reglab/statecodes huggingface dataset:
Wisconsin Administrative Code › Office of the Commissioner of Insurance › Chapter Ins 3 - Casualty Insurance › Section Ins 3.14 - Group accident and sickness insurance

Current through June 24, 2024
(1) PURPOSE. This
			 rule implements and interprets applicable statutes for the purpose of
			 establishing procedures and requirements to expedite the review and approval of
			 group accident and sickness policies permitted by s.
			 600.03(23),
			 Stats., and s.
			 Ins 6.75(1) (c) or
			 (2) (c).
(3)RATE FILINGS. Schedules of premium rates
			 shall be filed in accordance with the requirements of ch. 601, Stats., and s.
			 631.20,
			 Stats. The schedules of premium rates shall bear the insurer's name and shall
			 identify the coverages to which such rates are applicable.
(4)CERTIFICATES.
(a) Each certificate issued to an employee or
			 member of an insured group in connection with a group insurance policy shall
			 include a statement in summary form of the provisions of the group policy
			 relative to:
1. The essential features of the
			 insurance coverage,
2. To whom
			 benefits are payable,
3. Notice or
			 proof of loss,
4. The time for
			 paying benefits, and
5. The time
			 within which suit may be brought.
Wisconsin Administrative Code › Office of the Commissioner of Insurance › Chapter Ins 3 - Casualty Insurance › Section Ins 3.15 - Blanket accident and sickness insurance

Current through June 24, 2024
(1)
			 PURPOSE. This rule implements and interprets applicable statutes for the
			 purpose of establishing procedures and requirements to expedite the review and
			 approval of blanket accident and sickness policies permitted by s. 600.03 (4),
			 Stats., and s.  Ins 6.75 (1) (c) or (2) (c).
(3) RATE FILINGS. Schedules of premium rates
			 shall be filed in accordance with the requirements of ch. 601, Stats., and s.
			 631.20, Stats. The schedules of premium rates shall bear the insurer's name and
			 shall identify the coverages to which such rates are applicable.
(4) ELIGIBLE RISKS.
(a) In accordance with the provisions of s.
			 600.03 (4), Stats., the following are eligible for blanket accident and health
			 insurance:
1. Volunteer fire
			 departments.
2. National guard
			 units.
3. Newspaper delivery
			 carriers.
4. Dependents of
			 students.
5. Volunteer civil
			 defense organizations.
6. Volunteer
			 auxiliary police organizations.
7.
			 Law enforcement agencies.
8.
			 Cooperatives organized under ch. 185, Stats., on a membership basis without
			 capital stock.
9. Registered guests
			 in a motel, hotel, or resort.
10.
			 Members or members and advisors of fraternal organizations including women's
			 auxiliaries of such organizations and fraternal youth organizations.
11. Associations of sports
			 officials.
12. Purchasers of
			 protective athletic equipment.
13.
			 Migrant workers.
14. Participants
			 in racing meets.
15. Patrons or
			 guests of a recreational facility or resort.
16. Veterans.
Wisconsin Administrative Code › Office of the Commissioner of Insurance › Chapter Ins 3 - Casualty Insurance › Section Ins 3.18 - Total consideration for accident and sickness insurance policies

Current through June 24, 2024
The total consideration charged for accident and sickness
				insurance policies must include policy and other fees. Such total consideration
				charged must be stated in the policy, and shall be subject to the reserve
				requirements of ch. 623, Stats., and s.
				Ins
				3.17, and must be the basis for computing the amount
				to be refunded in the event of cancellation of the policy.
Wisconsin Administrative Code › Office of the Commissioner of Insurance › Chapter Ins 3 - Casualty Insurance › Section Ins 3.19 - Group accident and sickness insurance insuring debtors of a creditor

Current through June 24, 2024
(1)This rule implements and interprets ss.
			 and , 1973 Stats., with regard to issuance of a group policy of accident and
			 sickness insurance issued to a creditor to insure debtors of a
			 creditor.
(2)A group accident and
			 sickness insurance policy may be issued to a creditor to insure debtors of the
			 creditor if the class or classes of insured debtors meet the requirements of s.
			 and , 1973 Stats., and such a policy shall be subject to the requirements of
			 such paragraphs in addition to other requirements applicable to group accident
			 and sickness insurance policies.
Wisconsin Administrative Code › Office of the Commissioner of Insurance › Chapter Ins 3 - Casualty Insurance › Section Ins 3.20 - Substandard risk automobile physical damage insurance for financed vehicles

Current through June 24, 2024
(1) PURPOSE. In accordance with s.
			 625.34,
			 Stats., this rule is to accomplish the purpose and enforce the provisions of
			 ch. 625, Stats., in relation to automobile physical damage insurance for
			 substandard risks.
(2)SCOPE. This
			 rule applies to any automobile physical damage insurance policy procured or
			 delivered by a finance company.
(3)DEFINITIONS.
(a) "Substandard risk" means an applicant for
			 insurance who presents a greater exposure to loss than that contemplated by
			 commonly used rate classifications as evidenced by one or more of the following
			 conditions:
1. Record of traffic
			 accidents.
2. Record of traffic law
			 violations.
3. Undesirable
			 occupational circumstances.
4.
			 Undesirable moral characteristics.
Wisconsin Administrative Code › Office of the Commissioner of Insurance › Chapter Ins 3 - Casualty Insurance › Section Ins 3.23 - Franchise accident and sickness insurance

Current through June 24, 2024
(1) FRANCHISE GROUP
			 HEADQUARTERS. A franchise group described in s.
			 600.03(22),
			 Stats., need not have its headquarters or other executive offices domiciled in
			 Wisconsin.
(2)ACCOUNTING. All
			 premiums paid in connection with franchise accident and sickness insurance on
			 Wisconsin residents shall be reported for annual statement purposes as
			 Wisconsin business and shall be subject to the applicable Wisconsin premium
			 tax.
Wisconsin Administrative Code › Office of the Commissioner of Insurance › Chapter Ins 3 - Casualty Insurance › Section Ins 3.25 - Credit life insurance and credit accident and sickness insurance

