reglab/statecodes huggingface dataset:
2023 Wisconsin Statutes & Annotations › Chapter 632 - Insurance contracts in specific lines. › 632.66 - Annuity contracts without life contingencies.

632.66
Annuity contracts without life contingencies.
(1)
The commissioner may by rule authorize insurers to issue annuity contracts which are without life contingencies. If the commissioner authorizes insurers to issue annuity contracts without life contingencies, the commissioner shall promulgate rules regulating those contracts.
(2)
(a)
In this subsection, “funding agreement” means an annuity without life contingencies that is an agreement for an insurer to accept and accumulate funds and to make one or more payments at future dates in fixed or variable amounts, or both, that are not based on mortality or morbidity contingencies.
(b)
A domestic insurer that holds a valid certificate of authority to transact the business of life insurance and annuities in this state may issue a funding agreement if all of the following conditions are met:
1.
The domestic insurer's board of directors, or an authorized committee of the board, approves the domestic insurer's plan relating to funding agreements.
2.
The commissioner determines that the issuance of funding agreements by the domestic insurer is not adverse to the interests of the policyholders of the domestic insurer, except that no determination from the commissioner is required if the domestic insurer has more than $200 billion in admitted assets. In making a determination under this subdivision, the commissioner shall consider the domestic insurer's specific policy objective and strategies, investment and risk management guidelines, and aggregate maximum limits on the funding agreement business.
3.
No amounts may be guaranteed or credited under the funding agreement except upon reasonable assumptions as to investment income and expenses and on a basis equitable to all holders of a given class of the funding agreement.
4.
The domestic insurer complies with the form filing requirements under s. 631.20 with respect to the funding agreement.
(c)
The issuance or delivery of a funding agreement by an insurer in this state shall constitute doing an insurance business herein.
(d)
A domestic insurer may offer funding agreements directly through the domestic insurer and is not required to use licensed intermediaries when marketing funding agreements.
(e)
Amounts paid to the domestic insurer, and proceeds applied under optional modes of settlement, under funding agreements may be allocated to one or more separate accounts pursuant to s. 611.24.
(f)
Notwithstanding ch. 551, the commissioner has sole authority to regulate the issuance and sale of funding agreements, including the persons selling funding agreements on behalf of insurers.
(g)
Notwithstanding s. 601.465 (1m) and subch. II of ch. 19, any materials submitted to the commissioner pursuant to an approval under par. (b) 2. or pursuant to a request from the commissioner related to a funding agreement shall be held confidential pursuant to s. 601.465 (1n).
(h)
The commissioner may promulgate rules as necessary for the implementation of this subsection.
History:  1987 a. 247; 2021 a. 114.
2023 Wisconsin Statutes & Annotations › Chapter 632 - Insurance contracts in specific lines. › 632.67 - Effect of power of attorney for health care.

632.67
Effect of power of attorney for health care.
Executing a power of attorney for health care under ch. 155 may not be used to impair in any manner the procurement of a life insurance policy or to modify the terms of an existing life insurance policy. A life insurance policy may not be impaired or invalidated in any manner by the exercise of a health care decision by a health care agent on behalf of a person whose life is insured under the policy and who has authorized the health care agent under ch. 155.
History:  1989 a. 200.
2023 Wisconsin Statutes & Annotations › Chapter 632 - Insurance contracts in specific lines. › 632.697 - Benefits subject to department's right to recover.

632.697
Benefits subject to department's right to recover.
Death benefits payable under a life insurance policy or an annuity are subject to the right of the department of health services to recover under s. 46.27 (7g), 2017 stats., or s. 49.496, 49.682, or 49.849 an amount equal to the medical assistance that is recoverable under s. 49.496 (3) (a), an amount equal to aid under s. 49.68, 49.683, 49.685, or 49.785 that is recoverable under s. 49.682 (2) (a) or (am), or an amount equal to long-term community support services under s. 46.27, 2017 stats., that is recoverable under s. 46.27 (7g) (c) 1., 2017 stats., and that was paid on behalf of the deceased policyholder or annuitant.
History:  2013 a. 20; 2015 a. 55; 2019 a. 9; 2021 a. 239 s. 74.
2023 Wisconsin Statutes & Annotations › Chapter 632 - Insurance contracts in specific lines. › 632.71 - Estoppel from medical examination, assignability and change of beneficiary.

632.71
Estoppel from medical examination, assignability and change of beneficiary.
Sections 632.47 to 632.50 apply to disability insurance policies.
History:  1975 c. 373, 375, 422.
2023 Wisconsin Statutes & Annotations › Chapter 632 - Insurance contracts in specific lines. › 632.715 - Reports of action against health care provider.

