reglab/statecodes huggingface dataset:
Wisconsin Administrative Code › Office of the Commissioner of Insurance › Chapter Ins 6 - General › Section Ins 6.785 - Exemption from rate and form filing requirements

Current through June 24, 2024
(1) PURPOSE. This
			 section is intended to exempt certain classes of property and casualty rates
			 and commercial property and casualty forms from the rate and form filing
			 requirements. This section implements and interprets ss.
			 625.04,
			 625.13,
			 625.15,
			 and
			 631.20,
			 Stats.
(2) SCOPE. This section
			 applies to the lines or classes of insurance which are listed in s. Ins 6.75
			 (2) (a), (d), (e), (f), (g), (h), (i), (j), (L), (m) and (n) of direct
			 insurance written on risks or operations in this state subject to s.
			 625.03,
			 Stats., and which are exempted under the consent-to-rate provision of s. Ins
			 6.78.
(3) FINDINGS. The
			 commissioner of insurance finds that for certain classes of business certain
			 risks within other classes of business and certain situations, the rate filing
			 requirements set forth in s.
			 625.13,
			 Stats., are unnecessary to achieve the purposes of ch. 625, Stats., and the
			 policy form filing requirements set forth in s.
			 631.20,
			 Stats., are unnecessary to achieve the purposes of ch. 631, Stats. The
			 commissioner bases this finding on the following reasons:
(a) The manual rate, classification or form
			 is inappropriate because it does not adequately reflect the exposure
			 represented by the risk;
(b) The
			 risk is so different from other risks that no single manual rate or
			 classification could be representative of all such risks;
(c) The risk belongs to a classification that
			 does not develop enough experience to warrant sufficient credibility for
			 rate-making purposes;
(d) The risk
			 involves a new product or coverage as to which there are no appropriate
			 analogous exposures for rate-making purposes;
(e) The risk is a specialty type of insurance
			 where enhanced speed to market for such insurance products will enhance
			 competition and provide commercial policyholders with quicker access to new and
			 innovative products; or
(f) The
			 risk constitutes a business-to-business transaction of a sufficient size or
			 specialized nature as to not warrant filings in order to accomplish the
			 purposes of the statute.
Wisconsin Administrative Code › Office of the Commissioner of Insurance › Chapter Ins 6 - General › Section Ins 6.79 - Advisory councils and committees

Current through June 24, 2024
(1) PURPOSE. The
			 purpose of this section is to delineate the process by which the commissioner
			 may create advisory councils and committees under s.
			 15.04(1)
			 (c), Stats., to assist in dealing with
			 regulatory problems pursuant to s.
			 601.20,
			 Stats., and may include assistance with rule-making pursuant to s.
			 227.13,
			 Stats.
(2) DUTIES. Each council or
			 committee shall advise the commissioner on matters relating to specific issues
			 or subjects presented to the members for study and review by the commissioner
			 of insurance.
(3) EXPENSE
			 REIMBURSEMENT. Members of the councils and committees shall receive no salary
			 or compensation for service on the councils or committees but shall be
			 reimbursed for their actual and necessary expenses in attending meetings or
			 while performing other duties as directed by the commissioner.
(4) MEETINGS. The councils or committees
			 shall meet as needed or at such times as requested by the
			 commissioner.
(5) MEMBERSHIP. For
			 each council or committee created by the commissioner, membership may not
			 exceed 15 members and shall be representative of the various interested parties
			 and include persons who possess expertise or interest on the issue or topic of
			 the council or committee.
(6)
			 CHAIRS. The commissioner shall appoint the chair, unless the commissioner
			 authorizes a different process for selection. The commissioner shall appoint an
			 employee of the office as a non-voting member to assist the council or
			 committee with its duties. The commissioner or a designee shall keep a record
			 of all proceedings, transactions, communications, and other official acts of
			 the councils and committees. The commissioner or a designee appointed by the
			 commissioner shall serve as a voting member when the council or committee is
			 convened in accordance with s.
			 15.04(1)
			 (c), Stats. The files and records of the
			 councils and committees shall be maintained at the office of the commissioner
			 of insurance.
(7) TERM. Members of
			 the councils and committees serve at the pleasure of the
			 commissioner.
Wisconsin Administrative Code › Office of the Commissioner of Insurance › Chapter Ins 6 - General › Section Ins 6.80 - Retention of records

