Wis. Stat. § 632.897 — WI Code / Chapter 632 / Section 632.897
Section 632.897
Status: in_force

4. The fact that the child is a nonmarital child.

5. The fact that the child resides outside the insurer’s geographical service area.

(am) If a court orders an individual to provide coverage for health care expenses for a child of the individual and the individual is eligible for family coverage under a group policy or individual policy, the insurer shall do all of the following:

1. Provide family coverage under the group policy or individual policy for the individual’s child, if eligible for coverage, without regard to any enrollment period restrictions that may apply under the policy.

2. Provide family coverage under the group policy or individual policy for the individual’s child, if eligible for coverage, upon application by the individual, the child’s other parent, the department of children and families or the county child support agency under s. 59.53 (5) .

3. After the child is covered under the group policy or individual policy, and as long as the individual is eligible for family coverage under the policy, continue to provide coverage for the child unless the insurer receives satisfactory written evidence that the court order is no longer in effect or that the child has coverage under another group policy or individual policy that provides comparable health care coverage.

(b) Paragraphs (a) and (am) do not prohibit an insurer from determining the eligibility of a group member’s or insured’s child for coverage under the group policy or individual policy, or the premium for that coverage, based on factors that are not prohibited by par. (a) 1. to 5. and that the insurer applies generally to determine the eligibility of children for coverage, and the premium for coverage, under the group policy or individual policy.

(bf) If an insurer provides coverage under a group policy or an individual policy for a child of a group member or an insured who is not the custodial parent of the child, the insurer shall do all of the following:

1. Provide to the custodial parent of the child information related to the child’s enrollment.

2. Permit the custodial parent of the child, a health care provider that provides services to the child or the department of health services to submit claims for covered services without the approval of the parent who is the group member or insured.

3. Pay claims directly to the health care provider, the custodial parent of the child or the department of health services, as appropriate.

(c) This subsection applies to any group policy that would otherwise be exempt under s. 600.01 (1) (b) 3. if at least 25 of the certificate holders or insureds are residents of this state.

(11)

(a) Notwithstanding subs. (2) to (10) , the commissioner may promulgate rules establishing standards requiring insurers to provide continuation of coverage for any individual covered at any time under a group policy who is a terminated insured or an eligible individual under any federal program that provides for a federal premium subsidy for individuals covered under continuation of coverage under a group policy, including rules governing election or extension of election periods, notice, rates, premiums, premium payment, application of preexisting condition exclusions, election of alternative coverage, and status as an eligible individual, as defined in s. 149.10 (2t) , 2011 stats.

(b) The commissioner may promulgate the rules under par. (a) as emergency rules under s. 227.24 . Notwithstanding s. 227.24 (1) (c) , emergency rules promulgated under this paragraph may remain in effect for one year and may be extended under s. 227.24 (2) . Notwithstanding s. 227.24 (1) (a) and (3) , the commissioner is not required to provide evidence that promulgating a rule under this paragraph as an emergency rule is necessary for the preservation of the public peace, health, safety, or welfare and is not required to provide a finding of emergency for a rule promulgated under this paragraph.

History: 1979 c. 285 , 355 ; 1981 c. 41 ; 1983 a. 27 , 274 ; 1985 a. 29 ; 1987 a. 287 , 413 ; 1989 a. 31 ; 1993 a. 481 ; 1995 a. 27 s. 9126 (19) ; 1995 a. 201 ; 1997 a. 27 , 191 , 237 ; 1999 a. 9 ; 2005 a. 443 s. 265 ; 2007 a. 20 ss. 3689 , 9121 (6) (a) ; 2009 a. 342 ; 2013 a. 20 ; 2015 a. 345 ; 2017 a. 366 ; 2021 a. 127 .