632.715
Reports of action against health care provider.
Every insurer that has taken any action against a person who holds a license granted by the medical examining board or an affiliated credentialing board attached to the medical examining board shall notify the board or affiliated credentialing board of the action taken against the person if the action relates to unprofessional conduct or negligence in treatment by the person who holds the license.
History:  1985 a. 340; 1993 a. 107.
2023 Wisconsin Statutes & Annotations › Chapter 632 - Insurance contracts in specific lines. › 632.72 - Medical benefits or assistance; assignment.

632.72
Medical benefits or assistance; assignment.
(1g)
In this section:
(a)
“Department or contract provider" means the department of health services, the county providing the medical benefits or assistance or a health maintenance organization that has contracted with the department of health services to provide the medical benefits or assistance.
(b)
“Medical benefits or assistance" means health care services funded by a relief block grant, as defined in s. 49.001 (5p); medical assistance, as defined under s. 49.43 (8); or maternal and child health services under s. 253.05.
(1r)
The providing of medical benefits or assistance constitutes an assignment to the department or contract provider. The assignment shall be, to the extent of the medical benefits or assistance provided, for benefits to which the recipient would be entitled under any policy of health and disability insurance.
(2)
An insurer may not impose on the department or contract provider, as assignee of a person who is covered under the policy of health and disability insurance and who is eligible for medical benefits or assistance, requirements that are different from those imposed on any other agent or assignee of a person who is covered under the policy of health and disability insurance.
History:  1977 c. 29; 1985 a. 29; 1987 a. 27 s. 3202; 1989 a. 31, 173; 1991 a. 178, 214; 1993 a. 481; 1995 a. 27 ss. 7042 to 7046, 9126 (19); 1995 a. 407; 2007 a. 20 s. 9121 (6) (a); 2009 a. 28.
2023 Wisconsin Statutes & Annotations › Chapter 632 - Insurance contracts in specific lines. › 632.725 - Standardization of health care billing and insurance claim forms.

632.725
Standardization of health care billing and insurance claim forms.
(1)
Definition. In this section, “health care provider" has the meaning given in s. 146.81 (1) (a) to (p).
(2)
Rules for standardization of forms. The commissioner, in consultation with the department of health services, shall, by rule, do all of the following:
(a)
Establish a standardized billing format for health care services and require that a health care provider that provides health care services in this state use, by July 1, 1993, the standardized format for all printed billing forms.
(b)
Establish a standardized claim format for health care insurance benefits and require that an insurer that provides health care coverage to one or more residents of this state use, by July 1, 1993, the standardized format for all printed claim forms.
(c)
Establish a standardized explanation of benefits format for health care insurance benefits and require that an insurer that provides health care coverage to one or more residents of this state use, by July 1, 1993, the standardized format for all printed forms that contain an explanation of benefits. The rule shall also require that benefits be explained in easily understood language.
(d)
Establish a uniform statewide patient identification system in which each individual who receives health care services in this state is assigned an identification number. The standardized billing format established under par. (a) and the standardized claim format established under par. (b) shall provide for the designation of an individual's patient identification number.
(3)
Proposals for legislation. The commissioner shall develop proposals for legislation for the use of the patient identification system established under sub. (2) (d) and for the implementation of the proposed uses, including any proposals for safeguarding patient confidentiality.
History:  1991 a. 250; 1995 a. 27 s. 9126 (19); 2007 a. 20 s. 9121 (6) (a); 2009 a. 28.
2023 Wisconsin Statutes & Annotations › Chapter 632 - Insurance contracts in specific lines. › 632.726 - Current procedural terminology code changes.

632.726
Current procedural terminology code changes.
(1)
In this section, “current procedural terminology code" means a number established by the American Medical Association that a health care provider puts on a health insurance claim form to describe the services that he or she performed.
(2)
If an insurer changes a current procedural terminology code that was submitted by a health care provider on a health insurance claim form, the insurer shall include on the explanation of benefits form the reason for the change to the current procedural terminology code and shall cite on the explanation of benefits form the source for the change.
History:  2007 a. 20.
2023 Wisconsin Statutes & Annotations › Chapter 632 - Insurance contracts in specific lines. › 632.729 - Prohibiting discrimination based on COVID-19.