Current through June 24, 2024
(1) PURPOSE. The purpose of this section is to establish standards for
								 record retention by insurers and other persons subject to the regulation of the commissioner.
(2) SCOPE.
(a) This section shall apply
								 to all insurers licensed under chs. 611, 612, 613, 614, and 618, Stats., and including the Local Property
								 Insurance Fund, the State Life Insurance Fund, and the State Indemnity Fund.
(b) The following sections also apply:
1.
								 Section Ins 1.01 (3) applies to fraternals.
2. Sections Ins 2.07
								 (5) (a) 2. d. and (b) 2. b. apply to life insurance.
Note:
Sections Ins 2.07 (5) (a) 2. d. and (b) 2. b. do not exist.
										Section Ins 2.07 was repealed and recreated eff. 3-1-82.
3.
								 Section Ins 3.25 (9) (d) applies to credit life and accident and sickness insurance.
4. Section Ins 3.27 (28) applies to disability insurance.
5. Section Ins 6.17 (3) (c) and (d) apply to surplus lines.
6. Sections Ins 6.30 (2) (a) 1. e., 6.30 (3) (a) 3. e., (4) (a) 2. e. and
								 (5) (a) 3. apply to property and casualty insurers.
7. Section Ins
								 6.55 (5) (b) applies to all insurers.
8. Section Ins 6.61 applies
								 to intermediaries.
9. Section Ins 8.09 applies to employee
								 welfare funds.
Note:
Section Ins 8.09 has been repealed.
10. Sections Ins 8.65 (4) and 8.69 (6) apply to small employer
								 insurers.
Wisconsin Administrative Code › Office of the Commissioner of Insurance › Chapter Ins 6 - General › Section Ins 6.85 - Notification of a person's right to file a complaint with the commissioner

Current through June 24, 2024
(1)
			 PURPOSE. This section interprets and implements s.
			 631.28,
			 Stats., by specifying the contents of a notice insurers must provide to
			 insureds about their right to file a complaint with the office of the
			 commissioner of insurance. This section also describes when and the manner in
			 which such notice must be provided.
(2) SCOPE. This section applies to all
			 policies or certificates in force, issued or renewed in Wisconsin on or after
			 the effective date of this section.
(3) DEFINITIONS. For purposes of this
			 section, "insured" means the policyholder for individual policies and both the
			 group policyholder and certificate holder for group policies.
(4) NOTICE FORMAT. Every insurer shall
			 disclose the insured's right to contact the office of the commissioner of
			 insurance regarding an insurance problem by providing a notice which shall:
(a) Be in the form as prescribed in Appendix
			 I or for policies subject to sub. (5) (d) in form as prescribed in Appendix
			 2;
(b) Include the issuer's
			 address, toll free phone number, if available, and phone number in no less than
			 12-point type and bold print.
Note:
The language in sub. (4) (b) applies to
				notices sent on or after March 1, 1995.
(c) Be in no less than 10-point type;
			 and
(d) Have the phrase "KEEP THIS
			 NOTICE WITH YOUR INSURANCE PAPERS," "PROBLEMS WITH YOUR INSURANCE?" in Appendix
			 I and the "OFFICE OF THE COMMISSIONER OF INSURANCE" in Appendices I and 2
			 capitalized and in bold lettering.
Wisconsin Administrative Code › Office of the Commissioner of Insurance › Chapter Ins 6 - General › Section Ins 6.90 - Prohibited uses of senior-specific designations

