reglab/housing_qa huggingface dataset:
WI Stat § 632.825 (2021)
2021 Wisconsin Statutes & Annotations|Chapter 632 - Insurance contracts in specific lines.|632.825 - Midterm termination of long-term care insurance policy by insured.

632.825  Midterm termination of long-term care insurance policy by insured. (1) Permitted cancellation and refund. (a) No insurer that provides coverage under a long-term care insurance policy may prohibit the insured under the policy from canceling the policy before the expiration of the agreed term.(b) If an insured under a long-term care insurance policy cancels the policy before the expiration of the agreed term, the insurer shall issue a prorated premium refund to the insured.(c) If an insured under a long-term care insurance policy dies during the term of the policy, the insurer shall issue a prorated premium refund to the insured's estate. (2)  Policy provision. Every long-term care insurance policy shall contain a provision that apprises the insured of the insured's right to cancel and the insurer's premium refund responsibilities under sub. (1).History:  1993 a. 207.
WI Stat § 632.83 (2021)
2021 Wisconsin Statutes & Annotations|Chapter 632 - Insurance contracts in specific lines.|632.83 - Internal grievance procedure.

632.83  Internal grievance procedure. (1) In this section, “health benefit plan" has the meaning given in s. 632.745 (11), except that “health benefit plan" includes the coverage specified in s. 632.745 (11) (b) 10. and includes a policy, certificate or contract under s. 632.745 (11) (b) 9. that provides only limited-scope dental or vision benefits. (2) Every insurer that issues a health benefit plan shall do all of the following:(a) Establish and use an internal grievance procedure that is approved by the commissioner and that complies with sub. (3) for the resolution of insureds' grievances with the health benefit plan.(b) Provide insureds with complete and understandable information describing the internal grievance procedure under par. (a).(c) Submit an annual report to the commissioner describing the internal grievance procedure under par. (a) and summarizing the experience under the procedure for the year. (3) The internal grievance procedure established under sub. (2) (a) shall include all of the following elements:(a) The opportunity for an insured to submit a written grievance in any form.(b) Establishment of a grievance panel for the investigation of each grievance submitted under par. (a), consisting of at least one individual authorized to take corrective action on the grievance and at least one insured other than the grievant, if an insured is available to serve on the grievance panel.(c) Prompt investigation of each grievance submitted under par. (a).(d) Notification to each grievant of the disposition of his or her grievance and of any corrective action taken on the grievance.(e) Retention of records pertaining to each grievance for at least 3 years after the date of notification under par. (d).History:  1999 a. 155 ss. 8 to 17; Stats. 1999 s. 632.83.
WI Stat § 632.84 (2021)
2021 Wisconsin Statutes & Annotations|Chapter 632 - Insurance contracts in specific lines.|632.84 - Benefit appeals under certain policies.

632.84  Benefit appeals under certain policies. (1) Definitions. In this section:(a) “Nursing home" has the meaning given in s. 50.01 (3).(b) “Nursing home insurance policy" means an individual or group insurance policy which provides coverage primarily for confinement or care in a nursing home. (2)  Review and appeal. (a) Except as provided in sub. (3), an insurer offering a medicare supplement policy, medicare replacement policy, nursing home insurance policy or long-term care insurance policy shall establish an internal procedure by which the policyholder or the certificate holder or a representative of the policyholder or the certificate holder may appeal the denial of any benefits under the medicare supplement policy, medicare replacement policy, nursing home insurance policy or long-term care insurance policy. The procedure established under this paragraph shall include all of the following:1. The opportunity for the policyholder or certificate holder or a representative of the policyholder or certificate holder to submit a written request, which may be in any form and which may include supporting material, for review by the insurer of the denial of any benefits under the policy.2. Within 30 days after receiving the request under subd. 1., disposition of the review and notification to the person submitting the request of the results of the review.(b) An insurer shall describe the procedure established under par. (a) in every policy, group certificate and outline of coverage issued in connection with a medicare supplement policy, medicare replacement policy, nursing home insurance policy or long-term care insurance policy.(c) If an insurer denies any benefits under a medicare supplement policy, medicare replacement policy, nursing home insurance policy or long-term care insurance policy, the insurer shall, at the time the insurer gives notice of the denial of any benefits, provide the policyholder and certificate holder with a written description of the appeal process established under par. (a).(d) An insurer offering a medicare supplement policy, medicare replacement policy, nursing home insurance policy or long-term care insurance policy shall annually report to the commissioner a summary of all appeals filed under this section and the disposition of those appeals. (3)  Exceptions. This section does not apply to a health maintenance organization, limited service health organization or preferred provider plan, as defined in s. 609.01.History:  1987 a. 156, 403; 1989 a. 31.
WI Stat § 632.845 (2021)
2021 Wisconsin Statutes & Annotations|Chapter 632 - Insurance contracts in specific lines.|632.845 - Prohibiting refusal to cover services because liability policy may cover.