Current through June 24, 2024
(1)
			 PURPOSE. The purpose of this section is to assist in the maintenance of a fair
			 and equitable credit insurance market and to ensure that policyholders,
			 claimants and insurers are treated fairly and equitably by providing a system
			 of rate, policy form and operating standards for the transaction of credit life
			 insurance and credit accident and sickness insurance. This section interprets
			 and implements ss.
			 601.01,
			 601.415(9),
			 601.42,
			 623.06,
			 625.11,
			 625.12,
			 625.34,
			 631.20,
			 632.44(3)
			 and
			 632.60,
			 Stats., and chs. 421, 422 and 424, Stats.
(2)SCOPE.
(a) This section shall apply to the
			 transaction of credit life insurance as defined in s.
			 Ins 6.75(1) (a)
			 1. and s.
			 632.44,
			 Stats., and subject to ch. 424, Stats., and to the transaction of credit
			 accident and sickness insurance as defined in s.
			 Ins 6.75(1) (c) 1.
			 and (2) (c) 1. and subject to ch. 424,
			 Stats.
(b) This rule shall be the
			 basis for review of all policy forms, certificates of insurance, notices of
			 proposed insurance, applications for insurance, endorsements and riders and the
			 schedules of premium rates to be used in Wisconsin on or after the effective
			 date of the rule for credit life and credit accident and sickness
			 insurance.
Wisconsin Administrative Code › Office of the Commissioner of Insurance › Chapter Ins 3 - Casualty Insurance › Appendix A - SPECIFIC STANDARDS FOR MORBIDITY, INTEREST AND MORTALITY

Current through June 24, 2024
Original number of equal monthly
							 installments
The 14th day of disability Retroactive to first
							 day
Non-retroactive
The 30th day of disability Retroactive to first
							 day
Non-retroactive
6
1.74
1.39
1.10
.69
7
1.84
1.56
1.30
.80
8
1.94
1.66
1.40
.89
9
2.02
1.74
1.49
.97
10
2.10
1.82
1.58
1.05
11
2.17
1.89
1.63
1.12
12
2.23
1.95
1.68
1.18
13
2.29
2.01
1.72
1.24
14
2.35
2.07
1.75
1.30
15
2.41
2.13
1.79
1.35
16
2.46
2.18
1.82
1.40
17
2.51
2.23
1.86
1.45
18
2.56
2.27
1.89
1.50
19
2.60
2.32
1.91
1.54
20
2.65
2.36
1.94
1.59
21
2.69
2.40
1.97
1.62
22
2.73
2.44
1.99
1.64
23
2.77
2.48
2.02
1.67
24
2.81
2.52
2.04
1.69
25
2.85
2.56
2.06
1.71
26
2.88
2.60
2.09
1.73
27
2.92
2.63
2.11
1.75
28
2.95
2.67
2.13
1.77
29
2.99
2.70
2.15
1.79
30
3.02
2.74
2.17
1.82
31
3.06
2.77
2.19
1.83
32
3.09
2.80
2.21
1.85
33
3.12
2.83
2.23
1.87
34
3.15
2.86
2.25
1.89
35
3.18
2.90
2.27
1.91
36
3.21
2.93
2.29
1.93
37
3.24
2.96
2.30
1.94
38
3.27
2.99
2.32
1.96
39
3.30
3.01
2.34
1.98
40
3.33
3.04
2.35
1.99
41
3.36
3.07
2.37
2.01
42
3.39
3.10
2.39
2.03
43
3.41
3.13
2.40
2.04
44
3.44
3.15
2.42
2.06
45
3.47
3.18
2.44
2.08
46
3.50
3.21
2.45
2.09
47
3.52
3.23
2.47
2.11
48
3.55
3.26
2.48
2.12
49
3.57
3.29
2.50
2.14
50
3.60
3.31
2.51
2.15
51
3.62
3.34
2.53
2.16
52
3.65
3.36
2.54
2.18
53
3.67
3.39
2.56
2.19
54
3.70
3.41
2.57
2.21
55
3.72
3.43
2.58
2.22
56
3.75
3.46
2.60
2.24
57
3.77
3.48
2.61
2.25
58
3.79
3.51
2.63
2.26
59
3.82
3.53
2.64
2.28
60
3.84
3.55
2.65
2.29
61
3.88
3.58
2.68
2.30
62
3.91
3.60
2.69
2.32
63
3.93
3.62
2.70
2.33
64
3.95
3.64
2.72
2.34
65
3.97
3.67
2.73
2.35
66
4.00
3.69
2.74
2.37
67
4.02
3.71
2.76
2.38
68
4.04
3.73
2.77
2.39
69
4.06
3.75
2.78
2.40
70
4.08
3.77
2.79
2.42
71
4.11
3.80
2.81
2.43
72
4.13
3.82
2.82
2.44
73
4.15
3.84
2.83
2.45
74
4.17
3.86
2.84
2.47
75
4.19
3.88
2.85
2.48
76
4.21
3.90
2.87
2.49
77
4.23
3.92
2.88
2.50
78
4.25
3.94
2.89
2.51
79
4.27
3.96
2.90
2.52
80
4.29
3.98
2.91
2.54
81
4.31
4.00
2.92
2.55
82
4.33
4.02
2.94
2.56
83
4.35
4.04
2.95
2.57
84
4.37
4.06
2.96
2.58
85
4.39
4.08
2.97
2.59
86
4.41
4.10
2.98
2.60
87
4.43
4.12
2.99
2.61
88
4.45
4.14
3.00
2.63
89
4.47
4.16
3.01
2.64
90
4.49
4.18
3.03
2.65
91
4.51
4.20
3.04
2.66
92
4.52
4.21
3.05
2.67
93
4.54
4.23
3.06
2.68
94
4.56
4.25
3.07
2.69
95
4.58
4.27
3.08
2.70
96
4.60
4.29
3.09
2.71
97
4.62
4.31
3.10
2.72
98
4.64
4.32
3.11
2.73
99
4.65
4.34
3.12
2.74
100
4.67
4.36
3.13
2.75
101
4.69
4.38
3.14
2.76
102
4.71
4.40
3.15
2.77
103
4.73
4.41
3.16
2.78
104
4.74
4.43
3.17
2.79
105
4.76
4.45
3.18
2.80
106
4.78
4.47
3.19
2.81
107
4.80
4.49
3.20
2.82
108
4.81
4.50
3.21
2.84
109
4.83
4.52
3.22
2.84
110
4.85
4.54
3.23
2.85
111
4.86
4.55
3.24
2.86
112
4.88
4.57
3.25
2.87
113
4.90
4.59
3.26
2.88
114
4.92
4.61
3.27
2.89
115
4.93
4.62
3.28
2.90
116
4.95
4.64
3.29
2.91
117
4.97
4.66
3.30
2.92
118
4.98
4.67
3.31
2.93
119
5.00
4.69
3.32
2.94
120
5.02
4.71
3.33
2.95
Formula 1.25 x Claim Cost + $.60 (subject to a maximum of 2 x
				Claim Cost)
Wisconsin Administrative Code › Office of the Commissioner of Insurance › Chapter Ins 3 - Casualty Insurance › Section Ins 3.26 - Unfair trade practices in credit life insurance and credit accident and sickness insurance

