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HIV and Enteropathy
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Wisconsin State Insurance Exchange
Exchange:
The Wisconsin Insurance Exchange (Marketplace) is the Federally-Facilitated Marketplace.
The Federally-facilitated Marketplace is administered by the federal government, under the Department of Health and Human Services (HHS).
General information about the Federally-facilitated Marketplace can be found at: https://www.healthcare.gov/marketplace/individual/#state=wisconsin.
Learn more: Background
Patients:
The Federally-facilitated Marketplace is essentially a marketplace for individuals to shop for health insurance if they do not already have insurance coverage from another source. If individuals have insurance from another source such as employment, retirement benefits, or spousal benefits, they do not need to obtain it from the Marketplace.
HIV Providers:
Providers must contract with each of the Qualified Health Plans offered in the marketplace individually to participate fully in the Federally-facilitated Marketplace.
This process is similar to enrolling in insurance or managed care organization provider networks. See below the list of insurers participating in the Federally-facilitated Marketplace, and information about contacting them.
As an HIV provider, you may qualify for designation as an “Essential Community Provider (ECP).” The Qualified Health Plans participating in the Insurance Exchange (Marketplace) are required to contract with a minimum number of ECPs and Specialists to ensure network adequacy.
Visit our Provider Resources Section for more specific instructions to assist you in contacting health plans.

Learn More
: Health Reform & My Practice
Reporting Problems

The state office of insurance is primarily responsible for examining and addressing issues with the plans offered within the state Exchange (Marketplace), and the companies that offer them. If you are experiencing problems as a medical provider with the plans or companies in the state exchange, or if your patients are experiencing problems with the plans or companies in the state exchange, including trouble with access to medications, access to preferred providers, navigating the appeals process, excessive costs, or possible discriminatory policies, or any other problems related to the Affordable Care Act, please report these problems to the state office of insurance:

Wisconsin Office of the Commissioner of Insurance

125 S Webster St.

Madison, WI 53703
608-266-3585

http://oci.wi.gov/

Complaints: https://ociaccess.oci.wi.gov/complaints-public/

Additionally, if you are experiencing these or other problems, please report these problems to AAHIVM, so that we may track issues affecting our members, and seek additional policies remedies.

 
Qualified Health Plans Participating In the Exchange:
Below is a list of the Qualified Health Plans that have publicly announced that they will offer plans in the Federally-facilitated Marketplace.
Wisconsin has established United- Choice Plus as the “benchmark” plan.
This list is being routinely updated, and may change as insurers join or drop out of the exchange. Please check back for updates.
Anthem Blue Cross and Blue Shield
 
Arise Health Plan
 
Common Ground Healthcare Cooperative
 
Dean Health Plan
 
Group Health Cooperative- SCW
Plan Website: https://ghcscw.com/
 
Gundersen Health Plan, Inc.
 
Health Tradition Health Plan
 
Medica
 
MercyCare Health Plans
 
Molina Healthcare of Wisconsin
 
Physicians Plus Insurance Corporation
Provider Enrollment: https://www.pplusic.com/contact
 
Security Health Plan of Wisconsin, Inc.
 
Unity Health Insurance
Provider Enrollment: http://unityhealth.com/AboutUs/Contactus/index.htm
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