Skip Navigation LinksOCI > Health Insurance

Health Insurance

​​​​​ Health, disability, long-term care, medicare and more. 

Last Updated: January 5, 2022

Health Topics

​Both state and federal law give certain individuals, who would otherwise lose their group health insurance​coverage​ under an employer or association plan, the right to continue their coverage for a period of time. Learn more about Consolidated Omnibus Budget Reconciliation Act (COBRA)​ and Wisconsin’s continuation law​ at the links below.

Insurance that provides income if a policyholder cannot work or earn an income due to a disability. Learn more about disability income insurance here. If you have questions about disability income insurance, a member of our life insurance team will be happy to assist you.
Grievances, Denied Health Claims, Complaints, and Independent Review

Surprise Medical Bills
The No Surprises Act protects you from surprise bills for covered emergency out-of-network services, including air ambulance services (but not ground ambulance services), and surprise bills for covered non-emergency services at an in-network facility. Learn more about surprise bills and the No Surprises Act here.

File a Complaint Online
You may file a complaint with us if you are unable to resolve a dispute with an insurance company or agent, you have a problem with a pharmacy benefit manager service, or you receive a surprise medical bill. We follow a “no wrong door” policy and will work to make sure your complaint goes to the correct place – within OCI or to another state agency. 

​File a Complaint
About 60% of Americans will need assistance with things like getting dressed, getting to appointments, or making meals at some point. Long-term care is a range of services and supports to meet personal care needs. It’s important to plan ahead and understand what is covered by insurance and what is covered by Medicare. Learn more about long-term care here.
Get more information about Original Medicare, Medicare Advantage, prescription drug plans, and Medicare Supplement (Medigap) Insurance Policies in Wisconsin. Learn more about Medicare here.
Prescription drugs are a vital part of the health and wellbeing of Wisconsin residents. To control the cost of prescription medications, the Wisconsin Legislature passed a law  in March 2021 requiring Pharmacy Benefit Managers (PBM) to be licensed and regulated by OCI. The goal of the oversight is to increase transparency, control costs, and protect consumers. Learn more about 2021 Wis. Act 9 here.

 Learn all the ways OCI is working to increase access to health care and control costs in the section below.


Improving Healthcare Quality and Cost

In recent years, Wisconsin has acted to improve health care quality and reduce health care cost by supporting:

The Wisconsin Healthcare Stability Plan (WIHSP) is a state reinsurance program that helps offset the cost of high-cost claims to keep rates low for everyone. Learn more about WIHSP here.
Made up of multiple stakeholders, the Rx Task Force proposed actionable solutions to help Wisconsinites access affordable pharmaceuticals. Learn more about the Task Force here .
OCI supported legislation that further regulates the practices of Pharmacy Benefit Managers in order to increase transparency and ensure consumers get the best price at the pharmacy counter. Read more here:
Gov. Evers Signs Bill to Increase Transparency in Prescription Drug Supply Chain.

Learn more about Pharmacy Benefit Managers in the section above.​
Telehealth helps people get care they need without having to leave home. It protects the most vulnerable and eliminates transportation barriers. That’s why OCI supports telehealth access for all Wisconsinites.

In 2020, OCI conducted a Telehealth Survey​ of the comprehensive health insurers in Wisconsin to establish a better understanding of the Wisconsin health plans’ experiences and plans regarding the delivery of telehealth in the year 2020. 

The questions were designed to gauge and measure:
  • services expanded
  • technological impediments
  • cost controls
  • access to providers
  • provider resources
  • intent to continue expanded telehealth services
  • state regulations and statutes perceived as barriers to the delivery of telehealth
  • state actions that a company would support or oppose in relation to telehealth
  • assistance OCI could provide​
Advancing a Healthier Wisconsin is a statewide health philanthropy established by the Medical College of Wisconsin through a generous gift from Blue Cross & Blue Shield United of Wisconsin to serve as a resource for health improvement efforts across Wisconsin. Learn more about the Endowment here .

2020 Annual Report
2014-2018 Program Audit


We are here to help​​​​

Whether it is auto, health, home, or life insurance, our Consumer Affairs team is here to help you if you have a question or concern about your insurance policy or claim. 

Phone: ​(800) 236-8517 or (608) 266-3585​​
File a Complaint​
Ask a General Insurance Question​​​​​




​Resources​

​​​Look Up an Agent/Company​​​​ ​ Buying Insurance Online​Denials and Cancellations​
​
​​
​