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How Government Mandates Affect your Coverage

Several State and Federal legislative mandates on insurance coverage have passed in recent years and are scheduled to take effect as outlined in the sections below. As these changes happen, we will continue to update the site to help you navigate the changes and determine whether they affect you and your insurance coverage.

Dependent Coverage

Effective January 1, 2012, the State Dependent Mandate was revised to mirror the Federal Dependent Mandate as it relates to the minimum required age for plans to cover dependents. As such, starting with 2012 renewals and new business, a dependent is covered on the parent's policy until the dependent turns age 26, regardless of marital status.

Financial support from parents is no longer required, and full-time student status is no longer required, except in certain cases of students returning to school from military service.

Frequently Asked Questions

 

 

Autism Coverage

The State of Wisconsin now requires health insurance plans to cover Autism Spectrum Disorder, including Autism, Asperger's syndrome, and Pervasive Developmental Disorders not otherwise specified. The frequently asked questions on this website are intended to provide an overview of your health plan coverage for autism spectrum disorder treatments and help you better understand your options as you discuss treatment options with your child's health care provider.

If you have any questions, please contact the Customer Care Center at (800) 279-1301.Frequently Asked Questions  

 

Preventive Care Coverage

The Affordable Care Act (ACA) has added new requirements for insurance coverage of preventive care for women and children. Section 2713 of the ACA, and the interim final regulations (IFR) require health insurers offering large group, small group and individual health insurance to provide benefits and prohibit cost-sharing for certain preventive services and screenings. Cost sharing is defined as when both member and health plan are responsible for a portion of the cost of care and includes deductibles, copayments and co-insurance.

Preventive Care Page