Current through June 24, 2024
(1) PURPOSE. The purpose of this rule is to
			 assist in the maintenance of a fair and equitable credit life insurance and
			 credit accident and sickness insurance market. This rule interprets, including
			 but not limited to, the following ss.
			 601.04,
			 601.01(1), (2), (3), (7) and
			 (8),
			 601.41(1), (2) and
			 (3), Stats., and ch. 628, Stats.
(2)SCOPE. This rule shall apply to the
			 transaction of credit life insurance as defined in s.
			 Ins 6.75(1) (a)
			 1. and s.
			 632.44(3),
			 Stats., and the transaction of credit accident and sickness insurance as
			 defined in s.
			 Ins 6.75(1) (c) 1. or
			 (2) (c) 1.
(3)UNFAIR TRADE PRACTICES DEFINED. The
			 following acts, whether done directly or indirectly, in consideration of or in
			 connection with a policy issued or proposed to be issued are defined to be
			 prohibited unfair trade practices in the transaction of insurance described in
			 sub. (2):
(a) The offer or grant by an insurer
			 of any special favor or advantage, or any valuable consideration or inducement
			 not set out in the insurance contract. The payment of agents' commissions,
			 reported annually in Schedule 24S, shall not be a violation of this paragraph
			 but the acts cited in pars. (b), (c), (d), (e) and (f) may not in any way be
			 construed as agents' commissions.
(b) The offer to deposit or the deposit with
			 a bank or other financial institution, money or securities of the insurer or of
			 any affiliate of the insurer with the design or intent that the deposit offset
			 or take the place of a deposit of money or securities which otherwise would be
			 required of the creditor by such bank or financial institution as a
			 compensating balance or offsetting deposit for a loan or other
			 advancement.
(c) The deposit with a
			 bank or other financial institution of money or securities without interest or
			 at a lessor rate of interest than is currently being paid other depositors on
			 similar deposits with such bank or other financial institution. This shall not
			 be construed to prohibit the maintenance by an insurer of such demand deposits
			 as are reasonably necessary for use in the ordinary course of business of the
			 insurer.
(d) The offer to sell or
			 the sale of any capital stock or other security or certificate of indebtedness
			 of the insurer or affiliated person.
(e) The offer to pay or the payment of any
			 part of the premium for any insurance on the life, health or property of any
			 creditor or any employee or other person affiliated with the
			 creditor.
(f) The extension to the
			 creditor of credit for the remittance of premium beyond the grace period of a
			 group policy or for more than 45 days from the effective date of an individual
			 policy.
Wisconsin Administrative Code › Office of the Commissioner of Insurance › Chapter Ins 3 - Casualty Insurance › Section Ins 3.29 - Replacement of accident and sickness insurance

Current through June 24, 2024
(1) PURPOSE. The
			 purpose of this section is to safeguard the interests of persons covered under
			 accident and sickness insurance who consider the replacement of their insurance
			 by making available to them information regarding replacement and thereby
			 reducing the opportunity for misrepresentation and other unfair practices and
			 methods of competition in the business of insurance. This section implements
			 and interprets ss.
			 601.01(2)
			 and
			 628.34,
			 Stats.
(2) SCOPE. This rule shall
			 apply to the solicitation of accident and sickness insurance covering residents
			 of this state and issued by insurance corporations, fraternal benefit societies
			 or nonprofit service plans in accordance with s. Ins 6.75(1) (c) or (2) (c), s.
			 614.01, Stats., and
			 ch. 613, Stats.
(3) EXEMPT
			 INSURANCE. This rule shall not apply to the solicitation of the following
			 accident and sickness insurance:
(a) Group,
			 blanket or group type, except Medicare supplement and Medicare cost insurance
			 policies subject to s. Ins 3.39(4), (4m), (4t), (5), (5m), (5t), and
			 (7).
(b) Accident only.
(c) Single premium nonrenewable.
(d) Nonprofit dental care.
(e) Nonprofit prepaid optometric
			 service.
(f) A limited policy
			 conforming to s. Ins 3.13(2) (h).
(g) Under which dental expenses only,
			 prescription expenses only, vision care expenses only or blood service expenses
			 only are covered.
(h) Conversion to
			 another individual or family policy in the same insurer with continuous
			 coverage.
(i) Conversion to an
			 individual or family policy to replace group, blanket or group type coverage in
			 the same insurer.
Wisconsin Administrative Code › Office of the Commissioner of Insurance › Chapter Ins 3 - Casualty Insurance › Section Ins 3.30 - Change of beneficiary and related provisions in accident and sickness insurance policies

