reglab/housing_qa huggingface dataset:
WI Stat § 632.91 (2021)
2021 Wisconsin Statutes & Annotations|Chapter 632 - Insurance contracts in specific lines.|632.91 - Definition.

632.91  Definition. In this subchapter: (1) “Insured employee" means an employee of a fraternal or of a subsidiary or other affiliate of a fraternal who is provided insurance benefits by the fraternal under s. 614.10 (2) (c) 2. but is not a member of the fraternal. (2) “Owner" means the owner of a policy or certificate issued by a fraternal in accordance with s. 614.10.History:  1989 a. 336; 1991 a. 189; 1997 a. 177.
WI Stat § 632.93 (2021)
2021 Wisconsin Statutes & Annotations|Chapter 632 - Insurance contracts in specific lines.|632.93 - The fraternal contract.

632.93  The fraternal contract. (1) Issuance of certificate. A fraternal shall issue to each owner a policy or certificate specifying the benefits provided and containing at least in substance all sections of the laws of the fraternal which might result in the termination of coverage or the reduction of benefits. The policy or certificate, any riders or endorsements attached thereto, the laws of the fraternal, and the application and declarations made in connection therewith and signed by the applicant, constitute the agreement between the fraternal and the owner, and the policy or certificate shall so state. (2)  Changes in laws of fraternals. Except as provided in s. 614.24 (1m), any changes in the laws of a fraternal made subsequent to the issuance of a policy or certificate bind the owner and any beneficiary under the policy or certificate as if they had been in force at the time of the application, so long as they do not destroy or diminish benefits promised in the policy or certificate. (3)  Proof of terms. Copies of any documents mentioned in subs. (1) and (2), certified by the secretary or corresponding officer of the fraternal, are evidence of the terms and conditions of the contract. (4)  Inapplicable provisions. Sections 631.13 and 632.44 (2) do not apply to fraternal contracts. (5)  Grace period. Every fraternal certificate shall contain a provision entitling the owner to a grace period of not less than one month, or 30 days at the fraternal's option, for the payment of any premium due except the first, during which the death benefit shall continue in force. A fraternal may specify in the grace period provision that the overdue premium will be deducted from the death benefit in the event of death before it is paid. (6)  Compliance with other provisions. If a fraternal's laws provide for expulsion or suspension of a member for any reason other than nonpayment of premium or under s. 632.46, the fraternal's insurance certificate shall contain a provision that if a member is expelled or suspended for any reason other than nonpayment of premium or under s. 632.46, the expelled member, or other owner who was provided insurance benefits under s. 614.10 on the application of the expelled member, has the right to maintain the policy in force by continuing payment of the required premium. (7)  Scope of application. This section applies to all contracts made by a fraternal beginning 6 months after December 18, 1979. A fraternal may elect to have this section apply at an earlier date, so long as it applies simultaneously to all such contracts and the fraternal gives the commissioner at least 30 days' notice of intention to adopt this section.History:  1975 c. 373; 1979 c. 102 ss. 179 to 182, 237; 1987 a. 361; 1989 a. 336; 1997 a. 177.
WI Stat § 632.95 (2021)
2021 Wisconsin Statutes & Annotations|Chapter 632 - Insurance contracts in specific lines.|632.95 - Fraud in obtaining membership.

632.95  Fraud in obtaining membership. Subject to s. 632.46, any certificate of membership secured by misrepresentation in or with reference to any application for membership or documentary or other proof for the purpose of obtaining membership in or noninsurance benefit from the fraternal is void, if the fraternal relied on it and it is either material or fraudulent.History:  1975 c. 373.Legislative Council Note, 1975: This section continues the contractual portion of s. 208.38, edited with a change in meaning, to include nonfraudulent but material misrepresentation, and also to subject the provision to the rule of incontestability provided in s. 632.46. [Bill 643-S]
WI Stat § 632.96 (2021)
2021 Wisconsin Statutes & Annotations|Chapter 632 - Insurance contracts in specific lines.|632.96 - Beneficiaries in fraternal contracts.