Current through June 24, 2024
(1) PURPOSE. The
			 purpose of this rule is to set forth standards to protect consumers from
			 advertising and trade practices that are deceptive, misleading, or restrain
			 competition unreasonably, with respect to the use of senior-specific
			 certifications and professional designations in the advertising, solicitation,
			 sale or purchase of, or advice made in connection with, life or health
			 insurance, or an annuity product.
(2) AUTHORITY.
(a) This rule is adopted pursuant to the
			 Office of the Commissioner of Insurance's authority under ss.
			 601.42(3)
			 and
			 628.34(12),
			 Stats.
(b) Nothing in this rule
			 shall limit the commissioner's authority to enforce existing provisions of
			 law.
Wisconsin Administrative Code › Office of the Commissioner of Insurance › Chapter Ins 6 - General › Section Ins 6.91 - Definitions

Current through June 24, 2024
(1) "Business checking account" means any
			 account utilized by a navigator, navigator entity, nonnavigator assister or
			 nonnavigator assister entity in their capacity as a navigator, nonnavigator
			 assister or related entity and in transacting of the business of
			 insurance.
(2) "Cash disbursed
			 record" means a record showing all monies paid out by the navigator, navigator
			 entity, nonnavigator assister or nonnavigator assister entity in their capacity
			 as a navigator, nonnavigator assister or related entity in transacting the
			 business of insurance.
(3) "Cash
			 receipts record" means a record showing all monies received by the navigator,
			 navigator entity, nonnavigator assister or nonnavigator assister entity in
			 their capacity as a navigator, nonnavigator assister or related entity and in
			 transacting the business of insurance.
(4) "Certified application counselors" means
			 a person who is a nonnavigator assister who is not an in-person assister and
			 who is employed, supervised or affiliated with a registered nonnavigator
			 assister entity.
(5) "Commissioner"
			 means the commissioner of insurance.
(6) "Formal administrative action" includes
			 consent decrees, cease and desist orders, stipulations, suspensions,
			 revocations, license denials, fines, forfeitures, settlement agreements,
			 navigator license restrictions or other actions limiting the navigator's method
			 of transacting the business of insurance.
(7) "Insurance agent" means an "intermediary"
			 as defined in s.
			 628.02(4),
			 Stats.
(8) "Navigator entity" means
			 an entity or organization that employs, supervises or is affiliated with, one
			 or more licensed navigators; is designated by the exchange as a navigator,
			 works on behalf of the exchange, and receives federal navigator grant funding;
			 and is registered with the commissioner.
(9) "Nonnavigator assister entity" means an
			 entity or organization that employs, supervises or is affiliated with one or
			 more nonnavigator assisters including certified application counselors; is
			 designated by and works on behalf of the exchange, enters into an agreement
			 with the exchange; and is registered with the commissioner.
(10) "Personnel records" means those records
			 pertaining to anyone who is employed by, supervised by or affiliated with a
			 navigator entity or nonnavigator assister entity including independent
			 contractors.
(11) "Policyholder
			 records" means all records, applications, request for coverage changes, and
			 coverage complaints associated with a policy generated by or through the
			 navigator, navigator entity, certified application counselor or nonnavigator
			 assister entity.
Wisconsin Administrative Code › Office of the Commissioner of Insurance › Chapter Ins 6 - General › Section Ins 6.93 - Registration of navigator entities