Current through June 24, 2024
(1) PURPOSE. The purpose of this rule is to
			 establish guidelines for wording change of beneficiary provisions and related
			 provisions in accident and sickness insurance policies.
(2)SCOPE. This rule shall apply to policy
			 forms subject to s.
			 Ins 6.75(1) (c) or
			 (2) (c) and s.
			 600.03(4), (22)
			 and (23), Stats.
(3)GUIDELINES. A change of beneficiary
			 provisions and any related provision:
(a)
			 Shall comply with s.
			 632.71,
			 Stats., except as provided in ss.
			 631.81
			 and
			 632.77(4),
			 Stats., where applicable, and
(b)
			 May include requirements or limitations which would be consistent with an
			 orderly method of handling beneficiary designations and changes such as:
1. A requirement that a beneficiary
			 designation or change be recorded by the insurer;
2. A provision that a claim payment made
			 before a change in beneficiary designation is recorded is not subject to such
			 change;
3. A requirement that a
			 beneficiary designation or change be written as opposed to oral; or
4. A requirement that a beneficiary
			 designation or change be given to a particular agent, representative or
			 office.
Wisconsin Administrative Code › Office of the Commissioner of Insurance › Chapter Ins 3 - Casualty Insurance › Section Ins 3.32 - Title insurance; prohibited practices

Current through June 24, 2024
(1) PURPOSE. This
			 rule implements and interprets s.
			 601.01(3),
			 Stats., and ch. 628, Stats., for the purpose of prohibiting unfair practices in
			 the transaction of the business of title insurance.
(2)SCOPE. This section applies to all title
			 insurers and title insurance agents.
(3)DEFINITIONS. In this section:
(a) "Affiliate" has the meaning provided
			 under s.
			 600.03(1),
			 Stats.
(am) "Agent" has the meaning
			 provided under s.
			 600.03(1r),
			 Stats.
(b) "Affiliate producer"
			 means an affiliate of a producer of title insurance, but only for the 12-month
			 period commencing after June 30, 1987, and after the end of any quarter
			 calendar year in which the affiliate's gross revenue from operation in this
			 state from title insurance directly or indirectly referred by affiliated
			 producers of title insurance exceeds 40% of the affiliate's gross revenue from
			 operations in this state for title insurance in the previous quarter calendar
			 year. However, if the previous quarter calendar year commences prior to July 1,
			 1988, the percentage is 80%; and if it commences prior to July 1, 1989, the
			 percentage is 60%. "Affiliate producer" does not include a person who is
			 affiliated with producers of title insurance who are all attorneys if the
			 affiliate examines the title for each title insurance policy it
			 issues.
(bm) "Control" has the
			 meaning provided under s.
			 600.03(13),
			 Stats.
(c) "Producer of title
			 insurance" means any of the following, other than a title insurer, who order or
			 influence, directly or indirectly, the ordering of title insurance and related
			 services:
1. Any owner or prospective owner of
			 real or personal property or any interest therein;
2. Any lender or prospective lender in a
			 transaction involving an obligation secured or to be secured either in whole or
			 in part by real or personal property or any interest therein; and
3. Any agent, representative, attorney or
			 employee of any owner or prospective owner or of any lender or prospective
			 lender.
4. An affiliate
			 producer.
(cm)
			 "Supplementary rate information" has the meaning provided under s.
			 625.02(3),
			 Stats.
(d) "Title insurance rates"
			 means all charges made by a title insurer in connection with the issuance of a
			 title insurance policy or a commitment to issue a title insurance policy and
			 includes, but is not limited to, search and examination charges.
(e) "Title insurer" means all insurance
			 companies authorized to write title insurance as defined by s.
			 Ins 6.75(2)
			 (h) and their affiliates, and includes all
			 officers, employees and representatives of the insurance companies or their
			 affiliates.
Wisconsin Administrative Code › Office of the Commissioner of Insurance › Chapter Ins 3 - Casualty Insurance › Section Ins 3.33 - Individual uniform application for health insurance

Current through June 24, 2024
(1) DEFINITIONS.
			 For purposes of this section:
(a) "Individual
			 major medical health insurance policy" means a comprehensive health care plan
			 offered by an insurer authorized to write individual health or disability
			 insurance for an individual or family. Individual major medical health
			 insurance policies excludes limited-scope dental and vision policies, specified
			 disease policies, short-term medical, hospital indemnity, and other
			 limited-benefit individual insurance products and policies issued by an
			 association plan under a group policy that may be underwritten on an individual
			 basis.
(b) "Individual uniform
			 application" means the uniform questions and format for applications that are
			 to be used by insurers offering individual major medical health insurance
			 policies or certificates, including an individual major medical health
			 insurance coverage provided through an association as individual coverage and
			 underwritten on an individual basis and issued to individuals or families, as
			 it appears as form OCI 26-503 in Appendix 1.
Wisconsin Administrative Code › Office of the Commissioner of Insurance › Chapter Ins 3 - Casualty Insurance › Section Ins 3.34 - Coverage of dependent