632.96  Beneficiaries in fraternal contracts. (1) Any owner may designate as beneficiary any person permitted by the laws of the fraternal. Those laws shall authorize the designation of the estate of a member or insured employee as beneficiary. (2) Subject to sub. (1), s. 632.48 applies.History:  1975 c. 373, 421; 1989 a. 336; 1997 a. 177.Legislative Council Note, 1975: Sub. (1) states a rule slightly more restrictive of the range of permitted beneficiaries than for commercial life insurance; this reflects the nature of the fraternal. Sub. (2) applies the general provision for life insurance, subject to sub. (1). [Bill 643-S]
WI Stat § 632.97 (2021)
2021 Wisconsin Statutes & Annotations|Chapter 632 - Insurance contracts in specific lines.|632.97 - Application of proceeds of credit insurance policy.

632.97  Application of proceeds of credit insurance policy. Payment to a creditor of any amounts insured under the terms of a credit insurance policy reduces the debt proportionately. This rule does not apply to an insurance policy on which the debtor pays no part of the premium, directly or indirectly.History:  1975 c. 375.
WI Stat § 632.98 (2021)
2021 Wisconsin Statutes & Annotations|Chapter 632 - Insurance contracts in specific lines.|632.98 - Worker's compensation insurance.

632.98  Worker's compensation insurance. Sections 102.31, 102.315, and 102.62 apply to worker's compensation insurance. History:  1975 c. 375, 421; 1979 c. 102; 2007 a. 185.
WI Stat § 632.99 (2021)
2021 Wisconsin Statutes & Annotations|Chapter 632 - Insurance contracts in specific lines.|632.99 - Certifications of disability.

632.99  Certifications of disability. For the purpose of insurance policies that they issue, every insurer doing a health or disability insurance business in this state shall afford equal weight to a certification of disability signed by a physician with respect to matters within the scope of the physician's professional license, to a certification of disability signed by a chiropractor with respect to matters within the scope of the chiropractor's professional license, and to a certification of disability signed by a podiatrist with respect to matters within the scope of the podiatrist's professional license. This section does not require an insurer to treat any certification of disability as conclusive evidence of disability. History:  1981 c. 55; 2009 a. 113.
WI Stat § 633.04 (2021)
2021 Wisconsin Statutes & Annotations|Chapter 633 - Employee benefit plan administrators, principals, and pharmacy benefit managers.|633.04 - Written agreement required.

633.04  Written agreement required. An administrator may not administer an employee benefit plan in the absence of a written agreement between the administrator and a principal. The administrator and principal shall each retain a copy of the written agreement for the duration of the agreement and for 5 years thereafter. The written agreement shall contain the following terms:NOTE: Section 633.04 (intro.) is shown as amended eff. 1-1-22 by 2021 Wis. Act 9. Prior to 1-1-22 it reads: 633.04 Written agreement required. An administrator may not administer a plan in the absence of a written agreement between the administrator and a principal. The administrator and principal shall each retain a copy of the written agreement for the duration of the agreement and for 5 years thereafter. The written agreement shall contain the following terms: (1) That the administrator and principal shall each retain a copy of the written agreement as provided under this section. (2) If a policy is issued to a trust, that the administrator shall retain a copy of the trust agreement for the duration of the trust agreement and for 5 years thereafter. (3) If the principal is an insurer, that payments to an administrator shall be treated as provided in s. 633.05. (4) That the administrator shall maintain and retain books and records pertaining to a principal dating back 5 years at all times or until delivered to the principal by the administrator, with the right of examination and audit as provided in s. 633.06 (1), and the right of inspection and any restrictions on the right of inspection, as provided in s. 633.06 (2). (5) If the principal is an insurer, that advertising shall be approved as provided in s. 633.07. (6) If the principal is an insurer, that the terms, as required by s. 633.08, specify any underwriting responsibilities which the insurer has delegated to the administrator. (7) That funds shall be collected and received as provided in s. 633.09 (1), that funds shall be paid and deposited as provided in s. 633.09 (1), that fiduciary account records shall be maintained and provided as provided in s. 633.09 (2), that interest shall be treated as provided in s. 633.09 (3) or that other terms shall specify treatment of interest, that withdrawals for payments of claims are not permitted as provided in s. 633.09 (4) (a), and that other withdrawals are permitted only as provided under s. 633.09 (4) (b). (8) That claims are to be paid as provided in s. 633.10. (9) That compensation to an administrator shall be paid as provided in s. 633.11. (10) That notification shall be given as provided in s. 633.12. (11) That an administrator has been licensed as provided in s. 633.13 (1) or need not be licensed as provided in s. 633.13 (2).History:  1991 a. 39; 2021 a. 9.
WI Stat § 633.05 (2021)
2021 Wisconsin Statutes & Annotations|Chapter 633 - Employee benefit plan administrators, principals, and pharmacy benefit managers.|633.05 - Payment to administrator.