632.729
Prohibiting discrimination based on COVID-19.
(1)
Definitions. In this section:
(a)
“COVID-19” means an infection caused by the SARS-CoV-2 coronavirus.
(b)
“Health benefit plan” has the meaning given in s. 632.745 (11).
(c)
“Pharmacy benefit manager” has the meaning given in s. 632.865 (1) (c).
(d)
“Self-insured health plan” has the meaning given in s. 632.85 (1) (c).
(2)
Issuance or renewal.
(a)
An insurer that offers an individual or group health benefit plan, a pharmacy benefit manager, or a self-insured health plan may not establish rules for the eligibility of any individual to enroll, for the continued eligibility of any individual to remain enrolled, or for the renewal of coverage under the plan based on a current or past diagnosis or suspected diagnosis of COVID-19.
(b)
An insurer that offers a group health benefit plan, a pharmacy benefit manager, or a self-insured health plan may not establish rules for the eligibility of any employer or other group to enroll, for the continued eligibility of any employer or group to remain enrolled, or for the renewal of an employer's or group's coverage under the plan based on a current or past diagnosis or suspected diagnosis of COVID-19 of any employee or other member of the group.
(3)
Cancellation. An insurer that offers an individual or group health benefit plan, a pharmacy benefit manager, or a self-insured health plan may not use as a basis for cancellation of coverage during a contract term a current or past diagnosis of COVID-19 or suspected diagnosis of COVID-19.
(4)
Rates. An insurer that offers an individual or group health benefit plan, a pharmacy benefit manager, or a self-insured health plan may not use as a basis for setting rates for coverage a current or past diagnosis of COVID-19 or suspected diagnosis of COVID-19.
(5)
Premium grace period. An insurer that offers an individual or group health benefit plan, a pharmacy benefit manager, or a self-insured health plan may not refuse to grant to an individual, employer, or other group a grace period for the payment of a premium based on an individual's, employee's, or group member's current or past diagnosis of COVID-19 or suspected diagnosis of COVID-19 if a grace period for payment of premium would generally be granted under the plan.
History: 2019 a. 185.
2023 Wisconsin Statutes & Annotations › Chapter 632 - Insurance contracts in specific lines. › 632.73 - Right to return policy.

632.73
Right to return policy.
(1)
Right of return. A policyholder may return an individual or franchise disability policy within 10 days after receipt. If the policyholder does so, the contract is void, and all payments made under it shall be refunded. This subsection does not apply to medicare supplement policies, medicare replacement policies or long-term care insurance policies subject to sub. (2m).
(2)
Notification. Subsection (1) shall in substance be conspicuously printed on the first page of each such policy or conspicuously attached thereto.
(2m)
Medicare supplement policies, medicare replacement policies and long-term care insurance policies. Medicare supplement policies, medicare replacement policies and long-term care insurance policies shall have a notice that complies with this subsection prominently printed on the first page of the policy or certificate, or attached thereto. The notice shall state that the policyholder or certificate holder shall have the right to return the policy or certificate within 30 days of its delivery to the policyholder or certificate holder and to have the premium refunded to the person who paid the premium if, after examination of the policy or certificate, the policyholder or certificate holder is not satisfied for any reason. The commissioner may by rule exempt from this subsection certain classes of medicare supplement policies, medicare replacement policies and long-term care insurance policies, if the commissioner finds the exemption is not adverse to the interests of policyholders and certificate holders.
(3)
Exemptions.
(a)
Specified. This section does not apply to single premium nonrenewable policies issued for terms not greater than 6 months or covering accidents only or accidental bodily injuries only.
(b)
By rule. The commissioner may by rule permit exemptions from subs. (1) and (2) for additional classes or parts of classes of insurance where the right to return the policy would be impracticable or is not necessary to protect the policyholder's interests.
History:  1975 c. 375, 421; 1981 c. 82; 1985 a. 29; 1985 a. 332 s. 253; 1989 a. 31.
2023 Wisconsin Statutes & Annotations › Chapter 632 - Insurance contracts in specific lines. › 632.74 - Reinstatement of individual or franchise disability insurance policies.

632.74
Reinstatement of individual or franchise disability insurance policies.
(1)
Conditions of reinstatement. If an insurer, after termination of an individual or franchise disability insurance policy for nonpayment of premium, within one year after the termination accepts without reservation a premium payment, the policy is reinstated as of the date of the acceptance. There is no acceptance without reservation if the insurer delivers or mails a written statement of reservations within 45 days after receipt of the payment.
(2)
Consequences of reinstatement. If a policy is reinstated under sub. (1) or if the insurer within one year after the termination issues to the policyholder a reinstatement policy, any losses resulting from accidents occurring or sickness beginning between the termination and the effective date of the reinstatement or the new policy are not covered, and no premium is payable for that period, except to the extent that the premium is applied to a reserve for future losses. The insurer may also charge a reinstatement fee in accordance with a schedule that has been filed with and expressly approved by the commissioner as not excessive and not unreasonably discriminatory. In all other respects, the reinstated or renewed contract shall be treated as an uninterrupted contract subject to any provisions which are endorsed on or attached to the contract in connection with the reinstatement and which are fully and prominently disclosed to the policyholder.
History:  1975 c. 375; 1985 a. 280; 1987 a. 247.
2023 Wisconsin Statutes & Annotations › Chapter 632 - Insurance contracts in specific lines. › 632.747 - Guaranteed acceptance.

