Wisconsin Mandates for Health Insurance policies

Health insurance policies sold in Wisconsin often include "mandated benefits." These are benefits that an insurer must include in certain types of health insurance policies. Except for HMOs organized as cooperatives under ch.185, Wis. Stat., HMOs are required to provide the same benefits as traditional insurers.

The mandated benefits required by Wisconsin state law for health insurance policies include coverage for: professional health-care services, adopted children, handicapped children, nervous and mental disorders, alcoholism and other drug abuse, home health care, skilled nursing home care, kidney disease, mammography, newborn infants, coverage for grandchildren born to dependent children under the age of 18 who are covered by the policy, diabetes, lead screening, and maternity coverage for all persons covered under the policy if it provides maternity coverage for anyone, genetic testing, drugs for treatment of HIV infection, TMJ disorder, hospital and ambulatory surgery center charges and anesthetics for dental care, breast reconstruction, and coverage for certain health-care cost in cancer clinical trials.

Co-operative HMOs are subject to the mandates regarding chiropractors, optometrist, genetic testing, nurse practitioners, newborns, adopted children, HIV drugs, dentists, TMJ disorders, breast reconstruction, and hospital and ambulatory surgery center charges and anesthetics for dental care.

("Consumer's guide to insurance", Wisconsin office of the Commissioner of Insurance)