633.05  Payment to administrator. If a principal is an insurer, payment to the administrator of a premium or charge by or on behalf of an insured employee is payment to the insurer, but payment of a return premium or claim by the insurer to the administrator is not payment to an insured employee until the payment is received by the insured employee. This section does not limit any right of the insurer against the administrator for failure to make payments to the insurer or an insured employee.NOTE: This section is shown as amended eff. 1-1-22 by 2021 Wis. Act 9. Prior to 1-1-22 it reads: 633.05 Payment to administrator. If a principal is an insurer, payment to the administrator of a premium or charge by or on behalf of an insured is payment to the insurer, but payment of a return premium or claim by the insurer to the administrator is not payment to an insured until the payment is received by the insured. This section does not limit any right of the insurer against the administrator for failure to make payments to the insurer or an insured.History:  1991 a. 39; 2021 a. 9.
WI Stat § 633.06 (2021)
2021 Wisconsin Statutes & Annotations|Chapter 633 - Employee benefit plan administrators, principals, and pharmacy benefit managers.|633.06 - Examination and inspection of books and records.

633.06  Examination and inspection of books and records. (1) The commissioner may examine, audit or accept an audit of the books and records of an administrator or pharmacy benefit manager as provided for examination of licensees under s. 601.43 (1), (3), (4) and (5), to be conducted as provided in s. 601.44, and with costs to be paid as provided in s. 601.45. (2) A principal that uses an administrator may inspect the books and records of the administrator, subject to any restrictions set forth in ss. 146.81 to 146.835 and in the written agreement required under s. 633.04, for the purpose of enabling the principal to fulfill its contractual obligations to insured employees.NOTE: This section is shown as amended eff. 1-1-22 by 2021 Wis. Act 9. Prior to 1-1-22 it reads: 633.06 Examination and inspection of books and records. (1) The commissioner may examine, audit or accept an audit of the books and records of an administrator as provided for examination of licensees under s. 601.43 (1), (3), (4) and (5), to be conducted as provided in s. 601.44, and with costs to be paid as provided in s. 601.45. (2) A principal that uses an administrator may inspect the books and records of the administrator, subject to any restrictions set forth in ss. 146.81 to 146.835 and in the written agreement required under s. 633.04, for the purpose of enabling the principal to fulfill its contractual obligations to insureds.History:  1991 a. 39; 2021 a. 9.
WI Stat § 633.07 (2021)
2021 Wisconsin Statutes & Annotations|Chapter 633 - Employee benefit plan administrators, principals, and pharmacy benefit managers.|633.07 - Approval of advertising.

633.07  Approval of advertising. An administrator may not use any advertising for an employee benefit plan underwritten by an insurer unless the insurer approves the advertising in advance.NOTE: This section is shown as amended eff. 1-1-22 by 2021 Wis. Act 9. Prior to 1-1-22 it reads: 633.07 Approval of advertising. An administrator may not use any advertising for a plan underwritten by an insurer unless the insurer approves the advertising in advance.History:  1991 a. 39; 2021 a. 9.
WI Stat § 633.08 (2021)
2021 Wisconsin Statutes & Annotations|Chapter 633 - Employee benefit plan administrators, principals, and pharmacy benefit managers.|633.08 - Underwriting responsibilities.

633.08  Underwriting responsibilities. If a principal is an insurer, any underwriting responsibilities regarding eligibility that the insurer has delegated to an administrator shall be set forth in the written agreement required under s. 633.04.History:  1991 a. 39.
WI Stat § 633.09 (2021)
2021 Wisconsin Statutes & Annotations|Chapter 633 - Employee benefit plan administrators, principals, and pharmacy benefit managers.|633.09 - Accounts.