632.845  Prohibiting refusal to cover services because liability policy may cover. (1) In this section, “health care plan" has the meaning given in s. 628.36 (2) (a) 1. (2) An insurer that provides coverage under a health care plan may not refuse to cover health care services that are provided to an insured under the plan and for which there is coverage under the plan on the basis that there may be coverage for the services under a liability insurance policy.History:  2009 a. 28.
WI Stat § 632.85 (2021)
2021 Wisconsin Statutes & Annotations|Chapter 632 - Insurance contracts in specific lines.|632.85 - Coverage without prior authorization for treatment of an emergency medical condition.

632.85  Coverage without prior authorization for treatment of an emergency medical condition. (1) In this section:(a) “Emergency medical condition" means a medical condition that manifests itself by acute symptoms of sufficient severity, including severe pain, to lead a prudent layperson who possesses an average knowledge of health and medicine to reasonably conclude that a lack of immediate medical attention will likely result in any of the following:1. Serious jeopardy to the person's health or, with respect to a pregnant woman, serious jeopardy to the health of the woman or her unborn child.2. Serious impairment to the person's bodily functions.3. Serious dysfunction of one or more of the person's body organs or parts.(b) “Health care plan" has the meaning given in s. 628.36 (2) (a) 1.(c) “Self-insured health plan" means a self-insured health plan of the state or a county, city, village, town or school district. (2) If a health care plan or a self-insured health plan provides coverage of any emergency medical services, the health care plan or self-insured health plan shall provide coverage of emergency medical services that are provided in a hospital emergency facility and that are needed to evaluate or stabilize, as defined in section 1867 of the federal Social Security Act, an emergency medical condition. (3) A health care plan or a self-insured health plan that is required to provide the coverage under sub. (2) may not require prior authorization for the provision or coverage of the emergency medical services specified in sub. (2).History:  1997 a. 155.
WI Stat § 632.853 (2021)
2021 Wisconsin Statutes & Annotations|Chapter 632 - Insurance contracts in specific lines.|632.853 - Coverage of drugs and devices.

632.853  Coverage of drugs and devices. A health care plan, as defined in s. 628.36 (2) (a) 1., or a self-insured health plan, as defined in s. 632.85 (1) (c), that provides coverage of only certain specified prescription drugs or devices shall develop a process through which a physician may present medical evidence to obtain an individual patient exception for coverage of a prescription drug or device not routinely covered by the plan. The process shall include timelines for both urgent and nonurgent review.History:  1997 a. 237.
WI Stat § 632.855 (2021)
2021 Wisconsin Statutes & Annotations|Chapter 632 - Insurance contracts in specific lines.|632.855 - Requirements if experimental treatment limited.