632.747
Guaranteed acceptance.
(1)
Employee becomes eligible after commencement of coverage. Unless otherwise permitted by rule of the commissioner, if an insurer provides coverage under a group health benefit plan, the insurer shall provide coverage under the group health benefit plan to an eligible employee who becomes eligible for coverage after the commencement of the employer's coverage, and to the eligible employee's dependents, regardless of health condition or claims experience, if all of the following apply:
(a)
The employee has satisfied any applicable waiting period.
(b)
The employer agrees to pay the premium required for coverage of the employee under the group health benefit plan.
(3)
State or municipal self-insured plans. If the state or a county, city, village, town or school district provides coverage under a self-insured health plan, it shall provide coverage under the self-insured health plan to an eligible employee who waived coverage during an enrollment period during which the employee was entitled to enroll in the self-insured health plan, regardless of health condition or claims experience, if all of the following apply:
(a)
The eligible employee was covered as a dependent under creditable coverage when he or she waived coverage under the self-insured health plan.
(b)
The eligible employee's coverage under the creditable coverage has terminated or will terminate due to a divorce from the insured under the creditable coverage, the death of the insured under the creditable coverage, loss of employment by the insured under the creditable coverage or involuntary loss of coverage under the creditable coverage by the insured under the creditable coverage.
(c)
The eligible employee applies for coverage under the self-insured health plan not more than 30 days after termination of his or her coverage under the creditable coverage.
History:  1995 a. 289; 1997 a. 27.
2023 Wisconsin Statutes & Annotations › Chapter 632 - Insurance contracts in specific lines. › 632.748 - Prohibiting discrimination.

632.748
Prohibiting discrimination.
(1)
(a)
Subject to subs. (3) and (4), an insurer may not establish rules for the eligibility of any individual to enroll, or for the continued eligibility of any individual to remain enrolled, under a group health benefit plan based on any of the following factors with respect to the individual or a dependent of the individual:
1.
Health status.
2.
Medical condition, including both physical and mental illnesses.
3.
Claims experience.
4.
Receipt of health care.
5.
Medical history.
6.
Genetic information.
7.
Evidence of insurability, including conditions arising out of acts of domestic violence.
8.
Disability.
(b)
For purposes of par. (a), rules for eligibility to enroll under a group health benefit plan include rules defining any applicable waiting periods for enrollment.
(2)
An insurer offering a group health benefit plan may not require any individual, as a condition of enrollment or continued enrollment under the plan, to pay, on the basis of any health status-related factor with respect to the individual or a dependent of the individual, a premium or contribution that is greater than the premium or contribution for a similarly situated individual enrolled under the plan.
(3)
To the extent consistent with s. 632.746, sub. (1) shall not be construed to do any of the following:
(a)
Require a group health benefit plan to provide particular benefits other than those provided under the terms of the plan.
(b)
Prevent a group health benefit plan from establishing limitations or restrictions on the amount, level, extent or nature of benefits or coverage for similarly situated individuals enrolled under the plan.
(4)
Nothing in sub. (1) shall be construed to do any of the following:
(a)
Restrict the amount that an insurer may charge an employer for coverage under a group health benefit plan.
(b)
Prevent an insurer offering a group health benefit plan from establishing premium discounts or rebates, or from modifying otherwise applicable copayments or deductibles, in return for adherence to programs of health promotion and disease prevention.
(c)
Provide an exception from, or limit, the rate regulation under s. 635.05.
History:  1997 a. 27.
2023 Wisconsin Statutes & Annotations › Chapter 632 - Insurance contracts in specific lines. › 632.7497 - Modifications at renewal.

