reglab/housing_qa huggingface dataset:
WI Stat § 609.03 (2021)
2021 Wisconsin Statutes & Annotations|Chapter 609 - Defined network plans.|609.03 - Indication of operations.

609.03  Indication of operations. (1) Certificate of authority. An insurer may apply to the commissioner for a new or amended certificate of authority that limits the insurer to engaging in only the types of insurance business described in sub. (3). (2)  Statement of operations. If an insurer is a cooperative association organized under ss. 185.981 to 185.985, the insurer may apply to the commissioner for a statement of operations that limits the insurer to engaging in only the types of insurance business described in sub. (3). (3)  Restrictions on operations. (a) An insurer that has a new or amended certificate of authority under sub. (1) or a statement of operations under sub. (2) may engage in only the following types of insurance business:1. As a health maintenance organization.2. As a limited service health organization.3. In other insurance business that is immaterial in relation to, or incidental to, the insurer's business under subd. 1. or 2.(b) The commissioner may, by rule, define “immaterial" or “incidental", or both, for purposes of par. (a) 3. as a percentage of premiums, except the percentage may not exceed 10 percent of the total premiums written by the insurer. (4)  Removing restrictions. An amendment to a certificate of authority or statement of operations that removes the limitation imposed under this section is not effective unless the insurer, on the effective date of the amendment, complies with the capital, surplus and other requirements applicable to the insurer under chs. 600 to 645.History:  1989 a. 23.
WI Stat § 609.05 (2021)
2021 Wisconsin Statutes & Annotations|Chapter 609 - Defined network plans.|609.05 - Primary provider and referrals.

609.05  Primary provider and referrals. (1) Except as provided in subs. (2) and (3), a limited service health organization, preferred provider plan, or defined network plan shall permit its enrollees to choose freely among participating providers. (2) Subject to s. 609.22 (4) and (4m), a limited service health organization, preferred provider plan, or defined network plan may require an enrollee to designate a primary provider and to obtain health care services from the primary provider when reasonably possible. (3) Except as provided in ss. 609.22 (4m), 609.65, and 609.655, a limited service health organization, preferred provider plan, or defined network plan may require an enrollee to obtain a referral from the primary provider designated under sub. (2) to another participating provider prior to obtaining health care services from that participating provider.History:  1985 a. 29; 1987 a. 366; 1989 a. 121; 1997 a. 237; 1999 a. 9; 2001 a. 16.
WI Stat § 609.17 (2021)
2021 Wisconsin Statutes & Annotations|Chapter 609 - Defined network plans.|609.17 - Reports of disciplinary action.

609.17  Reports of disciplinary action. Every limited service health organization, preferred provider plan, and defined network plan shall notify the medical examining board or appropriate affiliated credentialing board attached to the medical examining board of any disciplinary action taken against a participating provider who holds a license or certificate granted by the board or affiliated credentialing board.History:  1985 a. 340; 1993 a. 107; 1997 a. 237; 2001 a. 16.
WI Stat § 609.20 (2021)
2021 Wisconsin Statutes & Annotations|Chapter 609 - Defined network plans.|609.20 - Rules for preferred provider and defined network plans.

609.20  Rules for preferred provider and defined network plans. (1m) The commissioner may promulgate rules relating to preferred provider plans and defined network plans for any of the following purposes, as appropriate:(a) To ensure that enrollees are not forced to travel excessive distances to receive health care services.(b) To ensure that the continuity of patient care for enrollees meets the requirements under s. 609.24.(c) To define substantially equivalent coverage of health care expenses for purposes of s. 609.10 (1) (am).(d) To ensure that employees offered a health maintenance organization or a preferred provider plan that provides comprehensive services under s. 609.10 (1) (am) are given adequate notice of the opportunity to enroll, as well as complete and understandable information under s. 609.10 (1) (c) concerning the differences among the health maintenance organization or preferred provider plan, the standard plan and the point-of-service option plan, as defined in s. 609.10 (1) (ac), including differences among providers available and differences resulting from special limitations or requirements imposed by an institutional provider because of its affiliation with a religious organization. (2m) Any rule promulgated under this chapter shall recognize the differences between preferred provider plans and other types of defined network plans, take into account the fact that preferred provider plans provide coverage for the services of nonparticipating providers, and be appropriate to the type of plan to which the rule applies.History:  1985 a. 29; 1997 a. 237; 1999 a. 9; 2001 a. 16.
WI Stat § 609.205 (2021)
2021 Wisconsin Statutes & Annotations|Chapter 609 - Defined network plans.|609.205 - Public health emergency for COVID-19.