Current through June 24, 2024
(1) PURPOSE. This section implements s.
			 632.885,
			 Stats.
(2) APPLICABILITY.
(a) This section applies to disability
			 insurance policies as defined at s.
			 632.895(1)
			 (a), Stats., that are issued or renewed on or
			 after January 1, 2010, including individual health and group health benefit
			 plans. It applies to limited scope plans including vision and dental plans but
			 does not include hospital indemnity, income continuation, accident-only
			 benefits, long-term care and Medigap policies. This section also applies to
			 self-insured health plans as defined at s.
			 632.745(24),
			 Stats.
(b) For a disability
			 insurance policy covering employees who are affected by a collective bargaining
			 agreement this coverage under this section first applies as follows:
1. If the collective bargaining agreement
			 contains provisions consistent with this law or that are silent on dependent
			 eligibility, coverage under this section first applies the earliest of any of
			 the following; the date the disability insurance policy is issued or renewed on
			 or after January 1, 2010, or the date the self-insured health plan is
			 established, modified, extended or renewed on or after January 1,
			 2010.
2. If the collective
			 bargaining agreement contains provisions inconsistent with this law, the
			 coverage under this section first applies on the date the health policy is
			 first issued or renewed or a self-insured health plan is first established,
			 modified, extended, or renewed on or after the earlier of the date the
			 collectively bargained agreement expires, or the date the collectively
			 bargained agreement it is modified, extended or renewed.
Wisconsin Administrative Code › Office of the Commissioner of Insurance › Chapter Ins 3 - Casualty Insurance › Section Ins 3.35 - Colorectal cancer screening coverage

Current through June 24, 2024
(1) APPLICABILITY.
(a) This section applies to disability
			 insurance policies as defined at s.
			 632.895(1)
			 (a), Stats., unless otherwise excepted in s.
			 632.895(16m)
			 (c), Stats., that are issued or renewed on or
			 after December 1, 2010. This section applies to Medicare supplement and cost
			 plans but does not include limited -scope plans including vision and dental,
			 hospital indemnity, income continuation, accident-only benefits, and long-term
			 care policies. This section also applies to self-insured health plans as
			 defined at s.
			 632.745(24),
			 Stats.
(b) For a disability
			 insurance policy and a self-insured health plan covering employees who are
			 affected by a collective bargaining agreement the coverage under this section
			 first applies as follows:
1. If the
			 collective bargaining agreement contains provisions consistent with s.
			 632.895(16m),
			 Stats., coverage under this section first applies the earliest of any of the
			 following: the date the disability insurance policy is issued or renewed on or
			 after December 1, 2010, or the date the self-insured health plan is
			 established, modified, extended or renewed on or after December 1,
			 2010.
2. If the collective
			 bargaining agreement contains provisions inconsistent with s.
			 632.895(16m),
			 Stats., the coverage under this section first applies on the date the health
			 benefit plan is first issued or renewed or a self-insured health plan is first
			 established, modified, extended, or renewed on or after the earlier of the date
			 the collectively bargained agreement expires, or the date the collectively
			 bargained agreement is modified, extended, or renewed on or after December 1,
			 2010.
Wisconsin Administrative Code › Office of the Commissioner of Insurance › Chapter Ins 3 - Casualty Insurance › Section Ins 3.36 - Coverage of autism spectrum disorders

Current through June 24, 2024
(1) APPLICABILITY.
(a) This section applies to disability
			 insurance policies as defined in s.
			 632.895(1)
			 (a), Stats., except as provided in s.
			 632.895(12m)
			 (e), Stats., and self-insured health plans
			 sponsored by the state, county, city, town, village, or school
			 district.
(b) For a disability
			 insurance policy covering employees who are affected by a collective bargaining
			 agreement the coverage under this section first applies as follows:
1. If the collective bargaining agreement
			 contains provisions consistent with s.
			 632.895(12m),
			 Stats., coverage under this section first applies the earliest of any of the
			 following: the date the disability insurance policy is issued or renewed on or
			 after November 1, 2009, or the date the self-insured health plan is
			 established, modified, extended or renewed on or after November 1,
			 2009.
2. If the collective
			 bargaining agreement contains provisions inconsistent with s.
			 632.895(12m),
			 Stats., the coverage under this section first applies on the date the health
			 benefit plan is first issued or renewed or a self-insured health plan is first
			 established, modified, extended, or renewed on or after the earlier of the date
			 the collectively bargained agreement expires, or the date the collectively
			 bargained agreement is modified, extended or renewed.
Wisconsin Administrative Code › Office of the Commissioner of Insurance › Chapter Ins 3 - Casualty Insurance › Section Ins 3.37 - Transitional treatment arrangements

Current through June 24, 2024
(1) PURPOSE. This
			 section implements s.
			 632.89(4)
			 (a), Stats.
(2) APPLICABILITY.
(a) This section applies to group and blanket
			 disability insurance policies issued or renewed on and after November 1, 1992,
			 and prior to December 1, 2010, and group health benefit plans and self-insured
			 governmental plans that elect and are eligible to be exempt pursuant to s.
			 632.89(3c),
			 (3f) or (5), Stats., that provide coverage
			 for inpatient hospital services or outpatient services, as defined in s.
			 632.89(1)
			 (d) or (e), Stats. Group and blanket
			 disability insurance policies and exempted group health benefit plans and
			 self-insured governmental plans shall cover transitional treatment services and
			 comply with subs. (2m), (3), (4), and (5).
(b) Policies issued on or after December 1,
			 2010, by a group health benefit plan and a self-insured governmental health
			 plan that are not otherwise exempt under s.
			 632.89(3c),
			 (3f) or (5), Stats., shall comply with subs.
			 (2m), (3m), (4m), and (5m).
Wisconsin Administrative Code › Office of the Commissioner of Insurance › Chapter Ins 3 - Casualty Insurance › Section Ins 3.375 - Coverage of nervous and mental disorders and substance use disorders