Current through June 24, 2024
(1) INITIAL
			 APPLICATION.
(a)
Registration
			 application for navigator entity.
An entity registering as a navigator
			 entity shall submit an application to the commissioner in the form prescribed
			 by the commissioner. A completed application shall include: the navigator
			 entity's name; the names of the entity's officers; the current mailing address;
			 the name and contact email address of at least one licensed designated
			 responsible navigator; names, license number, contact email addresses, and
			 mailing addresses for the navigators it employs, supervises or is affiliated
			 with; proof of financial responsibility under sub. (4) (b), and compliance with
			 competence and trustworthiness criteria under s.
			 Ins
			 6.92(3), and any documentation
			 required to questions on the application.
Note:
A copy of the navigator entity registration
				application form OCI 11-091, required in par. (a), may be obtained at no cost
				from the Office of the Commissioner of Insurance at 125 S. Webster Street,
				Madison WI 53703, or at the Office's web address: oci.wi.gov.
(b)
Payment of fees.
An
			 applicant for an original registration shall pay an initial, non-refundable,
			 registration fee of $100.00 is due with submission of the
			 application.
(c)
Acknowledgement of registration.
Determination of the
			 acceptance or rejection of a completed application shall be made within 90 days
			 of receipt by the commissioner of the completed application, which is tolled
			 until receipt of any additional required or requested documentation. The
			 commissioner shall accept a registration if the applicant satisfies the
			 requirements of pars. (a) and (b), and if the applicant is designated by the
			 exchange as a navigator entity, receives funding through a federal grant, is in
			 compliance with s.
			 628.92(2),
			 Stats., and is in compliance with applicable federal requirements including
			 45
			 CFR 155.215(a) (1), as
			 amended.
Wisconsin Administrative Code › Office of the Commissioner of Insurance › Chapter Ins 6 - General › Section Ins 6.95 - Registration of certified application counselors, nonnavigator assisters and nonnavigator assister entities

Current through June 24, 2024
(1g) REGISTRATION
			 REQUIREMENT. Certified application counselors and other nonnavigator assisters
			 shall be employed or supervised by a registered nonnavigator assister entity,
			 or be affiliated with a registered nonnavigator assister entity.
(1r) ELECTRONIC REGISTRATION FOR A
			 NONNAVIGATOR ASSISTER ENTITY. An entity registering as a nonnavigator assister
			 entity shall provide all of the following information to the commissioner in
			 the form prescribed by the commissioner:
(a)
			 The nonnavigator assister entity's name and current mailing address.
(b) The name and contact information for the
			 nonnavigator assister entity.
(c)
			 The name, business address, and type of nonnavigator assister for each
			 nonnavigator assister it employs, supervises, or is affiliated with.
(d) An attestation that each nonnavigator
			 assister is in compliance with applicable state law including any nonnavigator
			 assister who is a certified application counselor and who has complied with s.
			 628.96(2),
			 Stats.
(e) The nonnavigator
			 assister entity's agreement to provide to the commissioner all supporting
			 documents as requested by the commissioner.
Wisconsin Administrative Code › Office of the Commissioner of Insurance › Chapter Ins 6 - General › Section Ins 6.96 - Prohibited business practices

Current through June 24, 2024
In addition to the prohibited acts contained in s.
				628.95(2),
				Stats., navigators, navigator entities, nonnavigator assisters and nonnavigator
				assister entities are prohibited from all of the following:
(1) Providing enrollment or other specific
			 information regarding a health benefit plan that is not offered in the federal
			 exchange.
(2) Providing a
			 recommendation comparing health benefit plans that may be better or worse for
			 the consumer or employer.
(3)
			 Making misleading statements to a consumer or employer regarding or otherwise
			 misrepresenting one's qualifications or services.
(4) Offering a recommendation directly to a
			 consumer or employer regarding a particular health benefit plan concerning
			 deductible, coinsurance, or any substantive benefits, terms, or conditions of
			 the contract.
(5) Asking or urging
			 a consumer to apply for a particular health benefit plan from a particular
			 insurance company.
(6) Distributing
			 cards, documents or advertisements regarding a particular health
			 insurer.
(7) Recommending a
			 particular health benefit plan or insurer.
(8) Receiving consideration directly or
			 indirectly from any health insurer in connection with the enrollment of
			 individual or employees into a qualified health plan as defined , as
			 amended.
(9) Using a single
			 appointment for selling, soliciting or advising a consumer or employer about a
			 product other than health benefit plans by a navigator or nonnavigator assister
			 who is also a licensed insurance agent. Insurance agents shall make a separate
			 appointment with the consumer or employer for selling, soliciting, or advising
			 about a product other than a health benefit plan.
Wisconsin Administrative Code › Office of the Commissioner of Insurance › Chapter Ins 6 - General › Section Ins 6.97 - Navigator, nonnavigator assister, navigator entity, and nonnavigator assister entity records