633.09  Accounts. (1) Moneys held in fiduciary capacity. An administrator shall hold in a fiduciary capacity all moneys that the administrator collects or receives on behalf of other persons. Within 2 business days after collection or receipt of such moneys, the administrator either shall pay the moneys to the persons entitled to them or shall deposit the moneys in a fiduciary account established and maintained by the administrator in a financial institution. (2)  Fiduciary account records. An administrator shall maintain fiduciary account records in accordance with generally accepted accounting principles. The administrator shall retain the fiduciary account records pertaining to a principal for at least 5 years beginning on the date of creation of the records. If an administrator deposits in a fiduciary account moneys that the administrator has collected on behalf of more than one principal, the administrator shall keep records of the account that clearly indicate deposits made under sub. (1) and withdrawals made under sub. (4) on behalf of each principal. Upon request by a principal, the administrator shall provide the principal copies of those portions of the records pertaining to deposits and withdrawals made on behalf of the principal and shall otherwise permit inspection by the principal as provided under s. 633.06 (2). (3)  Interest on deposits. Interest earned on moneys deposited in a fiduciary account is the property of the principal unless otherwise provided in the written agreement required under s. 633.04. (4)  Withdrawals from fiduciary account.  (a) An administrator may not pay any claim by withdrawal from a fiduciary account.(b) An administrator may make the following payments from a fiduciary account:1. To a principal, the funds belonging to the principal.2. To an employee benefit plan policyholder for payment to a principal, the funds belonging to the principal.NOTE: Subd. 2. is shown as amended eff. 1-1-22 by 2021 Wis. Act 9. Prior to 1-1-22 it reads: 2. To a plan policyholder for payment to a principal, the funds belonging to the principal. 3. To an insured employee, the funds belonging to the insured employee.NOTE: Subd. 3. is shown as amended eff. 1-1-22 by 2021 Wis. Act 9. Prior to 1-1-22 it reads: 3. To an insured, the funds belonging to the insured. 4. To another account maintained in the name of a principal, the funds belonging to the principal.5. To a claims paying account, the funds belonging to a principal for payment of claims owed by the principal.6. To the administrator, commissions, fees or charges owed the administrator by a principal.History:  1991 a. 39; 2021 a. 9.
WI Stat § 633.10 (2021)
2021 Wisconsin Statutes & Annotations|Chapter 633 - Employee benefit plan administrators, principals, and pharmacy benefit managers.|633.10 - Payment of claims.

633.10  Payment of claims. An administrator shall pay claims from funds paid to the claims paying account under s. 633.09 (4) (b) 5. on drafts or checks authorized in advance by the principal.History:  1991 a. 39.
WI Stat § 633.11 (2021)
2021 Wisconsin Statutes & Annotations|Chapter 633 - Employee benefit plan administrators, principals, and pharmacy benefit managers.|633.11 - Claim adjustment compensation.

633.11  Claim adjustment compensation. If an administrator adjusts or settles claims under an employee benefit plan, the commission, fees or charges that the principal pays the administrator may not be based on the employee benefit plan's loss experience. This section does not prohibit compensation based on the number or amount of premiums or charges collected, or the number or amount of claims paid or processed by the administrator.NOTE: This section is shown as amended eff. 1-1-22 by 2021 Wis. Act 9. Prior to 1-1-22 it reads: 633.11 Claim adjustment compensation. If an administrator adjusts or settles claims under a plan, the commission, fees or charges that the principal pays the administrator may not be based on the plan's loss experience. This section does not prohibit compensation based on the number or amount of premiums or charges collected, or the number or amount of claims paid or processed by the administrator.History:  1991 a. 39; 2021 a. 9.
WI Stat § 633.12 (2021)
2021 Wisconsin Statutes & Annotations|Chapter 633 - Employee benefit plan administrators, principals, and pharmacy benefit managers.|633.12 - Notification required.