609.205  Public health emergency for COVID-19. (1) In this section, “COVID-19” means an infection caused by the SARS-CoV-2 coronavirus. (2) All of the following apply to a defined network plan or preferred provider plan during the state of emergency related to public health declared under s. 323.10 on March 12, 2020, by executive order 72, and for the 60 days following the date that the state of emergency terminates:(a) The plan may not require an enrollee to pay, including cost sharing, for a service, treatment, or supply provided by a provider that is not a participating provider in the plan's network of providers more than the enrollee would pay if the service, treatment, or supply is provided by a provider that is a participating provider. This subsection applies to any service, treatment, or supply that is related to diagnosis or treatment for COVID-19 and to any service, treatment, or supply that is provided by a provider that is not a participating provider because a participating provider is unavailable due to the public health emergency.(b) The plan shall reimburse a provider that is not a participating provider for a service, treatment, or supply provided under the circumstances described under par. (a) at 225 percent of the rate the federal Medicare program reimburses the provider for the same or a similar service, treatment, or supply in the same geographic area. (3) During the state of emergency related to public health declared under s. 323.10 on March 12, 2020, by executive order 72, and for the 60 days following the date that the state of emergency terminates, all of the following apply to any health care provider or health care facility that provides a service, treatment, or supply to an enrollee of a defined network plan or preferred provider plan but is not a participating provider of that plan:(a) The health care provider or facility shall accept as payment in full any payment by a defined network plan or preferred provider plan that is at least 225 percent of the rate the federal Medicare program reimburses the provider for the same or a similar service, treatment, or supply in the same geographic area.(b) The health care provider or facility may not charge the enrollee for the service, treatment, or supply an amount that exceeds the amount the provider or facility is reimbursed by the defined network plan or preferred provider plan. (4) The commissioner may promulgate any rules necessary to implement this section.History: 2019 a. 185.
WI Stat § 609.30 (2021)
2021 Wisconsin Statutes & Annotations|Chapter 609 - Defined network plans.|609.30 - Provider disclosures.

609.30  Provider disclosures. (1) Plan may not contract. A defined network plan may not contract with a participating provider to limit the provider's disclosure of information, to or on behalf of an enrollee, about the enrollee's medical condition or treatment options. (2)  Plan may not penalize or terminate. A participating provider may discuss, with or on behalf of an enrollee, all treatment options and any other information that the provider determines to be in the best interest of the enrollee. A defined network plan may not penalize or terminate the contract of a participating provider because the provider makes referrals to other participating providers or discusses medically necessary or appropriate care with or on behalf of an enrollee.History:  1997 a. 237; 2001 a. 16.
WI Stat § 609.32 (2021)
2021 Wisconsin Statutes & Annotations|Chapter 609 - Defined network plans.|609.32 - Quality assurance.

609.32  Quality assurance. (1) Standards; other than preferred provider plans. A defined network plan that is not a preferred provider plan shall develop comprehensive quality assurance standards that are adequate to identify, evaluate, and remedy problems related to access to, and continuity and quality of, care. The standards shall include at least all of the following:(a) An ongoing, written internal quality assurance program.(b) Specific written guidelines for quality of care studies and monitoring.(c) Performance and clinical outcomes-based criteria.(d) A procedure for remedial action to address quality problems, including written procedures for taking appropriate corrective action.(e) A plan for gathering and assessing data.(f) A peer review process. (1m)  Procedure for remedial action; preferred provider plans. A preferred provider plan shall develop a procedure for remedial action to address quality problems, including written procedures for taking appropriate corrective action. (2)  Selection and evaluation of providers.  (a) A defined network plan shall develop a process for selecting participating providers, including written policies and procedures that the plan uses for review and approval of providers. After consulting with appropriately qualified providers, the plan shall establish minimum professional requirements for its participating providers. The process for selection shall include verification of a provider's license or certificate, including the history of any suspensions or revocations, and the history of any liability claims made against the provider.(b) A defined network plan shall establish in writing a formal, ongoing process for reevaluating each participating provider within a specified number of years after the provider's initial acceptance for participation. The reevaluation shall include all of the following:1. Updating the previous review criteria.2. Assessing the provider's performance on the basis of such criteria as enrollee clinical outcomes, number of complaints and malpractice actions.(c) A defined network plan may not require a participating provider to provide services that are outside the scope of his or her license or certificate.History:  1997 a. 237; 2001 a. 16.
WI Stat § 609.34 (2021)
2021 Wisconsin Statutes & Annotations|Chapter 609 - Defined network plans.|609.34 - Clinical decision-making; medical director.