632.7497
Modifications at renewal.
(1)
In this section, “individual major medical or comprehensive health benefit plan" includes coverage under a group policy that is underwritten on an individual basis and issued to individuals or families.
(2)
An insurer that issues an individual major medical or comprehensive health benefit plan shall, at the time of a coverage renewal, at the request of an insured, permit the insured to do either of the following:
(a)
Change his or her coverage to any of the following:
1.
A different but comparable individual major medical or comprehensive health benefit plan currently offered by the insurer.
2.
An individual major medical or comprehensive health benefit plan currently offered by the insurer with more limited benefits.
3.
An individual major medical or comprehensive health benefit plan currently offered by the insurer with higher deductibles.
(b)
Modify his or her existing coverage by electing an optional higher deductible, if any, under the individual major medical or comprehensive health benefit plan.
(3)
(a)
The insurer may not impose any new preexisting condition exclusion under the new or modified coverage under sub. (2) that did not apply to the insured's original coverage and shall allow the insured credit under the new or modified coverage for the period of original coverage.
(b)
For the new or modified coverage, the insurer may not rate for health status other than on the insured's health status at the time the insured applied for the original coverage and as the insured disclosed on the original application.
(4)
(a)
Annually, the insurer shall mail to each insured under an individual major medical or comprehensive health benefit plan issued by the insurer, a notice that includes all of the following information:
1.
That the insured has the right to elect alternative coverage as described in sub. (2).
2.
A description of the alternatives available to the insured.
3.
The procedure for making the election.
(b)
The insurer shall mail the notice under par. (a) not more than 3 months nor less than 60 days before the renewal date of the insured's plan.
(5)
(a)
Nothing in this section requires an insurer to issue alternative coverage under sub. (2) if the insured's coverage may be nonrenewed or discontinued under s. 632.7495 (2), (3) (b), or (4).
(b)
Notwithstanding s. 600.01 (1) (b) 3. and 4., this section applies to a group health benefit plan described in s. 600.01 (1) (b) 3. or 4. if that group health benefit plan is an individual major medical or comprehensive health benefit plan as defined in sub. (1).
History:  2009 a. 28.
2023 Wisconsin Statutes & Annotations › Chapter 632 - Insurance contracts in specific lines. › 632.75 - Prohibited provisions for disability insurance.

632.75
Prohibited provisions for disability insurance.
(1)
Death presumed from extended absence. Section 813.22 (1) applies to any disability insurance policy providing a death benefit.
(2)
Dividends conditioned on continuation of policy or payment of premiums. Except on the first or second anniversary, no dividend payable on a disability insurance policy may be made contingent on the continuation of the policy or on premium payments.
(3)
Prohibition of exclusion from coverage of certain dependent children. No disability insurance policy issued or renewed on or after April 30, 1980, may exclude or terminate from coverage any dependent child of an insured person or group member solely because the child does not reside with the insured person or group member. This subsection does not apply to a group policy, as defined in s. 632.897 (1) (c), or an individual policy, as defined in s. 632.897 (1) (cm), that is subject to s. 632.897 (10).
(4)
Out-of-state service providers. Except as provided in s. 628.36, no disability insurance policy may exclude or limit coverage of health care services provided outside this state, if the services are provided within 75 miles of the insured's residence in a facility licensed or approved by the state where the facility is located.
(5)
Payments for hospital services. No insurer may reimburse a hospital for patient health care costs at a rate exceeding the rate established under ch. 54, 1985 stats., or s. 146.60, 1983 stats., for care provided prior to July 1, 1987.
History:  1975 c. 375; 1979 c. 221; 1981 c. 304; 1983 a. 27; 1985 a. 29 s. 3202 (27); 1987 a. 27; 1989 a. 31, 359.
2023 Wisconsin Statutes & Annotations › Chapter 632 - Insurance contracts in specific lines. › 632.755 - Public assistance and early intervention services.

632.755
Public assistance and early intervention services.
(1g)
(a)
A disability insurance policy may not exclude a person or a person's dependent from coverage because the person or the dependent is eligible for assistance under ch. 49 or because the dependent is eligible for early intervention services under s. 51.44.
(b)
A disability insurance policy may not terminate its coverage of a person or a person's dependent because the person or the dependent is eligible for assistance under ch. 49 or because the dependent is eligible for early intervention services under s. 51.44.
(c)
A disability insurance policy may not provide different benefits of coverage to a person or the person's dependent because the person or the dependent is eligible for assistance under ch. 49 or because the dependent is eligible for early intervention services under s. 51.44 than it provides to persons and their dependents who are not eligible for assistance under ch. 49 or for early intervention services under s. 51.44.
(2)
Benefits provided by a disability insurance policy shall be primary to those benefits provided under ch. 49 or under s. 51.44 or 253.05.
History:  1985 a. 29; 1989 a. 173; 1991 a. 178, 214; 1995 a. 407; 1997 a. 27.
2023 Wisconsin Statutes & Annotations › Chapter 632 - Insurance contracts in specific lines. › 632.77 - Permitted provisions for disability insurance policies.

