HIRSP Application
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Apply Online for HIRSP

Welcome! The HIRSP online application is designed to easily take you step-by-step through the application process.

Getting Started
To be considered for Health Insurance Risk-Sharing Plan (HIRSP) coverage, applicants are required to:
  1. Answer all questions completely to permit HIRSP to process the application. In order to process the application, HIRSP needs the applicant's Social Security Number and certain other personally identifiable information. Providing this information is voluntary. The personally identifiable information and Social Security Number will be kept confidential and used only in our administration of the HIRSP program, as authorized by Chapter 149, Wisconsin Statutes and federal law.
  2. Submit separate applications and separate premium payments for each applicant.
  3. Submit supporting documentation required to process the application.
  4. To receive additional information regarding the HIRSP Plan, visit: www.hirsp.org or call 1-800-828-4777
  
To complete your application, you may need the following:
Software:
  • Adobe Acrobat Reader  Download
    		•
    Current/Recent Insurance Information:
  • Employer Health Insurance
  • Other Medical Coverage
  • Medicaid/Medicare Information
    		•


    Begin a New Application
    To start a new application, simply enter the first name and date of birth of the person to be covered by HIRSP and click the Begin button.
    Your First Name:  
    Your Date of Birth:  /   /  (mm/dd/yyyy)
    		   What if I am applying for another person?
    This online process assumes that the person filling out the application is the person seeking HIRSP coverage. If you are filling out the application for another person (for example, you are that person's parent or legal guardian), please be aware that the following pages are worded as if you are the applicant.


    Continue an Application
    To continue an application you began earlier, enter the application number you received and click the Continue button.
    Enter your application number:
    		   What if I can't remember my application number?
    Please begin a new application.

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