HIRSP Federal Plan - Noncovered Services
The following is a partial list of treatments, services, supplies and expenses that HIRSP Federal Plan does not cover.
- Cosmetic treatments
- Custodial care
- Eyeglasses
- Hearing aids
- Charges for produres or services that are determined as not medically necessary and appropriate
- Expenses incurred for procedures or services that are of questionable medical value, experimental or investigative (except drugs for the treatment of HIV infection)
- Infertility, impotence and sterilization services or drugs
- Healthcare services performed by members of your immediate family or anyone else living with you
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Routine dental care
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Any services covered by any other policy of healthcare insurance
Refer to the HIRSP Federal policy for a full listing of covered/noncovered services, exclusions, conditions and limitations.
Provider Network and Your Coverage
To be covered by the HIRSP Federal Plan, healthcare providers must be Wisconsin Medicaid-certified. HIRSP Federal Plan will pay benefits up to the HIRSP Federal Plan allowed amount. You are responsible for any applicable deductible and coinsurance amounts.
If you receive emergency medical care from a healthcare provider located outside of the state of Wisconsin who is not Medicaid-certified, HIRSP Federal Plan will cover those health care services up to the HIRSP Federal Plan allowed amount. You are responsible for any applicable deductible and coinsurance amounts, and maybe balanced billed for the difference between the provider charges and the HIRSP Federal Plan allowed amount.