Current through June 24, 2024
(1) PURPOSE. This section protects consumers
			 by prescribing minimum standards and techniques of accounting and data handling
			 of navigators, nonnavigator assisters, navigator entities and nonnavigator
			 assister entities to ensure that timely and reliable information will exist, if
			 applicable, and be available to the commissioner. This section implements and
			 interprets ss.
			 601.42 and
			 628.34,
			 Stats., by establishing the minimum records that are to be
			 maintained.
(2) RECORDKEEPING
			 REQUIREMENTS.
(a)
Records,
			 generally.
Beginning October 1, 2013, each navigator, nonnavigator
			 assister, navigator entity or nonnavigator assister entity shall maintain, for
			 at least a 3-year period, unless a specific period is provided elsewhere, all
			 of the following financial, consumer, and employee records arising from or
			 related to the activities of the navigator or nonnavigator assister, as
			 applicable:
1. Business checking
			 account.
2. Cash disbursed
			 records.
3. Cash receipts
			 records.
4. Personnel
			 records.
5. Consumer or
			 policyholder records.
Wisconsin Administrative Code › Office of the Commissioner of Insurance › Chapter Ins 6 - General › Section Ins 6.98 - Prohibition of uses of designations

Current through June 24, 2024
(1) PROHIBITED USES
			 OF DESIGNATIONS. It is an unfair and deceptive trade practice under s.
			 628.34(12),
			 Stats., for a person to use terms including "navigator," "navigator entity,"
			 "nonnavigator assister," "certified application counselor," "certified," and
			 "nonnavigator assister entity," in such a way as to mislead a purchaser or
			 prospective purchaser that the person has special certification or training in
			 advising or providing services to consumers in connection with the advertising,
			 solicitation, sale, or purchase of a health benefit plan or in the provision of
			 advice as to the advisability of purchasing a health benefit plan, either
			 directly or indirectly, offered in the state either within or outside the
			 exchange. The terms may not be used by a person who is not licensed as a
			 navigator or registered as a nonnavigator assister. The terms may not be used
			 alone or in combination with one or more terms such as "certified," "licensed,"
			 "registered," or like words, in the name of a certification or professional
			 designation unless such terms appear in a certification or professional
			 designation and that person has attained the certification or professional
			 designation.
(2) PENALTIES. A
			 violation of this section is an unfair and deceptive trade practice under s.
			 628.34(12),
			 Stats., and shall subject the violator to ss.
			 601.41,
			 601.62,
			 601.64,
			 601.65
			 and
			 628.10,
			 Stats.
Wisconsin Administrative Code › Office of the Commissioner of Insurance › Chapter Ins 6 - General › Section Ins 6.99 - Exemption

Current through June 24, 2024
(1)
(a)
			 State and local governmental entities or any persons acting on behalf of a
			 state or local governmental entity are exempt from ss.
			 Ins 6.91 to provided
			 6.98 all of the following are met:
1. All
			 communications, advertisements, notices, or other marketing materials including
			 verbal communications must identify the entity as working on behalf of the
			 state or local unit of government.
2. The state or local unit of government,
			 upon request, confirms to the commissioner that the entity is responsible or
			 has an agreement or contract that establishes financial responsibility for the
			 acts of the entity and the individual navigators, and nonnavigator assisters
			 employed, supervised, or affiliated with the entity.
3. The state or local governmental entity
			 shall not use any term or designation denoting that it is certified as a
			 navigator, nonnavigator assister or related entity unless the person, persons,
			 or entity using the term or designation is in compliance with ss.
			 Ins 6.92 or
			 6.95 and any other applicable
			 sections.
Wisconsin Administrative Code › Office of the Commissioner of Insurance › Chapter Ins 6 - General › Appendix I

