Premium Subsidy Program
Purpose and focus
The AIDS/HIV Health Insurance Premium Subsidy Program helps persons with HIV maintain
access to health insurance when they reduce their work hours, take unpaid medical leave,
or terminate employment. The program does this by subsidizing (covering all or part of the
cost of) policy premiums. The program began in state fiscal year (SFY) 1991 and is
currently authorized under Wisconsin statute ss. 252.16 & 252.17. To be eligible, an
live in Wisconsin
have family income that does not exceed 300% of the federal poverty
have a doctor certify that the individual has HIV infection and had
to quit work, reduce work hours or take an unpaid medical leave from employment due to an
HIV-related medical condition
- have or be eligible for health insurance coverage under a group health plan or an
individual health plan.
Individuals with income between 201% and 300% of poverty are required
to cover 3% of the cost of their annual premium.
The program subsidizes premiums for the following types of policies:
Group Health Continuation Coverage
Under a federal law passed as part of the Consolidated Omnibus Budget Reconciliation Act
(COBRA) of 1986, individuals who are covered by employer provided group health plans may
continue to participate in the plan at their own expense for 18 months after leaving work.
Certain conditions apply, such as enrolling within a specified time period after leaving a
job. In certain circumstances, COBRA benefits can be extended to 29 months for people who
become eligible for Social Security disability.
Medicare Supplement Policies
Many people who leave work due to illness become eligible for federal Social Security
disability income (SSDI) benefits. SSDI recipients usually receive Medicare 24 months
after the date of their disability determination. Because Medicare does not offer
prescription drug coverage and involves a 20% co-pay for medical services, many
individuals seek additional coverage through private Medicare supplement policies.
For people who do not have health insurance (through a group plan provided by an employer
or other association), purchasing an individual policy may be another option for coverage.
Examples of individual policies include conversion plans offered by an insurance company
at the time COBRA benefits are ending. Individual policies often do not cover people with
certain pre-existing medical conditions like HIV. The State of Wisconsin Health Insurance
Risk Sharing Plan (HIRSP) provides major medical and Medicare supplement policies for
people with HIV and other pre-existing conditions.
Client access and benefits
To apply for the Program, clients typically work with case managers who are located at
AIDS service organizations throughout Wisconsin. The case managers assist clients in
completing the program application and then forward the application on to the Premium
Subsidy Program staff. If the client meets the program eligibility requirements, their
employer and/or insurance company is contacted to set up payment of the clients
monthly insurance premium.
In coordination with other state and federal programs, including the
AIDS Drug Assistance Program, Medicaid, and Medicare, the Program can provide
comprehensive health insurance coverage at little or no cost to clients. Program expansion
which occurred in April 1998 resulted in more persons being eligible for the benefits of
comprehensive health insurance.
Growth and trends
After initial startup of the program in SFY 91, client enrollment remained steady between
SFY 92 and SFY 97. The program had an increase in enrollment in SFY 98 with the expansion
of eligible insurance coverage. In April 1998, the AIDS/HIV health insurance premium
subsidy program offered additional options to a wider number of individuals. Program
- coverage of both individual and group health insurance
- higher income eligibility limits
- elimination of limits on length of coverage
For additional information on the Wisconsin AIDS/HIV Health Insurance Premium Subsidy
Program, call 1-800-991-5532.
Application Materials for
the Wisconsin AIDS/HIV Health Insurance Subsidy Program
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January 26, 2012