Current through June 24, 2024
(1)
			 PURPOSE. This section interprets and implements s.
			 632.89,
			 Stats.
(2)APPLICABILITY.
(a) This section applies to group health
			 benefit plans as defined in s.
			 632.745(9),
			 Stats., health benefit plans as defined in s.
			 632.745(11),
			 Stats., and self-insured governmental health plans unless otherwise excluded
			 pursuant to s.
			 632.89(5),
			 Stats.
(b) For group health benefit
			 plans and self-insured governmental plans covering employees who are affected
			 by a collective bargaining agreement, the coverage under this section applies
			 as follows:
1. If the collective bargaining
			 agreement contains provisions consistent with s.
			 632.89,
			 Stats., the coverage under this section first applies on the earliest of any of
			 the following: the date the group health benefit plan is issued or renewed on
			 or after December 1, 2010, or the date the self-insured governmental health
			 plan is established, modified, extended or renewed on or after December 1,
			 2010.
2. If the collective
			 bargaining agreement contains provisions inconsistent with s.
			 632.89,
			 Stats., the coverage under this section applies on the earliest of any of the
			 following: the date the collective bargaining agreement expires, or the date
			 the collective bargaining agreement is extended, modified, or
			 renewed.
Wisconsin Administrative Code › Office of the Commissioner of Insurance › Chapter Ins 3 - Casualty Insurance › Appendix 1 - Small Employer Notice of the Plan's Election of Exemption from Mental Health and Substance Use Disorder Parity for [This Plan Year]

Current through June 24, 2024
Small Employer Notice of the Plan's Election of Exemption from
				Mental Health and Substance Use Disorder Parity for [This Plan Year]
You are receiving this notice as an employee of [name of
				employer group]. This notice is to inform you that [name of employer group]
				qualifies and elects to be exempt from the state nervous and mental disorders
				and substance use disorders coverage parity requirements for this plan year,
				beginning [insert date of the first day of the plan year]. The employer is
				eligible to elect this exemption based upon having fewer than 10 eligible
				employees. Benefits may change as of [insert the date of the first day of the
				plan year].
Despite the exemption from the state nervous and mental
				disorders and substance use disorders coverage requirements, state law requires
				[name of employer group] to comply with the minimum mandated coverage
				requirements and limitations contained in s.
				632.89(2),
				2007 Stats., for treatment services for nervous and mental disorders and
				substance use disorders.
For this plan year, your plan provides the following coverage
				related to nervous and mental disorders and substance use disorders:
[Insert plain language benefits summary]
Carefully review your health plan's benefits, limitations, and
				exclusions for detailed information on services and coverage available to you
				and your family this plan year. If you have additional questions please contact
				[insert contact name, phone number and e-mail address if available].
Wisconsin Administrative Code › Office of the Commissioner of Insurance › Chapter Ins 3 - Casualty Insurance › Appendix 2 - Small Employer Notice of the Plan's Election of Exemption from Mental Health and Substance Use Disorder Parity for [This Plan Year]

Current through June 24, 2024
Group Health Benefit Plan Notice of Election of Exemption from
				Mental Health and Substance Use Disorder Parity for [This Plan Year]
You are receiving this notice as an employee of [name of
				employer group]. This notice is to inform you that [name of employer group]
				qualifies and elects to be exempt from the state nervous and mental disorders
				and substance use disorders coverage parity requirements for this plan year,
				beginning [insert date of the first day of the plan year].
A group health benefit plan may elect to be exempt from mental
				health and substance use disorder parity if there are increases in the
				employer's total cost of coverage for the treatment of physical conditions and
				nervous and mental disorders and substance use disorders by a percentage that
				exceeds either two percent (2%) in the first plan year in which the nervous and
				mental disorders and substance use disorders coverage requirements apply or one
				percent (1%) in any plan year after the first plan year in which the
				requirements apply. Benefits may change as of [insert the date of the first day
				of the plan year].
Despite the exemption from the state nervous and mental
				disorders and substance use disorders coverage requirements, state law requires
				[name of employer group] to comply with the minimum mandated coverage
				requirements and limitations contained in s.
				632.89(2),
				2007 Stats., for treatment services for nervous and mental disorders and
				substance use disorders.
For this plan year, your plan provides the following coverage
				related to nervous and mental disorders and substance use disorders:
[Insert plain language benefits summary]
Carefully review your health plan's benefits, limitations, and
				exclusions for detailed information on services and coverage available to you
				and your family this plan year. If you have additional questions please contact
				[insert contact name, phone number and e-mail address if available].
Wisconsin Administrative Code › Office of the Commissioner of Insurance › Chapter Ins 3 - Casualty Insurance › Section Ins 3.38 - Coverage of newborn infants

Current through June 24, 2024
(1) PURPOSE. This
			 section is intended to interpret and implement s.
			 632.895(5),
			 Stats.
(2)INTERPRETATION AND
			 IMPLEMENTATION.
(a) Coverage of each newborn
			 infant is required under a disability insurance policy if:
1. The policy provides coverage for another
			 family member, in addition to the insured person, such as the insured's spouse
			 or a child, and
2. The policy
			 specifically indicates that children of the insured person are eligible for
			 coverage under the policy.
Wisconsin Administrative Code › Office of the Commissioner of Insurance › Chapter Ins 3 - Casualty Insurance › Section Ins 3.39 - Standards for disability insurance sold to the Medicare eligible

