Navigators/Nonnavigator Assisters/Certified Application Counselors
Information on the licensing and registration of navigators and nonnavigator assisters is available on the Navigator Overview page at oci.wi.gov/navigator/overview.htm.
Frequently Asked Questions
The Wisconsin Office of the Commissioner of Insurance will continually update the FAQs below as additional information and guidance is published by the federal government.
- Agent (opens in new window) (Updated: October 8, 2014)
- Consumer (opens in new window) (Updated: October 8, 2014)
- Renewal Process (opens in new window) (Created: November 12, 2014)
- Employer (opens in new window) (Updated: October 8, 2014)
- Insurer (opens in new window) (Updated: March 10, 2014)
- Enrollment (opens in new window) (Updated: March 14, 2014)
Find Health Insurer
See Find Health Insurer.
Agents Completing BadgerCare Continuing Education Course
The agent list below was created to provide a resource to county income maintenance employees and other community organizations working with individuals ineligible for Medicaid but who may be eligible for federal premium tax credits and cost-sharing subsidies through the federally facilitated marketplace (FFM), also known as the federally facilitated exchange (FFE). Agents on this list have agreed to help this population enroll in private health insurance coverage through the FFM. This list does not represent an exhaustive list of licensed agents available to assist individuals interested in purchasing coverage on the FFM. There are many agents not listed who have completed the necessary federal requirements to sell products on the FFM.
Agents interested in having their name on this list must complete an approved BadgerCare Plus related continuing education course from an approved vendor. Online training is available. Interested agents can register for the online continuing education course at http://iiaw.aben.tv/product/frommedicaidtotheexchangewhateveryagentshouldknow%289804%29
Disclaimer: As of the date of posting, the agents included on this list are licensed with the state of Wisconsin and have completed a four-hour continuing education class focused on the Wisconsin BadgerCare Plus program. The Wisconsin Office of the Commissioner of Insurance does not endorse any specific agent and is not responsible for the actions of the agents included on this list. To verify an agent's license status, go to https://sbs-wi.naic.org/Lion-Web/jsp/sbsreports/AgentLookup.jsp.
Comprehensive Individual and Small Group Policy Form Filings
Federal law requires that all comprehensive individual and small group health insurance policies issued on or after January 1, 2014, comply with all requirements of the Affordable Care Act (ACA) including, but not limited to, essential health benefits (EHB), actuarial value (AV) requirements (also referred to as Metal Levels), and guaranteed availability requirements. All existing Wisconsin insurance laws continue to apply. Therefore, insurers operating in the individual and/or small group markets must ensure that policy language in full compliance with both state and federal statutes and regulations is on file with the Office of the Commissioner of Insurance (OCI) for use in Wisconsin.
Section 631.20, Wis. Stat., provides that Wisconsin is a file and use state and that insurers file their forms with OCI 30 days before use. The file and use requirement applies to individual and small group product filings whether the product is being offered on the FFM, off the FFM or both. Please refer to the Comprehensive Health Form Filing Requirements page for more information on policy form filing requirements.
Essential Health Benefit Benchmark Plan
Federal law requires that all comprehensive individual and small group health insurance policies issued on or after January 1, 2014, provide coverage of the essential health benefits (EHB) package as defined in the Affordable Care Act (ACA). The ACA provides that each state may select a benchmark plan to serve as the standard for plans required to offer EHB in the state. If a state does not exercise the option to select a benchmark plan, the default is the largest plan by enrollment in the largest product by enrollment in the state's small group market.
Wisconsin's benchmark plan is the largest plan by enrollment in the largest product by enrollment in the small group market. For Wisconsin's 2017 EHB benchmark plan, please refer to the federal 2017 EHB Benchmark Plan Summary (opens in a new window) document for detailed information on benefits included in the plan. Please note that the summary document may not capture all of the benefits included in the benchmark plan. Refer to the Comprehensive Health Form Filing Requirements page for links to actual benchmark plan language. All benefits in the Wisconsin benchmark plan are EHB in this state and all plans in the individual and small group markets must offer, at a minimum, benefits that are substantially equal to the EHB benchmark plan, including: covered benefits, limitations on coverage and prescription drug benefits. Plan offerings are not restricted to EHB so plans may offer additional benefits.
Stand-Alone Dental Policy Form and Rate Filings
A company wishing to offer in Wisconsin a marketplace-certified stand-alone dental plan that meets standards related to the pediatric dental essential health benefits must comply with all Wisconsin policy form and rate filing requirements. In order to be eligible for QHP certification as a stand-alone dental plan (SADP) for plan year 2017, all relevant policy forms and rates must be filed with OCI by July 15, 2016. In addition, the company must include with the policy form filing the following federal documents completed and signed by a qualified actuary: (1) Stand-Alone Dental Plan Actuarial Value Supporting Documentation and Justification (opens in new window), (2) Stand-Alone Dental Plans - Description of EHB Allocation (opens in new window).
Dental forms and rate filings should be submitted as one filing for each marketindividual and small employer. Forms may not include annual or lifetime limits on the dollar value of essential health benefits (EHB). The annual limitation on cost sharing for a SADP covering the pediatric dental EHB may not exceed $350 for one covered child or $700 for two or more covered children.
Off-Exchange certified dental plans for the plan year 2017 must be submitted to OCI by October 1, 2016 (30 days prior to the individual open enrollment period).
Comprehensive Health Rate Filings
For non-grandfathered individual and small group comprehensive health products issued on or after January 1, 2014, companies are required under federal law to develop rates based on a single, market-level index rate (single risk pool) adjusted pursuant to the rating rules prescribed in federal regulation, on and off the federal health insurance exchange. Federal rate review market rules provide that single risk pool premium rates for a particular plan may vary only based on (1) whether the plan covers an individual or family, (2) rating area, as established by the state or federal government, (3) age, consistent with the federal uniform age rating curve, and (4) tobacco status, consistent with the federal 1.5:1 restriction.
OCI established 16 geographic rating areas, the maximum number allowable for Wisconsin based on the criteria provided in federal regulation. Refer to the Geographic Rating Areas (opens in new window) document for the Geographic Rating Areas map and Rating Area IDs assigned to each area by the federal government for use in federal systems.
Please refer to the Comprehensive Health Rate Filings page for additional guidance and rate filing requirements.
Wisconsin Navigator Grant Recipients
Navigators serve as an in-person resource for eligible individuals who want additional assistance in shopping for and enrolling in plans in the health insurance marketplace this fall.
Additional information regarding Wisconsin navigator grant recipients is available at http://oci.wi.gov/navigator/overview.htm.
Town Hall Meeting PPACA Presentation
In an effort to provide a forum for citizens to gather unbiased information about the Patient Protection and Affordable Care Act (PPACA), the Office of the Commissioner of Insurance and the Department of Health Services held informational sessions across the state in the form of town hall meetings. These 90-minute meetings were open to anyone who has an interest in learning more about PPACA.