609.34  Clinical decision-making; medical director. (1) A defined network plan that is not a preferred provider plan shall appoint a physician as medical director. The medical director shall be responsible for clinical protocols, quality assurance activities, and utilization management policies of the plan. (2) A preferred provider plan may contract for services related to clinical protocols and utilization management. A preferred provider plan or its designee is required to appoint a medical director only to the extent that the preferred provider plan or its designee assumes direct responsibility for clinical protocols and utilization management policies of the plan. The medical director, who shall be a physician, shall be responsible for such protocols and policies of the plan.History:  1997 a. 237; 2001 a. 16.
WI Stat § 609.35 (2021)
2021 Wisconsin Statutes & Annotations|Chapter 609 - Defined network plans.|609.35 - Applicability of requirements to preferred provider plans.

609.35  Applicability of requirements to preferred provider plans. Notwithstanding ss. 609.22 (2), (3), (4), and (7), 609.32 (1), and 609.34 (1), a preferred provider plan that does not cover the same services when performed by a nonparticipating provider that it covers when those services are performed by a participating provider is subject to the requirements under ss. 609.22 (2), (3), (4), and (7), 609.32 (1), and 609.34 (1).History:  2001 a. 16.
WI Stat § 609.36 (2021)
2021 Wisconsin Statutes & Annotations|Chapter 609 - Defined network plans.|609.36 - Data systems and confidentiality.

609.36  Data systems and confidentiality. (1) Information and data reporting.  (a) A defined network plan shall provide to the commissioner information related to all of the following:1. The structure of the plan.2. Health care benefits and exclusions.3. Cost-sharing requirements.4. Participating providers.(b) Subject to sub. (2), the information and data reported under par. (a) shall be open to public inspection under ss. 19.31 to 19.39. (2)  Confidentiality. A defined network plan shall establish written policies and procedures, consistent with ss. 51.30, 146.82, and 252.15, for the handling of medical records and enrollee communications to ensure confidentiality.History:  1997 a. 237; 2001 a. 16.
WI Stat § 609.38 (2021)
2021 Wisconsin Statutes & Annotations|Chapter 609 - Defined network plans.|609.38 - Oversight.

609.38  Oversight. The office shall perform examinations of insurers that issue defined network plans consistent with ss. 601.43 and 601.44. The commissioner shall by rule develop standards for defined network plans for compliance with the requirements under this chapter.History:  1997 a. 237; 2001 a. 16.
WI Stat § 609.60 (2021)
2021 Wisconsin Statutes & Annotations|Chapter 609 - Defined network plans.|609.60 - Optometric coverage.

609.60  Optometric coverage. Health maintenance organizations and preferred provider plans are subject to s. 632.87 (2m).History:  1985 a. 29.
WI Stat § 609.70 (2021)
2021 Wisconsin Statutes & Annotations|Chapter 609 - Defined network plans.|609.70 - Chiropractic coverage.

609.70  Chiropractic coverage. Limited service health organizations, preferred provider plans, and defined network plans are subject to s. 632.87 (3).History:  1987 a. 27; 1997 a. 237; 2001 a. 16.
WI Stat § 609.71 (2021)
2021 Wisconsin Statutes & Annotations|Chapter 609 - Defined network plans.|609.71 - Disclosure of payments.

609.71  Disclosure of payments. Limited service health organizations, preferred provider plans, and defined network plans are subject to s. 632.798. History:  2009 a. 146.
WI Stat § 609.715 (2021)
2021 Wisconsin Statutes & Annotations|Chapter 609 - Defined network plans.|609.715 - Coverage of alcoholism and other diseases.

609.715  Coverage of alcoholism and other diseases. Defined network plans are subject to s. 632.89.History:  2009 a. 218 s. 14; 2011 a. 260 s. 80.
WI Stat § 609.717 (2021)
2021 Wisconsin Statutes & Annotations|Chapter 609 - Defined network plans.|609.717 - Mental health services provided by a recovery charter school.