632.855  Requirements if experimental treatment limited. (1) Definitions. In this section:(a) “Health care plan" has the meaning given in s. 628.36 (2) (a) 1.(b) “Self-insured health plan" has the meaning given in s. 632.85 (1) (c). (2)  Disclosure of limitations. Subject to s. 632.87 (6), a health care plan or a self-insured health plan that limits coverage of experimental treatment shall define the limitation and disclose the limits in any agreement, policy or certificate of coverage. This disclosure shall include the following information:(a) Who is authorized to make a determination on the limitation.(b) The criteria the plan uses to determine whether a treatment, procedure, drug or device is experimental. (3)  Denial of treatment. (am) A health care plan or a self-insured health plan that receives a request for prior authorization of an experimental procedure that includes all of the required information upon which to make a decision shall, within 5 working days after receiving the request, issue a coverage decision. If the health care plan or self-insured health plan denies coverage of an experimental treatment, procedure, drug or device for an insured who has a terminal condition or illness, the health care plan or self-insured health plan shall, as part of its coverage decision, provide the insured with a denial letter that includes all of the following:1. A statement setting forth the specific medical and scientific reasons for denying coverage.2. Notice of the insured's right to appeal and a description of the appeal procedure.(bm) A health care plan or a self-insured health plan may not deny coverage under par. (am) of an experimental treatment, procedure, drug, or device for an insured if the denial violates s. 632.87 (6).History:  1997 a. 237; 2005 a. 194.
WI Stat § 632.857 (2021)
2021 Wisconsin Statutes & Annotations|Chapter 632 - Insurance contracts in specific lines.|632.857 - Explanation required for restriction or termination of coverage.

632.857  Explanation required for restriction or termination of coverage. If an insurer restricts or terminates an insured's coverage for the treatment of a condition or complaint and, as a result, the insured becomes liable for payment for all of his or her treatment for the condition or complaint, the insurer shall provide on the explanation of benefits form a detailed explanation of the clinical rationale and of the basis in the policy, plan, or contract or in applicable law for the insurer's restriction or termination of coverage.History:  2007 a. 20.
WI Stat § 632.86 (2021)
2021 Wisconsin Statutes & Annotations|Chapter 632 - Insurance contracts in specific lines.|632.86 - Restrictions on pharmaceutical services.

632.86  Restrictions on pharmaceutical services. (1) In this section:(a) “Disability insurance policy" has the meaning given in s. 632.895 (1) (a), except that the term does not include coverage under a health maintenance organization, as defined in s. 609.01 (2), a limited service health organization, as defined in s. 609.01 (3), a preferred provider plan, as defined in s. 609.01 (4), or a health care plan operated by a cooperative association organized under s. 185.981. (b) “Pharmaceutical mail order plan" means a plan under which prescribed drugs or devices are dispensed through the mail.(c) “Prescribed drug or device" has the meaning given in s. 450.01 (18). (2) No group or blanket disability insurance policy that provides coverage of prescribed drugs or devices through a pharmaceutical mail order plan may do any of the following:(a) Exclude coverage, expressly or by implication, of any prescribed drug or device provided by a pharmacist or pharmacy selected by a covered individual if the pharmacist or pharmacy provides or agrees to provide prescribed drugs or devices under the terms of the policy and at the same cost to the insurer issuing the policy as a pharmaceutical mail order plan.(b) Contain coverage, deductible or copayment provisions for prescribed drugs or devices provided by a pharmacist or pharmacy selected by a covered individual that are different from the coverage, deductible or copayment provisions for prescribed drugs or devices provided by a pharmaceutical mail order plan.NOTE: This section is repealed eff. 1-1-22 by 2021 Wis. Act 9.History:  1991 a. 70; 2009 a. 165; 2021 a. 9.
WI Stat § 632.867 (2021)
2021 Wisconsin Statutes & Annotations|Chapter 632 - Insurance contracts in specific lines.|632.867 - Oral and injected chemotherapy.

