The national Group Health Insurance guide covers how group plans work: eligibility, the master contract and certificates, federal COBRA, HIPAA and coordination of benefits. This guide covers the Wisconsin rules: state continuation under Wis. Stat. 632.897, conversion, the group grace period and small employers.

State continuation (Wis. Stat. 632.897)

Who qualifies:

• A group member whose coverage would end, who has been continuously covered at least 3 months.
• A member discharged for misconduct doesn't qualify.
• Divorce: coverage of a spouse can't end just because the marriage breaks down, until a judgment of divorce or annulment is entered. The former spouse may then continue or convert.

How it works:

• The employer gives written notice of the right within 5 days after learning that coverage will end.
• The person keeps coverage without a gap by paying within 30 days after the notice.
• The premium is paid to the employer. It can't exceed the group rate for a member, including the employer's share.

When it ends:

• The person moves out of state, stops paying, or becomes eligible for similar group coverage, among other events.
• The insurer may require conversion 18 months after the person elects continuation.

Conversion

When continuation ends, the person may convert to an individual policy without new evidence of insurability (632.897(4)).

Grace period (Wis. Stat. 632.78)

Group and blanket health policies have a grace period of at least 31 days.

Small employers (Wis. Stat. 635.02(7))

A small employer averaged at least 2 and no more than 50 employees.

Common exam traps

• Wisconsin continuation requires 3 months of prior coverage and excludes a person fired for misconduct.
• The employer gives notice within 5 days, and the person pays within 30 days.
• The premium goes to the employer and is capped at the group rate.
• The insurer may force conversion after 18 months. Moving out of state ends continuation.
• Wisconsin's small employer definition is 2 to 50 employees.
• Group health grace is 31 days.