Tier 3 not covered without a medical          Tier 3 not covered without a medical
                              exception                                     exception
        Description                                         HIRSP and HIRSP Federal
Benefit Design                        Mandatory generic substitution program applies
                                      Generic co-pay waiver program available
                                      Some high-cost medications require prior approval
                                      Mandatory specialty pharmacy program
                                      90-day supply at retail and mail available


    Provider Network
        Description                            HIRSP                                    HIRSP Federal
In-State Network               Wisconsin Medicaid Certified Providers       Wisconsin Medicaid Certified Providers


Out-of-State Network           HIRSP pays HIRSP rates to out-of-state       The HIRSP Federal Plan will NOT
                               providers both in emergency situations       reimburse out-of-state providers for
                               and for scheduled services.                  services rendered, except in cases of
                                                                            emergency.
                               HIRSP members MAY be BALANCE
                               BILLED by out-of-state providers if they     In emergencies, the member WILL be
                               refuse to accept HIRSP payment rates as      responsible for the difference between the
                               payment in full for the services provided.   provider chargers and the HIRSP
                                                                            reimbursement rate.

                                                                            For non-emergency services the member
                                                                            IS responsible for 100% of the charges for
                                                                            any services provided by a non-Wisconsin
                                                                            Medicaid Certified provider.




                                                        5
    Customer Service & Website

       Description                             HIRSP                               HIRSP Federal
Customer Service               1.608.221.4551 (Madison, WI) or         1.608.221.5315 (Madison, WI) or
                               1.800.828.4777                          1.888.253.2698


Website Address                www.hirsp.org                           www.hirsp.org



    Frequently Asked Questions
      What are the benefits for the HIRSP Federal Plan?
         The HIRSP Federal Plan will offer medical and drug benefits that are comparable to Wisconsin
         HIRSP. The HIRSP Federal Plan will not have a pre-existing waiting period. To view the
         benefits, various plan options and out of pocket costs available under the Wisconsin HIRSP plan,
         please visit the HIRSP website at www.hirsp.org.

      Do I have to be uninsured for 6 months?
           You cannot have been enrolled in creditable coverage in the six months before applying to the
           HIRSP Federal Plan. Creditable Coverage includes a group health plan, Medicare Parts A, B and
           D, Medicaid, TriCare, Veterans Administration coverage, Indian Health Services, a state health
           benefits risk pool, a federal employee health plan, a public health plan and a Peace Corps health
           plan, among others.

      What qualifies as a pre-existing condition?
         You must obtain one letter of rejection due to medical underwriting from a commercial insurer.

      Prescription drug coverage? More than just generics?
          The HIRSP Federal Plan will offer a drug benefit, including generic and brand name drugs, that
          are comparable to Wisconsin HIRSP, with no waiting period for preexisting conditions.

      Can I apply over the internet?
          You can apply online by visiting www.hirsp.org.

      Will I lose my place on the BadgerCare Plus Core plan waiting list if I apply for this program?
           You will not lose you place on the BadgerCare Plus Core plan waiting list if you enroll in the
           HIRSP Federal Plan. However, if you enroll in the BadgerCare Plus Core or Basic plan first, you
           will not be eligible for the HIRSP Federal Plan.




                                                       6
                    HIRSP FEDERAL PREMIUM RATES
                 Rates Effective July 2010 – December 2011



              FEDERAL 500                                       FEDERAL 1000
            ($500 deductible)                                 ($1,000 Deductible)
          Monthly Premium Rates                             Monthly Premium Rates
         Age              Unisex                           Age               Unisex
     24 and Under          $214                        24 and Under          $176
        25 - 29            $227                          25 - 29             $186
        30 -34             $258                          30 -34              $212
        35 - 39            $306                          35 - 39             $251
        40 - 44            $364                          40 - 44             $298
        45 - 49            $450                          45 - 49             $369
        50 - 54            $559                          50 - 54             $458
        55 - 59            $686                          55 - 59             $562
         60 +              $802                           60 +               $658


             FEDERAL 2500                                      FEDERAL 3500
           ($2,500 deductible)                               ($3,500 Deductible)
          Monthly Premium Rates                             Monthly Premium Rates
         Age              Unisex                           Age              Unisex
     24 and Under          $127                        24 and Under          $106
        25 - 29            $134                          25 - 29             $113
        30 -34             $152                          30 -34              $128
        35 - 39            $181                          35 - 39             $152
        40 - 44            $215                          40 - 44             $181
        45 - 49            $266                          45 - 49             $223
        50 - 54            $330                          50 - 54             $277
        55 - 59            $405                          55 - 59             $340
         60 +              $474                           60 +               $398


For more information on the HIRSP Federal Plan or other HIRSP plan choices, please visit
www.hirsp.org or call 1.888.253.2698.