632.867  Oral and injected chemotherapy. (1) Definitions. In this section:(a) “Chemotherapy" means drugs and biologics that kill cancer cells directly, including antineoplastics, biologic response modifiers, hormone therapy, and monoclonal antibodies, and that are used to do any of the following:1. Cure a specific cancer.2. Control tumor growth when cure is not possible.3. Shrink tumors before surgery or radiation therapy.4. Destroy microscopic cancer cells that may be present after a tumor is removed by surgery to prevent a cancer recurrence.(b) “Disability insurance policy" has the meaning given in s. 632.895 (1) (a).(c) “Self-insured health plan" has the meaning given in s. 632.85 (1) (c). (2)  Copayment, deductible, or coinsurance requirements; limitations. (a) Except as provided in par. (am), a disability insurance policy that covers injected or intravenous chemotherapy and oral chemotherapy, or a self-insured health plan that covers injected or intravenous chemotherapy and oral chemotherapy, may not require a higher copayment, deductible, or coinsurance amount for oral chemotherapy than it requires for injected or intravenous chemotherapy, regardless of the formulation or benefit category determination by the policy or plan.(am) A disability insurance policy or self-insured health plan that limits copayments paid by a covered individual to no more than $100 for a 30-day supply of oral chemotherapy medication is considered to comply with this section. On January 1, 2016, and on each January 1 annually thereafter, a disability insurance policy or self-insured health plan may adjust the $100 limit under this paragraph by an amount that does not exceed the percentage increase in the U.S. consumer price index for all urban consumers, U.S. city average, as determined by the U.S. department of labor.(b) A disability insurance policy or a self-insured health plan may not comply with par. (a) by increasing the copayment, deductible, or coinsurance amount required for injected or intravenous chemotherapy that is covered under the policy or plan.(c) Notwithstanding par. (a), for a disability insurance policy, or self-insured health plan, that is a high deductible health plan, as defined in 26 USC 223 (c) (2), par. (a) applies only after the plan enrollee's deductible has been satisfied for the year. History:  2013 a. 186.
WI Stat § 632.873 (2021)
2021 Wisconsin Statutes & Annotations|Chapter 632 - Insurance contracts in specific lines.|632.873 - Restrictions relating to fees for dental services.

632.873  Restrictions relating to fees for dental services. (1) Definitions. In this section, unless the context requires otherwise:(a) “Covered service" means, with respect to dental or related services specified in a policy or plan that provides coverage for those services, a service provided by a dentist or at the direction of a dentist to an insured under the policy or an enrollee of the plan for which the policy or plan makes payment, administered consistently with policies traditionally governing covered services, or for which the policy or plan would make payment but for the application of contractual limitations of deductibles, copayments, coinsurance, waiting periods, annual maximums, lifetime maximums applicable to the same course of treatment, frequency limitations, or alternative benefit payments.(b) “Policy" means a policy, certificate, or contract of insurance that provides only limited-scope dental benefits.(c) “Related service" means a service that is commonly provided, by a dentist or at the direction of a dentist, in conjunction with a dental service. (2)  Prohibitions on setting fees.  (a)1. A contract between an insurer offering a policy that provides coverage for dental and related services and a dentist for the provision of dental and related services to an insured under the policy may not require the dentist to provide a service to an insured under the policy at a fee set by the insurer unless the service is a covered service under the policy.2. A policy that provides coverage for dental and related services may not provide nominal or de minimis coverage for a dental or related service for the sole purpose of avoiding the requirements under subd. 1.(b) An administrator providing 3rd-party administration services or a provider network for a plan that provides coverage for dental and related services may not require any dentist in the administrator's provider network that is eligible to provide services under the plan to charge set fees for dental or related services provided to enrollees of the plan that are not covered services under the plan. (3)  Prohibition on charges. A dentist who, under a contract with an insurer offering a policy that provides coverage for dental and related services, provides dental or related services to an insured under the policy may not charge the insured more than the dentist's usual nondiscounted fee for a dental or related service that is not a covered service under the policy.History:  2013 a. 26.
WI Stat § 632.88 (2021)
2021 Wisconsin Statutes & Annotations|Chapter 632 - Insurance contracts in specific lines.|632.88 - Policy extension for handicapped children.