609.717  Mental health services provided by a recovery charter school. Limited service health organizations, preferred provider plans, and defined network plans are subject to s. 632.87 (4m).History:  2017 a. 30.
WI Stat § 609.75 (2021)
2021 Wisconsin Statutes & Annotations|Chapter 609 - Defined network plans.|609.75 - Adopted children coverage.

609.75  Adopted children coverage. Limited service health organizations, preferred provider plans, and defined network plans are subject to s. 632.896. Coverage of health care services obtained by adopted children and children placed for adoption may be subject to any requirements that the limited service health organization, preferred provider plan, or defined network plan imposes under s. 609.05 (2) and (3) on the coverage of health care services obtained by other enrollees.History:  1989 a. 336; 1997 a. 237; 2001 a. 16.
WI Stat § 609.755 (2021)
2021 Wisconsin Statutes & Annotations|Chapter 609 - Defined network plans.|609.755 - Coverage of dependents.

609.755  Coverage of dependents. Limited service health organizations, preferred provider plans, and defined network plans are subject to s. 632.885.History:  2009 a. 28.
WI Stat § 609.76 (2021)
2021 Wisconsin Statutes & Annotations|Chapter 609 - Defined network plans.|609.76 - Coverage of student on medical leave.

609.76  Coverage of student on medical leave. Limited service health organizations, preferred provider plans, and defined network plans are subject to s. 632.895 (15).History:  2007 a. 36.
WI Stat § 609.77 (2021)
2021 Wisconsin Statutes & Annotations|Chapter 609 - Defined network plans.|609.77 - Coverage of breast reconstruction.

609.77  Coverage of breast reconstruction. Limited service health organizations, preferred provider plans, and defined network plans are subject to s. 632.895 (13).History:  1997 a. 27, 237; 2001 a. 16.
WI Stat § 609.78 (2021)
2021 Wisconsin Statutes & Annotations|Chapter 609 - Defined network plans.|609.78 - Coverage of treatment for the correction of temporomandibular disorders.

609.78  Coverage of treatment for the correction of temporomandibular disorders. Limited service health organizations, preferred provider plans, and defined network plans are subject to s. 632.895 (11).History:  1997 a. 27, 237; 2001 a. 16.
WI Stat § 609.79 (2021)
2021 Wisconsin Statutes & Annotations|Chapter 609 - Defined network plans.|609.79 - Coverage of hospital and ambulatory surgery center charges and anesthetics for dental care.

609.79  Coverage of hospital and ambulatory surgery center charges and anesthetics for dental care. Limited service health organizations, preferred provider plans, and defined network plans are subject to s. 632.895 (12).History:  1997 a. 27, 237; 2001 a. 16.
WI Stat § 609.80 (2021)
2021 Wisconsin Statutes & Annotations|Chapter 609 - Defined network plans.|609.80 - Coverage of mammograms.

609.80  Coverage of mammograms. Defined network plans are subject to s. 632.895 (8). Coverage of mammograms under s. 632.895 (8) may be subject to any requirements that the defined network plan imposes under s. 609.05 (2) and (3) on the coverage of other health care services obtained by enrollees.History:  1989 a. 129; 1997 a. 237; 2001 a. 16.
WI Stat § 609.805 (2021)
2021 Wisconsin Statutes & Annotations|Chapter 609 - Defined network plans.|609.805 - Coverage of contraceptives.

609.805  Coverage of contraceptives. Defined network plans are subject to s. 632.895 (17).History:  2009 a. 28.
WI Stat § 609.81 (2021)
2021 Wisconsin Statutes & Annotations|Chapter 609 - Defined network plans.|609.81 - Coverage related to HIV infection.

609.81  Coverage related to HIV infection. Limited service health organizations, preferred provider plans, and defined network plans are subject to s. 631.93. Defined network plans are subject to s. 632.895 (9).History:  1989 a. 201; 1989 a. 359 s. 389; 1997 a. 237; 2001 a. 16.
WI Stat § 609.82 (2021)
2021 Wisconsin Statutes & Annotations|Chapter 609 - Defined network plans.|609.82 - Coverage without prior authorization for emergency medical condition treatment.

609.82  Coverage without prior authorization for emergency medical condition treatment. Limited service health organizations, preferred provider plans, and defined network plans are subject to s. 632.85.History:  1997 a. 237; 2001 a. 16.
WI Stat § 609.83 (2021)
2021 Wisconsin Statutes & Annotations|Chapter 609 - Defined network plans.|609.83 - Coverage of drugs and devices.