Current through June 24, 2024
(1) PURPOSE.
(a) This section establishes requirements for
			 health and other disability insurance policies primarily sold to Medicare
			 eligible persons. Disclosure provisions are required for other disability
			 policies sold to Medicare eligible person because such policies frequently are
			 represented to, and purchased by, the Medicare eligible as supplements to
			 Medicare products.
(b) This section
			 seeks to reduce abuses and confusion associated with the sale of disability
			 insurance to Medicare eligible persons by providing reasonable standards. The
			 disclosure requirements and established benefit standards are intended to
			 provide to Medicare eligible persons guidelines that they can use to compare
			 disability insurance policies and certificates as described in s. Ins 6.75(1)
			 (c), and to aid them in the purchase of policies and certificates intended to
			 supplement Medicare policies that are suitable for their needs. This section is
			 designed not only to improve the ability of the Medicare eligible consumer to
			 make an informed choice when purchasing disability insurance, but also to
			 assure the Medicare eligible persons of this state that the commissioner will
			 not approve a policy or certificate as "Medicare supplement" or as "Medicare
			 cost" unless it meets the requirements of this section.
(d) Wisconsin statutes interpreted and
			 implemented by this rule are ss.
			 185.983(1m),
			 600.03,
			 601.01(2),
			 601.42,
			 609.01(1g)
			 (b),
			 625.16,
			 628.34(12),
			 628.38,
			 631.20(2),
			 632.73(2m),
			 632.76(2)
			 (b),
			 632.81,
			 632.895(2), (3), (4) and
			 (6), Stats.
Wisconsin Administrative Code › Office of the Commissioner of Insurance › Chapter Ins 3 - Casualty Insurance › Appendix 9

Current through June 24, 2024
FORM FOR REPORTING MEDICARE SUPPLEMENT POLICIES
Company Name:
				__________________________________________________________________________________________
Address:_________________________________________________________________________________
				___________________________________________________________________________________________
Phone Number:__________________________
Due March 1, annually
The purpose of this form is to report the following information
				on each resident of this state who has in force more than one Medicare
				supplement policy or certificate. The information is to be grouped by
				individual policyholder.
Policy and Certificate Number
Date of Issuance
___________________________________________________
Signature
___________________________________________________
Name and Title (please type)
___________________________________________________
Date
Wisconsin Administrative Code › Office of the Commissioner of Insurance › Chapter Ins 3 - Casualty Insurance › Section Ins 3.40 - Coordination of benefits provisions in group and blanket disability insurance policies

Current through June 24, 2024
(1) PURPOSE.
(a) This section establishes authorized
			 coordination of benefits provisions for group and blanket disability insurance
			 policies pursuant to s.
			 631.23,
			 Stats. It has been found that these clauses are necessary to provide certainty
			 of meaning. Regulation of contract forms will be more effective, and litigation
			 will be substantially reduced if there is uniformity regarding coordination of
			 benefits provisions in health insurance policies.
(b) A Coordination of benefits (COB)
			 provision as defined in sub. (3) (e) avoids claim payment delays be
			 establishing an order in which Plans pay their claims and by providing the
			 authority for the orderly transfer of information needed to pay claims
			 promptly. It avoids duplication of benefits by permitting a reduction of the
			 benefits of a Plan when, by the rules established by this section, a Plan does
			 not have to pay its benefits first.
(c) Coordinating health benefits has been
			 found to be an effective tool in containing health care costs. However, minimum
			 standards of protection and uniformity are needed to protect the insured's and
			 the public's interest.
Wisconsin Administrative Code › Office of the Commissioner of Insurance › Chapter Ins 3 - Casualty Insurance › Section Ins 3.41 - Individual conversion policies

Current through June 24, 2024
(1) REASONABLY
			 SIMILAR COVERAGE. An insurer provides reasonably similar coverage under s.
			 632.897(4),
			 Stats., to a terminated insured as defined in s.
			 632.897(1)
			 (f), Stats., if a person is offered
			 individual coverage under the group policy or individual policy, or is offered
			 his or her choice of the 3 plans described in s.
			 Ins
			 3.42, or is offered a high limit comprehensive plan of
			 benefits approved for the purpose of conversion by the commissioner as meeting
			 the standards described in s.
			 Ins
			 3.43. Individual conversion policies must include
			 benefits required for individual disability insurance policies by subch. VI,
			 Stats. This subsection does not apply to a long-term care policy as defined
			 under s.
			 Ins
			 3.46(3) (m).
(2)RENEWABILITY.
(a) Except as provided in par. (b),
			 individual conversion policies shall be renewable at the option of the insured
			 unless the insured fails to make timely payment of a required premium amount,
			 there is over-insurance as provided by s.
			 632.897(4)
			 (d), Stats., or there was fraud or material
			 misrepresentation in applying for any benefit under the policy.
(b) Conversion policies issued to a former
			 spouse under s.
			 632.897(9)
			 (b), Stats., must include renewal provisions
			 at least as favorable to the insured as did the previous coverage.
Wisconsin Administrative Code › Office of the Commissioner of Insurance › Chapter Ins 3 - Casualty Insurance › Section Ins 3.42 - Plans of conversion coverage

Current through June 24, 2024
Pursuant to s.
				632.897(4)
				(b), Stats., the following plans of
				conversion coverage are established.
(1)PLAN 1-BASIC COVERAGE. Plan 1 basic
			 coverage consists of the following:
(a)
			 Hospital room and board daily expense benefits in a maximum dollar amount
			 approximating the average semi-private rate charged in the major metropolitan
			 area of this state, for a maximum duration of 70 days per calendar
			 year;
(b) Miscellaneous in-hospital
			 expenses, including anesthesia services, up to a maximum amount of 20 times the
			 hospital room and board daily expense benefits per calendar year; and
(c) In-hospital and out-of-hospital surgical
			 expenses payable on a usual, customary and reasonable basis up to a maximum
			 benefit of $2,000 a calendar year.
Wisconsin Administrative Code › Office of the Commissioner of Insurance › Chapter Ins 3 - Casualty Insurance › Section Ins 3.43 - High limit comprehensive plan of benefits