632.77
Permitted provisions for disability insurance policies.
If any provisions are contained in a disability insurance policy dealing with the following subjects, they shall conform to the requirements specified:
(1)
Change of occupation. Any provision respecting change of occupation may provide only for a lower maximum payment and for reduction of loss payments proportionate to the change in appropriate premium rates if the change is to a higher rated occupation, and must provide for retroactive reduction of premium rates from the date of change of occupation or the last policy anniversary date, whichever is the more recent, if the change is to a lower rated occupation.
(2)
Misstatement of age. Any provision respecting misstatement of age may only provide for reduction of the loss payable to the amount that the premium paid would have purchased at the correct age.
(3)
Limitations on payments. Any limitation on payments because of other insurance or because of the income of the insured must be in accordance with provisions approved by the commissioner by rule or explicitly approved in approving the policy form, but the commissioner may not promulgate a rule that conflicts with s. 632.755 nor approve a policy form that does not comply with s. 632.755.
(4)
Facility of payment. Reasonable facility of payment clauses may be inserted. Payment in accordance with such clauses shall discharge the insurer's obligation to pay claims.
History:  1975 c. 375; 1979 c. 102; 1985 a. 29.
2023 Wisconsin Statutes & Annotations › Chapter 632 - Insurance contracts in specific lines. › 632.775 - Effect of power of attorney for health care.

632.775
Effect of power of attorney for health care.
(1)
Insurer may not require. An insurer may not require an individual to execute a power of attorney for health care under ch. 155 as a condition of coverage under a disability insurance policy.
(2)
Effect on disability policies. Executing a power of attorney for health care under ch. 155 may not be used to impair in any manner the procurement of a disability insurance policy or to modify the terms of an existing disability insurance policy. A disability insurance policy may not be impaired or invalidated in any manner by the exercise of a health care decision by a health care agent on behalf of a person who is insured under the policy and who has authorized the health care agent under ch. 155.
History:  1989 a. 200.
2023 Wisconsin Statutes & Annotations › Chapter 632 - Insurance contracts in specific lines. › 632.78 - Required grace period for disability insurance policies.

632.78
Required grace period for disability insurance policies.
Every disability insurance policy shall contain clauses providing for a grace period of at least 7 days for weekly premium policies, 10 days for monthly premium policies and 31 days for all other policies, for each premium after the first, during which the policy shall continue in force. In group and blanket policies the policy must provide for a grace period of at least 31 days unless the policyholder gives written notice of discontinuance prior to the date of discontinuance and in accordance with the policy terms. In group or blanket policies, the policy may provide for payment of a proportional premium for the period the policy is in effect during the grace period under this section.
History:  1975 c. 375; 1977 c. 371; 1979 c. 75; 1979 c. 110 s. 60 (11); 1979 c. 221; 1981 c. 39.
2023 Wisconsin Statutes & Annotations › Chapter 632 - Insurance contracts in specific lines. › 632.79 - Notice of termination of group hospital, surgical or medical expense insurance coverage due to cessation of business or default in payment of premiums.

632.79
Notice of termination of group hospital, surgical or medical expense insurance coverage due to cessation of business or default in payment of premiums.
(1)
Scope. This section shall apply to every group hospital, surgical or medical expense insurance policy or service plan purchased by or on behalf of an employer to provide coverage for employees and issued under s. 185.981 or by any insurer authorized under chs. 600 to 646 which has been delivered, renewed or is otherwise in force on or after June 12, 1976.
(2)
Notice to policyholder or party responsible for payment of premiums.
(a)
Prior to termination of any group policy, plan or coverage subject to this section due to a cessation of business or default in payment of premiums by the policyholder, trust, association or other party responsible for such payment, the insurer or organization issuing the policy, contract, booklet or other evidence of insurance shall notify in writing the policyholder, trust, association or other party responsible for payment of premiums of the date as of which the policy or plan will be terminated or discontinued. At such time, the insurer or organization shall additionally furnish to the policyholder, trust, association or other party a notice form in sufficient number to be distributed to covered employees or members indicating what rights, if any, are available to them upon termination.
(b)
For purpose of notice and distribution to covered employees and members under par. (a), the administrator responsible for determining the persons covered and the premiums payable to the insurer or organization under any group policy or plan of disability insurance is responsible for providing such notices.
(3)
Liability of insurer or service organization for payment of claims. Under any group policy or plan subject to this section, the insurer or organization shall be liable for all valid claims for covered losses prior to the expiration of any grace period specified in the group policy or plan.
(5)
Notice exception. The notice requirements of this section shall not apply if a group policy or plan providing coverage to employees or members is terminated and immediately replaced by another policy or plan providing similar coverage to such employees or members.
History:  1975 c. 352; Stats. 1975 s. 204.324; 1975 c. 422 s. 106; Stats. 1975 s. 632.79; 1979 c. 32, 221.
2023 Wisconsin Statutes & Annotations › Chapter 632 - Insurance contracts in specific lines. › 632.793 - Notice of loss of primary insurance coverage due to age.