633.12  Notification required. (1) An administrator shall prepare sufficient copies of a written notice approved in advance by the principal for distribution to all insured employees of the principal and either shall distribute the copies to the insured employees or shall provide the copies to the principal for distribution to the insured employees. The written notice shall contain all of the following:NOTE: Sub. (1) (intro.) is shown as amended eff. 1-1-22 by 2021 Wis. Act 9. Prior to 1-1-22 it reads:(a) The names and addresses of the administrator and the principal.(b) An explanation of the respective rights and responsibilities of the administrator, the principal and the insured employees.NOTE: Par. (b) is shown as amended eff. 1-1-22 by 2021 Wis. Act 9. Prior to 1-1-22 it reads: (b) An explanation of the respective rights and responsibilities of the administrator, the principal and the insureds. (c) A statement of the extent to which the employee benefit plan is insured or self-insured, and an explanation of the terms “insured" and “self-insured".NOTE: Par. (c) is shown as amended eff. 1-1-22 by 2021 Wis. Act 9. Prior to 1-1-22 it reads: (c) A statement of the extent to which the plan is insured or self-insured, and an explanation of the terms “insured" and “self-insured".  (2) If an administrator collects premiums or charges from a person on behalf of a principal, at least once in every year, prior to collecting the premiums or charges, the administrator shall provide written notice to the person stating the amount of the premiums or charges.History:  1991 a. 39; 2021 a. 9.
WI Stat § 633.13 (2021)
2021 Wisconsin Statutes & Annotations|Chapter 633 - Employee benefit plan administrators, principals, and pharmacy benefit managers.|633.13 - License required.

633.13  License required. (1) General. Except as provided in sub. (2), a person may not perform, offer to perform or advertise any service as an administrator or a pharmacy benefit manager unless the person has obtained a license under s. 633.14. A pharmacy benefit manager that also performs services as an administrator need only obtain an administrator license under s. 633.14.NOTE: Sub. (1) is shown as amended eff. 1-1-22 by 2021 Wis. Act 9. Prior to 1-1-22 it reads: (2)  Exemptions. The commissioner may exempt by rule certain classes of administrators from the requirement of sub. (1) if the commissioner determines any of the following:(a) That the functions that the administrators perform do not require special competence or trustworthiness or otherwise do not require the regulatory surveillance of a licensing requirement.(b) That other safeguards make a licensing requirement unnecessary. (3)  Responsibilities of principal. A principal may not use the services of an administrator unless the administrator furnishes proof of licensure under s. 633.14 or exemption under sub. (2). An insurer or a self-insured health plan may not use the services of a pharmacy benefit manager unless the pharmacy benefit manager furnishes proof of licensure under s. 633.14.NOTE: Sub. (3) is shown as amended eff. 1-1-22 by 2021 Wis. Act 9. Prior to 1-1-22 it reads:History:  1991 a. 39; 2021 a. 9.
WI Stat § 633.16 (2021)
2021 Wisconsin Statutes & Annotations|Chapter 633 - Employee benefit plan administrators, principals, and pharmacy benefit managers.|633.16 - Regulation.

633.16  Regulation. Nothing in this chapter gives the commissioner the authority to impose requirements on an employee benefit plan that is exempt from state law under 29 USC 1144 (b).NOTE: This section is shown as amended eff. 1-1-22 by 2021 Wis. Act 9. Prior to 1-1-22 it reads: 633.16 Regulation. Nothing in this chapter gives the commissioner the authority to impose requirements on a plan that is exempt from state law under 29 USC 1144 (b).History:  1991 a. 39; Stats. 1991 s. 633.16; 2021 a. 9.The commissioner lacks authority to regulate administrators of self-funded or self-insured employee benefit plans. 80 Atty. Gen. 290.
WI Stat § 633.17 (2021)
2021 Wisconsin Statutes & Annotations|Chapter 633 - Employee benefit plan administrators, principals, and pharmacy benefit managers.|633.17 - Rule-making authority.

633.17  Rule-making authority. The commissioner shall promulgate rules necessary for the implementation of this chapter, in addition to the rules permitted under s. 633.13 (2) and required under ss. 633.14 (3) and 633.15 (1) (b).History:  1991 a. 39.
WI Stat § 635.01 (2021)
2021 Wisconsin Statutes & Annotations|Chapter 635 - Small employer health insurance.|635.01 - Scope.

635.01  Scope. This chapter applies to all group health insurance plans, policies or certificates, written on risks or operations in this state, providing coverage for employees of a small employer, or employees of a small employer and the employer, and to individual health insurance policies, written on risks or operations in this state, providing coverage for employees of a small employer, or employees of a small employer and the employer when 3 or more are sold to or through a small employer.History:  1991 a. 39; 1997 a. 27.