$30,000 Coverage Mandate in Wisconsin
Fact Sheet on Mandated Benefits in Health Insurance Policies
- Policies that cover hospital expenses must provide at least $30,000 of coverage per year for inpatient and outpatient treatment of kidney disease, including dialysis, transplantation, and donor-related services.
- The coverage is not required to duplicate medicare benefits and may be subject to the same limitations that apply to other health conditions
632.895(4), Wis. Stat
- Kidney disease treatment
632.895(4)(a) (a) Every disability insurance policy which provides hospital treatment coverage on an expense incurred basis shall provide coverage for hospital inpatient and outpatient kidney disease treatment, which may be limited to dialysis, transplantation and donor-related services, in an amount not less than $30,000 annually, as defined by the department of health services under par. (d).
632.895(4)(b) (b) No insurer is required to duplicate coverage available under the federal medicare program, nor duplicate any other insurance coverage the insured may have. Other insurance coverage does not include public assistance under ch. 49.
632.895(4)(c) (c) Coverage under this subsection may not be subject to exclusions or limitations, including deductibles and coinsurance factors, which are not generally applicable to other conditions covered under the policy.
632.895(4)(d) (d) The department of health services may by rule impose reasonable standards for the treatment of kidney diseases required to be covered under this subsection, which shall not be inconsistent with or less stringent than applicable federal standards.
Note: under the Affordable Health Care Act, there may be an elimination of this $30,000 renal cap for insurance policies written in WI:
For a group policy that is based outside of the state of Wisconsin, annual or lifetime dollar limitations may apply. Verify benefits with insurance company.