                                                 7
                                                HIRSP PLAN MONTHLY PREMIUM RATES
                                                Rates Effective April 1, 2010 – December 31, 2011

   HIRSP 1,000 - ($1,000 deductible)                     HIRSP 2,500 - ($2,500 deductible)                  HIRSP 5,000 - ($5,000 deductible)
            Monthly Premium Rates                                 Monthly Premium Rates                               Monthly Premium Rates
    Age               Male        Female                  Age              Male         Female                Age             Male      Female
    0-18              $309          $303                  0-18             $151          $151                 0-18               $96      $95
    19-24             $309          $387                  19-24            $150          $190                 19-24              $94     $121
    25-29             $326          $437                  25-29            $156          $210                 25-29              $99     $133
    30-34             $376          $499                  30-34            $182          $241                 30-34           $116       $153
    35-39             $442          $582                  35-39            $208          $275                 35-39           $132       $174
    40-44             $533          $674                  40-44            $251          $319                 40-44           $159       $201
    45-49             $648          $761                  45-49            $316          $366                 45-49           $201       $231
    50-54             $781          $843                  50-54            $408          $421                 50-54           $258       $266
    55-59             $956          $935                  55-59            $521          $478                 55-59           $331       $303
    60+               $1,162        $989                  60+              $656          $545                 60+             $416       $346

                           HIRSP HSA 2,500 - ($2,500                                             HIRSP HSA 3,500 - ($3,500
                                  deductible)                                                           deductible)
                                Monthly Premium Rates                                               Monthly Premium Rates
                        Age              Male         Female                                Age             Male         Female
                        0-18             $135          $135                                 0-18            $122          $122
                        19-24            $134          $170                                 19-24           $121          $155
                        25-29            $138          $186                                 25-29           $126          $169
                        30-34            $162          $214                                 30-34           $147          $194
                        35-39            $185          $244                                 35-39           $168          $222
                        40-44            $222          $284                                 40-44           $202          $258
                        45-49            $282          $324                                 45-49           $256          $295
                        50-54            $361          $374                                 50-54           $328          $340
                        55-59            $463          $426                                 55-59           $421          $387
                        60+              $583          $486                                 60+             $530          $441

                                                 HEALTH INSURANCE RISK-SHARING PLAN
                                                     Plans Subsidy Discount Table

HIRSP 1,000, HIRSP 2,500 and HIRSP 5,000                                          HIRSP Health Savings Account 2500 / 3500
                            Medical                            Drug                                         Medical                         Drug
Household                  Deductible       Premium        Out-of-Pocket          Household                Deductible      Premium      Out-of-Pocket
Income                      Discount        Discount         Maximum              Income                    Discount       Discount       Maximum
$33,000 and Above          No Discount     No Discount        $2,000              $33,000 and Above        No Discount    No Discount   Not Applicable
$30,000 - 32,999.99             $100            15%              $1,250           $30,000 - 32,999.99         $100            15%       Not Applicable
$25,000 - 29,999.99             $100            20%              $1,000           $25,000 - 29,999.99         $100            20%       Not Applicable
$20,000 - 24,999.99             $100            25%              $750             $20,000 - 24,999.99         $100            25%       Not Applicable
$17,000 - 19,999.99             $200            29%              $600             $17,000 - 19,999.99         $200            29%       Not Applicable
$14,000 - 16,999.99             $300            34%              $525             $14,000 - 16,999.99         $300            34%       Not Applicable
$10,000 - 13,999.99             $400            39%              $450             $10,000 - 13,999.99         $400            39%       Not Applicable
Less than $10,000               $500            43%              $375             Less than $10,000           $500            43%       Not Applicable
        *The medical and drug benefit in the HSA plan is a combined benefit; therefore, a cap on out-of-pocket drug costs is not
                                                              available.




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