Current through June 24, 2024
(1)A policy form
			 providing a high limit comprehensive plan of benefits may be approved as an
			 individual conversion policy as provided by s.
			 632.897(4)
			 (b), Stats., if it provides comprehensive
			 coverage of expenses of hospital, surgical and medical services of not less
			 than the following:
(a) A lifetime maximum
			 benefit of $250,000.
(b) Payment of
			 benefits at the rate of 80% of covered hospital, medical, and surgical expenses
			 which are in excess of the deductible, until 20% of such expenses in a benefit
			 period reaches $1,000, after which benefits shall be paid at 100% for the
			 remainder of the benefit period; provided, however, benefits for outpatient
			 treatment of mental illness, if covered by the policy, may be limited as
			 provided in par. (g), and surgical expenses shall be covered at a usual,
			 customary and reasonable level.
(c)
			 A deductible for each benefit period of at least $250 and not more than $500
			 except that the deductible shall be at least $250 and not more than $1,000 for
			 each benefit period for a policy insuring members of a family. All covered
			 expenses of any insured family member may be applied to satisfy the
			 deductible.
(d) A "benefit period"
			 shall be defined as a calendar year.
(e) Payment for all services covered under
			 the contract by any licensed health care professional qualified to provide the
			 services; except payment for psychologists' services may be conditioned upon
			 referral or supervision by a physician.
(f) Payment of benefits for maternity,
			 subject to the limitations in pars. (a), (b), and (c), if maternity was covered
			 under the prior policy.
(g)
			 Benefits for outpatient treatment of mental illness, if provided by the policy,
			 may be limited to either of the following coverages at the option of the
			 insurer:
1. At least 50% of usual, customary
			 and reasonable expenses which are in excess of the policy deductible, subject
			 to the policy lifetime maximum.
2.
			 The minimum benefits for group policies described in s.
			 632.89(2)
			 (d), Stats.
Wisconsin Administrative Code › Office of the Commissioner of Insurance › Chapter Ins 3 - Casualty Insurance › Section Ins 3.44 - Effective date of s. 632.897, Stats

Current through June 24, 2024
(1)Section
			 632.897,
			 Stats., applies to group policies issued or renewed on or after May 14, 1980,
			 or if a policy is not renewed within 2 years after the effective date of the
			 act, s.
			 632.897,
			 Stats., is effective at the end of 2 years from May 14, 1980.
(2)
(a) A
			 group policy as defined in s.
			 632.897(1)
			 (c) 1 or 3., Stats., shall be considered to
			 have been renewed on any date specified in the policy as a renewal date or on
			 any date on which the insurer or the insured changed the rate of premium for
			 the group policy.
(b) A group
			 policy as defined in s.
			 632.897(1)
			 (c) 2, Stats., shall be considered to have
			 been renewed on any date on which an underlying collective bargaining agreement
			 or other underlying contract is renewed, or on which a significant change is
			 made in benefits.
Wisconsin Administrative Code › Office of the Commissioner of Insurance › Chapter Ins 3 - Casualty Insurance › Section Ins 3.45 - Conversion policies by insurers offering group policies only

Current through June 24, 2024
Section
				632.897(4)
				(d), Stats., (first sentence), establishes
				that an insurer offering group policies only is not required to offer
				individual coverage. Since the insurer has no individual conversion policies
				which it may offer, it may not require a terminated insured who elected to
				continue coverage under s.
				632.897(2),
				Stats., to convert to individual coverage under s.
				632.897(6),
				Stats., after 12 months. The terminated person may continue group coverage
				except as provided in s.
				632.897(3)
				(a), Stats.
Wisconsin Administrative Code › Office of the Commissioner of Insurance › Chapter Ins 3 - Casualty Insurance › Section Ins 3.455 - Long-term care, nursing home and home health care policies; loss ratios; rating practices; continuation and conversion, reserves

Current through June 24, 2024
(1) FINDINGS.
(a) The commissioner finds that long-term
			 care policies and life insurance-long-term care coverage are offered and
			 marketed to a population which is particularly susceptible to pressure sales
			 tactics and misleading or fraudulent sales activities. These products are also
			 complex and difficult for most purchasers to analyze and understand.
(b) The purchase of any of these products is
			 an important and significant decision because of the cost and the significance
			 of these insurance products in planning and providing for long-term care. This
			 section and s.
			 Ins
			 3.46 a readopted to provide adequate protection for
			 Wisconsin insureds and the public.
Wisconsin Administrative Code › Office of the Commissioner of Insurance › Chapter Ins 3 - Casualty Insurance › Section Ins 3.46 - Standards for long-term care, nursing home and home health care insurance and life insurance-long-term care coverage

Current through June 24, 2024
(1) FINDINGS. The
			 findings under s.
			 Ins
			 3.455(1) are incorporated by
			 reference. The commissioner finds that the adoption of minimum standards,
			 compensation restrictions and disclosure requirements for long-term care and
			 life insurance-long-term care coverage will reduce marketing abuses and will
			 assist consumers in their attempts to understand the benefits offered and to
			 compare different products. The commissioner finds that failure to comply with
			 this section is misleading and deceptive under s.
			 628.34(12),
			 Stats., and constitutes an unfair trade practice.
(2) APPLICABILITY.
(b) This section, except for sub. (10) (b) to
			 (e), does not apply to an individual long-term care policy or life
			 insurance-long-term care coverage, to a group long-term care policy or life
			 insurance-long-term care coverage or a certificate under the group policy, or
			 to a renewal policy or coverage or certificate, if:
1. The individual long-term care policy or
			 life insurance-long-term care coverage was issued prior to June 1, 1991;
			 or
2. The group policy is issued
			 prior to June 1, 1991 and all certificates under the policy are issued prior to
			 June 1, 1991.