632.793
Notice of loss of primary insurance coverage due to age.
(1)
Notice to insured and employer. If an individual who is covered under a group disability insurance policy, as defined in s. 632.895 (1) (a), that is purchased by or on behalf of an employer to provide coverage for employees will lose primary coverage under the policy upon reaching age 65, the insurer issuing the policy shall provide written notice of the change in coverage status by regular mail to the individual and shall send a copy of the notice by regular mail to the employer. The insurer shall provide the notice not less than 30 nor more than 60 days before the individual becomes 65 years of age. The notice shall specify the date on which the insurance coverage will no longer be primary and shall inform the individual that he or she will be eligible for coverage under the federal medicare program at age 65.
(2)
Applicability. Subsection (1) does not apply if the employer has at least 20 employees for each working day in at least 20 calendar weeks in the current year or the preceding year.
History:  1993 a. 108.
2023 Wisconsin Statutes & Annotations › Chapter 632 - Insurance contracts in specific lines. › 632.795 - Open enrollment upon liquidation.

632.795
Open enrollment upon liquidation.
(1)
Definition. In this section, “liquidated insurer" means an insurer ordered liquidated under ch. 645 or under similar laws of another jurisdiction.
(2)
Coverage for group members. Except as provided in sub. (5) and unless otherwise provided by rule or order of the commissioner, an insurer described in sub. (3) shall permit insureds or enrolled participants of a liquidated insurer's group health care policy or plan to obtain coverage under a comprehensive group health care policy or plan offered by the insurer in the manner and under the terms required by sub. (4).
(3)
Participating insurers. Subsection (2) applies to an insurer that participated in the most recent enrollment period in which the group members were able to choose among coverage offered by the liquidated insurer and coverage offered by one or more other insurers, if all of the following are satisfied:
(a)
Coverage under a comprehensive group health care policy or plan offered by the insurer was selected by one or more members of the group in the most recent enrollment period.
(b)
The most recent enrollment period occurred on or after July 1, 1989.
(4)
Terms and offering of coverage.
(a)
An insurer subject to sub. (2) shall provide coverage under the same policy form and for the same premium as it originally offered in the most recent enrollment period, subject only to the medical underwriting used in that enrollment period. Unless otherwise prescribed by rule, the insurer may apply deductibles, preexisting condition limitations, waiting periods or other limits only to the extent that they would have been applicable had coverage been extended at the time of the most recent enrollment period and with credit for the satisfaction or partial satisfaction of similar provisions under the liquidated insurer's policy or plan. The insurer may exclude coverage of claims that are payable by a solvent insurer under insolvency coverage required by the commissioner or by the insurance regulator of another jurisdiction. Coverage shall be effective on the date that the liquidated insurer's coverage terminates.
(b)
An insurer subject to sub. (2) shall offer coverage to the group members, and the policyholder shall provide group members with the opportunity to obtain coverage, in the manner and within the time limits required by the commissioner by rule or order.
(5)
Medical assistance enrollees. This section does not apply to persons enrolled in a health care plan offered by a liquidated insurer if the persons are enrolled in that plan under a contract between the department of health services and the liquidated insurer under s. 49.45 (2) (b) 2.
History:  1989 a. 23; 1995 a. 27 s. 9126 (19); 2007 a. 20 s. 9121 (6) (a).
2023 Wisconsin Statutes & Annotations › Chapter 632 - Insurance contracts in specific lines. › 632.797 - Disclosure of group health claims experience.

632.797
Disclosure of group health claims experience.
(1)
(a)
Except as provided in subs. (2) and (3), an insurer shall provide the policyholder of a group or blanket disability insurance policy, or an employer that provides health care coverage to its employees through a multiple-employer trust, with the policyholder's or the employer's aggregate group health claims experience for the current policy period, and for up to 2 policy periods immediately preceding the current policy period if the insurer provided coverage during those periods, upon request from the policyholder or employer.
(b)
The insurer shall provide the information under par. (a) no later than 30 days after receiving a request for that information from the policyholder or employer.
(c)
The insurer may not charge the policyholder or the employer for providing the information under par. (a) one time in a 12-month period.
(d)
Except for charging a fee under par. (c), an insurer may not change the rating methodology between community rating and experience rating or otherwise penalize a policyholder or employer for requesting the information under par. (a).
(2)
An insurer is not required to provide the information under sub. (1) unless the policyholder or employer requesting the information provides coverage under the policy for at least 50 individuals, exclusive of individuals who have coverage under the policy as a dependent of another individual.
(3)
Notwithstanding sub. (1), an insurer is not required to provide health claims experience under sub. (1) for any period of time that is before 18 months before the date on which the information is requested.
(4)
Subsection (1) does not require that an insurer provide the policyholder of a group or blanket disability insurance policy, or an employer that provides health care coverage to its employees through a multiple-employer trust, with the health claims experience of an individual employee or insured.
(5)
An insurer is not required under sub. (1) to provide information that identifies an individual or that is confidential under s. 146.82.
(6)
An insurer that provides aggregate health claims experience information in compliance with this section is immune from civil liability for its acts or omissions in providing such information.
History:  1993 a. 448; 2011 a. 32.
2023 Wisconsin Statutes & Annotations › Chapter 632 - Insurance contracts in specific lines. › 632.798 - Out-of-pocket costs.

