WISCONSIN 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.

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.

REPORTING PROBLEMS

QUALIFIED HEALH PLANS PARTICIPATING IN THE EXCHANGE

Below is a list of the Qualified Health Plans that have publically announced that they will offer plans in the Federally-facilitated Marketplace.
Wyoming has established Blue Cross Blue Shield of WY 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.

Ambetter from Managed Health Services
Plan Website: http://ambetter.magnoliahealthplan.com/
Provider Enrollment: http://ambetter.magnoliahealthplan.com/for-providers/join-our-network/
Plan types offered: Individual

Anthem Blue Cross and Blue Shield
Plan Website: https://www.anthem.com/health-insurance/Wisconsin/health-plans/
Provider Enrollment: http://www.anthem.com/wps/portal/ahpprovider?content_path=provider/nv/f5/s2/t0/pw_002297.htm&state=nv&label=Become%20an%20Anthem%20Blue%20Cross%20and%20Blue%20Shield%20Network%20Provider
Plan types offered: Individual

Arise Health Plan
Plan Website: http://www.wecareforwisconsin.com/visitors
Provider Enrollment: http://www.wecareforwisconsin.com/providers/become_a_provider
Plan types offered: Individual, SHOP

Common Ground Healthcare Cooperative
Plan Website: http://www.commongroundhealthcare.org/
Provider Enrollment: http://www.commongroundhealthcare.org/healthcare-providers/cghc-provider/
Plan types offered: Individual, SHOP

Dean Health Plan
Plan Website: http://www.deancare.com/
Provider Enrollment: http://www.deancare.com/providers/forms/
Plan types offered: Individual

Group Health Cooperative- SCW
Plan Website: https://ghcscw.com/
Provider Enrollment: https://ghcscw.com/SiteCollectionDocuments/Provider_Handbook/Credentialing_Policy.pdf
Plan types offered: Individual, SHOP

Gundersen Health Plan, Inc.
Plan Website: https://www.gundersenhealthplan.org/
Provider Enrollment: https://www.gundersenhealthplan.org/HealthcareProviders.aspx
Plan types offered: Individual, SHOP

Health Tradition Health Plan
Plan Website: http://www.healthtradition.com/
Provider Enrollment: http://www.healthtradition.com/providers
Plan types offered: Individual, SHOP

Medica
Plan Website: https://www.medica.com/
Provider Enrollment: https://www.medica.com/providers/join-our-provider-network/join-the-network
Plan types offered: Individual, SHOP

Medica Insurance Company
Plan Website: https://www.medica.com/
Provider Enrollment: https://www.medica.com/providers/join-our-provider-network/join-the-network
Plan types offered: SHOP

MercyCare Health Plans
Plan Website: http://www.mercycarehealthplans.com/
Provider Enrollment: http://www.mercycarehealthplans.com/
Plan types offered: Individual, SHOP

MercyCare HMO, Inc.
Plan Website: http://www.mercycarehealthplans.com/
Provider Enrollment: http://www.mercycarehealthplans.com/
Plan types offered: SHOP

Molina Healthcare of Wisconsin
Plan Website: http://www.molinahealthcare.com/members/wi/en-us/hp/marketplace/pages/marketplace.aspx
Provider Enrollment: http://www.molinahealthcare.com/members/common/en-us/abtmolina/compinfo/pages/contactus.aspx#
Plan types offered: Individual

Physicians Plus Insurance Corporation
Plan Website: http://www.pplusic.com/home
Provider Enrollment: https://www.pplusic.com/contact
Plan types offered: Individual

Security Health Plan
Plan Website: https://www.securityhealth.org/
Provider Enrollment: https://www.securityhealth.org/providers/partnering-with-security-health-plan
Plan types offered: SHOP

Security Health Plan of Wisconsin, Inc.
Plan Website: https://www.securityhealth.org/
Provider Enrollment: https://www.securityhealth.org/providers/partnering-with-security-health-plan
Plan types offered: Individual, SHOP

UnitedHealthcare
Plan Website: http://www.uhc.com/health_reform_guide.htm
Provider Enrollment: http://www.uhc.com/physicians/join_our_network.htm
Plan types offered: Individual

Unity Health Insurance
Plan Website: http://unityhealth.com/
Provider Enrollment: http://unityhealth.com/AboutUs/Contactus/index.htm
Plan types offered: Individual