632.88  Policy extension for handicapped children. (1) Termination of coverage. Every hospital or medical expense insurance policy or contract that provides that coverage of a dependent child of a person insured under the policy shall terminate upon attainment of a limiting age for dependent children specified in the policy shall also provide that the age limitation may not operate to terminate the coverage of a dependent child while the child is and continues to be both:(a) Incapable of self-sustaining employment because of intellectual disability or physical handicap; and (b) Chiefly dependent upon the person insured under the policy for support and maintenance. (2)  Proof of incapacity. The insurer may require that proof of the incapacity and dependency be furnished by the person insured under the policy within 31 days of the date the child attains the limiting age, and at any time thereafter except that the insurer may not require proof more frequently than annually after the 2-year period immediately following attainment of the limiting age by the child.History:  1975 c. 375; 2011 a. 126.
WI Stat § 632.885 (2021)
2021 Wisconsin Statutes & Annotations|Chapter 632 - Insurance contracts in specific lines.|632.885 - Coverage of dependents.

632.885  Coverage of dependents. (1) Definitions. In this section:(af) “Eligible employer-sponsored plan" has the meaning given in 26 USC 5000A (f) (2). (ar) “Grandfathered health plan" has the meaning given under section 1251 of the Patient Protection and Affordable Care Act (P.L. 111-148). (at) “Health insurance coverage" has the meaning given in 42 USC 300gg-91 (b) (1). (b) “Insured" includes an enrollee.(c) “Self-insured health plan" has the meaning given in s. 632.745 (24). (2)  Requirement to offer dependent coverage.  (a) Subject to ss. 632.88 and 632.895 (5), and except as provided in pars. (b) and (c), every insurer that offers health insurance coverage that provides dependent coverage of children, and every self-insured health plan that provides dependent coverage of children, shall provide coverage for any child of an applicant or insured as a dependent of the applicant or insured if the child is under the age of 26.(b) Except as provided in par. (c), the coverage requirement under this section applies to an adult child who satisfies all of the following criteria: 1. The child is a full-time student, regardless of age.3. The child was called to federal active duty in the national guard or in a reserve component of the U.S. armed forces while the child was attending, on a full-time basis, an institution of higher education.4. The child was under the age of 27 years when called to federal active duty under subd. 3.(c) For any policy year or plan year beginning before January 1, 2014, health insurance coverage or a self-insured health plan described in par. (a) that is a grandfathered health plan is required to provide dependent coverage for an adult child described in par. (a) or (b) only if the child is not eligible for coverage under an eligible employer-sponsored plan other than the health insurance coverage or self-insured health plan.  (3m)  Defining dependent; uniform terms. An insurer or self-insured health plan described in sub. (2) may not do any of the following:(a) Define “dependent" for purposes of eligibility for dependent coverage of children other than in terms of the relationship between a child and an applicant or insured.(b) Vary the terms of coverage under the health insurance coverage or self-insured health plan on the basis of age except for children 26 years of age or older. History:  2009 a. 28; 2011 a. 32.
WI Stat § 632.8985 (2021)
2021 Wisconsin Statutes & Annotations|Chapter 632 - Insurance contracts in specific lines.|632.8985 - Prohibiting abortion coverage.

632.8985  Prohibiting abortion coverage. (1) In this section, “abortion" has the meaning given in s. 253.10 (2) (a). (2) A qualified health plan, as defined in 42 USC 18021 (a), that is offered through any American health benefit exchange, as described in 42 USC 18031, that is operating in the state may not cover any abortion the performance of which is ineligible for funding under s. 20.927.History:  2011 a. 218.
WI Stat § 632.899 (2021)
2021 Wisconsin Statutes & Annotations|Chapter 632 - Insurance contracts in specific lines.|632.899 - Medical savings accounts study.

632.899  Medical savings accounts study. If the federal government enacts legislation providing for a federal income tax exemption for amounts deposited in a medical savings account and for any interest, dividends or other gain that accrues in the account if redeposited in the account, the commissioner shall conduct a study, to be completed within 4 years after the enactment of the federal legislation, of individuals and groups that had coverage under a high cost-share health plan, as defined in s. 632.898 (1) (c), 1995 stats., and that terminated that coverage in order to enroll in a health benefit plan that was not a high cost-share health plan, as defined in s. 632.898 (1) (c), 1995 stats. The commissioner shall submit a report of all findings, conclusions and recommendations to the appropriate standing committees in the manner provided under s. 13.172 (3).History:  1997 a. 27; 2007 a. 96.