632.798
Out-of-pocket costs.
(1)
Definitions. In this section:
(a)
“Disability insurance policy" has the meaning given in s. 632.895 (1) (a).
(b)
“Health care provider" has the meaning given in s. 146.903 (1) (c) and includes a hospital, as defined in s. 50.33 (2).
(c)
“Insured" includes an enrollee under a self-insured health plan and a representative or designee of an insured or enrollee.
(d)
“Self-insured health plan" means a self-insured health plan of the state or a county, city, village, town, or school district.
(2)
Provide estimate.
(a)
A self-insured health plan or an insurer that provides coverage under a disability insurance policy shall, at the request of an insured, provide to the insured a good faith estimate, as of the date of the request and assuming no medical complications or modifications in the insured's treatment plan, of the insured's total out-of-pocket cost according to the insured's benefit terms for a specified health care service in the geographic region in which the health care service will be provided.
(b)
An estimate provided by an insurer or self-insured health plan under this section is not a legally binding estimate of the out-of-pocket cost.
(c)
An insurer or self-insured health plan may not charge an insured for providing the information under this section.
(d)
Before providing the information requested under par. (a), the insurer or self-insured health plan may require the insured to provide in writing any of the following information:
1.
The name of the health care provider providing the service.
2.
The facility at which the service will be provided.
3.
The date the service will be provided.
4.
The health care provider's estimate of the charge for the service.
5.
The codes for the service under the Current Procedural Terminology of the American Medical Association or under the Current Dental Terminology of the American Dental Association.
(e)
The requirement to provide the information requested under par. (a) does not apply if the health care provider providing the health care service is any of the following:
1.
A health care provider that practices individually or in association with not more than 2 other individual health care providers.
2.
A health care provider that is an association of 3 or fewer individual health care providers.
History:  2009 a. 146.
2023 Wisconsin Statutes & Annotations › Chapter 632 - Insurance contracts in specific lines. › 632.80 - Restrictions on medical payments insurance.

632.80
Restrictions on medical payments insurance.
The provisions of this subchapter do not apply to medical payments insurance when it is a part of or supplemental to liability, steam boiler, elevator, automobile or other insurance covering loss of or damage to property, provided the loss, damage or expense arises out of a hazard directly related to such other insurance.
History:  1975 c. 375.
2023 Wisconsin Statutes & Annotations › Chapter 632 - Insurance contracts in specific lines. › 632.81 - Minimum standards for certain disability policies.

632.81
Minimum standards for certain disability policies.
The commissioner may by rule establish minimum standards for benefits, claims payments, marketing practices, compensation arrangements and reporting practices for medicare supplement policies, medicare replacement policies and long-term care insurance policies. The commissioner may by rule exempt from the minimum standards certain types of coverage, if the commissioner finds the exemption is not adverse to the interests of policyholders and certificate holders.
History:  1981 c. 82; 1985 a. 29; 1989 a. 31, 332.
2023 Wisconsin Statutes & Annotations › Chapter 632 - Insurance contracts in specific lines. › 632.82 - Renewability of long-term care insurance policies.

632.82
Renewability of long-term care insurance policies.
Notwithstanding s. 631.36 (2) to (5), the commissioner shall, by rule, require long-term care insurance policies that are issued on an individual basis to include a provision restricting the insurer's ability to terminate or alter the long-term care insurance policy except for nonpayment of premium. The rule may specify exceptions to the restriction, including exceptions that allow insurers to do any of the following:
(1)
Change the rates charged on a long-term care insurance policy if the rate change is made on a class basis.
(2)
Refuse to renew a long-term care insurance policy if conditions specified in the rule are satisfied. The conditions shall, at a minimum, require all of the following:
(a)
That the nonrenewal be on other than an individual basis.
(b)
That the insurer demonstrate to the commissioner that renewal will affect the insurer's solvency or loss experience as specified in the rule.
History:  1989 a. 31.
2023 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.
2023 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.