609.83  Coverage of drugs and devices. Limited service health organizations, preferred provider plans, and defined network plans are subject to ss. 632.853, 632.861, and 632.895 (16t) and (16v).NOTE: This section is shown as amended eff. 1-1-22 by 2021 Wis. Act 9. Prior to 1-1-22 it reads: 609.83 Coverage of drugs and devices. Limited service health organizations, preferred provider plans, and defined network plans are subject to ss. 632.853 and 632.895 (16t) and (16v).History:  1997 a. 237; 2001 a. 16; 2017 a. 305; 2019 a. 185; 2021 a. 9.
WI Stat § 609.837 (2021)
2021 Wisconsin Statutes & Annotations|Chapter 609 - Defined network plans.|609.837 - Copayment equality for oral and injected chemotherapy.

609.837  Copayment equality for oral and injected chemotherapy. Limited service health organizations, preferred provider plans, and defined network plans are subject to s. 632.867. History:  2013 a. 186.
WI Stat § 609.84 (2021)
2021 Wisconsin Statutes & Annotations|Chapter 609 - Defined network plans.|609.84 - Experimental treatment.

609.84  Experimental treatment. Limited service health organizations, preferred provider plans, and defined network plans are subject to s. 632.855.History:  1997 a. 237; 2001 a. 16.
WI Stat § 609.846 (2021)
2021 Wisconsin Statutes & Annotations|Chapter 609 - Defined network plans.|609.846 - Discrimination based on COVID-19 prohibited.

609.846  Discrimination based on COVID-19 prohibited. Limited service health organizations, preferred provider plans, and defined network plans are subject to s. 632.729.History: 2019 a. 185.
WI Stat § 609.85 (2021)
2021 Wisconsin Statutes & Annotations|Chapter 609 - Defined network plans.|609.85 - Coverage of lead screening.

609.85  Coverage of lead screening. Health maintenance organizations and preferred provider plans are subject to s. 632.895 (10).History:  1993 a. 450.
WI Stat § 609.86 (2021)
2021 Wisconsin Statutes & Annotations|Chapter 609 - Defined network plans.|609.86 - Coverage of hearing aids, cochlear implants, and related treatment for infants and children.

609.86  Coverage of hearing aids, cochlear implants, and related treatment for infants and children. Defined network plans are subject to s. 632.895 (16). History:  2009 a. 14.
WI Stat § 609.87 (2021)
2021 Wisconsin Statutes & Annotations|Chapter 609 - Defined network plans.|609.87 - Coverage of treatment for autism spectrum disorders.

609.87  Coverage of treatment for autism spectrum disorders. Defined network plans are subject to s. 632.895 (12m). History:  2009 a. 28.
WI Stat § 609.875 (2021)
2021 Wisconsin Statutes & Annotations|Chapter 609 - Defined network plans.|609.875 - Coverage of colorectal cancer screening.

609.875  Coverage of colorectal cancer screening. Defined network plans are subject to s. 632.895 (16m).History:  2009 a. 346 s. 8; 2011 a. 260 s. 80.
WI Stat § 609.88 (2021)
2021 Wisconsin Statutes & Annotations|Chapter 609 - Defined network plans.|609.88 - Coverage of immunizations.

609.88  Coverage of immunizations. Defined network plans are subject to s. 632.895 (14).History:  1999 a. 115; 2001 a. 16.
WI Stat § 609.885 (2021)
2021 Wisconsin Statutes & Annotations|Chapter 609 - Defined network plans.|609.885 - Coverage of COVID-19 testing.

609.885  Coverage of COVID-19 testing. Defined network plans, preferred provider plans, and limited service health organizations are subject to s. 632.895 (14g).History: 2019 a. 185.
WI Stat § 609.89 (2021)
2021 Wisconsin Statutes & Annotations|Chapter 609 - Defined network plans.|609.89 - Written reason for coverage denial.

609.89  Written reason for coverage denial. Limited service health organizations, preferred provider plans, and defined network plans are subject to s. 631.17.History:  1999 a. 95; 2001 a. 16.
WI Stat § 609.90 (2021)
2021 Wisconsin Statutes & Annotations|Chapter 609 - Defined network plans.|609.90 - Restrictions related to domestic abuse.

609.90  Restrictions related to domestic abuse. Limited service health organizations, preferred provider plans, and defined network plans are subject to s. 631.95.History:  1999 a. 95; 2001 a. 16.