Current through June 24, 2024
KEEP THIS NOTICE WITH YOUR INSURANCE
				PAPERS
PROBLEMS WITH YOUR INSURANCE?
-If you are having
				problems with your insurance company or agent, do not hesitate to contact the
				insurance company or agent to resolve your problem.
(INSURER NAME)
(CUSTOMER SERVICE)
(ADDRESS)
(CITY, STATE, ZIP)
(TOLL FREE TELEPHONE NUMBER, if available)
(TELEPHONE NUMBER)
You can also contact the
OFFICE OF THE COMMISSIONER OF
				INSURANCE,
a state agency which enforces Wisconsin's insurance laws, and
				file a complaint. You can contact the
OFFICE OF THE COMMISSIONER OF
				INSURANCE
by contacting:
Office of the Commissioner of Insurance
Complaints Department
P. O. Box 7873
Madison, WI 53707-7873
1-800-236-8517
608-266-0103.
Wisconsin Administrative Code › Office of the Commissioner of Insurance › Chapter Ins 6 - General › Appendix 2

Current through June 24, 2024
You may resolve your problem by taking the steps outlined in
				your HMO grievance procedure. You may also contact the
OFFICE OF THE
				COMMISSIONER OF INSURANCE,
a state agency which enforces Wisconsin's
				insurance laws, and file a complaint. You can contact the
OFFICE OF THE
				COMMISSIONER OF INSURANCE
by writing to:
Office of the Commissioner of Insurance
Complaints Department
P. O. Box 7873
Madison, WI 53707-7873
or you can call 1-800-236-8517 outside of Madison or 266-0103
				in Madison, and request a complaint form.
Wisconsin Administrative Code › Office of the Commissioner of Insurance › Chapter Ins 7 - Forms › Section Ins 7.01 - Purpose

Current through June 24, 2024
This chapter lists the title and form number of each form
				prescribed by the office of the commissioner of insurance which imposes
				requirements meeting the definition of a rule in s.
				227.01(13),
				Stats., and which is required to be published under s.
				227.23(3),
				Stats.
Wisconsin Administrative Code › Office of the Commissioner of Insurance › Chapter Ins 7 - Forms › Section Ins 7.02 - Bureau of financial analysis and examinations forms

Current through June 24, 2024
Form Number
Title
21-002
Application for Certificate of Authority-Domestic
							 Nonprofit HMO
21-004
Application for Limited Certificate of Authority
							 Warranty Plans
21-005
Application for Certificate of
							 Authority-Domestic
21-030
Application for Certificate of Authority-Domestic
							 Nonprofit LSHO
21-031
Application for Certificate of Authority-Nondo-mestic
							 HMO
21-032
Application for Certificate of Authority-Domestic for
							 Profit HMO
21-040
Application for Certificate of
							 Authority-Fraternals
21-050
Initial Registration for Vehicle Protection Product
							 Warranty
21-051
Vehicle Protection Product Warranty Annual
							 Registration
21-063
Application for Continuing Care Permit
21-064
Application for Initial and Renewal Life Settlement
							 Provider License
21-190
Application for Admission-Motor Clubs
22-007
Comparative Balance Sheet
22-008
P&C Compulsory and Security Surplus
							 Calculation-Quarterly Statement
22-009
Life Compulsory and Security Surplus
							 Calculation-Quarterly Statement
22-010
Fire and Casualty-Domestic Annual Statement
							 Packet
22-011
Fire and Casualty-Nondomestic Annual Statement
							 Packet
22-020
Title Annual Statement Packet
22-030
Fraternal Annual Statement Packet
22-040
Life and Accident & Health-Domestic Annual
							 Statement Packet
22-041
Life and Accident & Health-Nondomestic Annual
							 Statement Packet
22-050
Hospital, Medical & Dental Service or Indemnity
							 Corporation-Annual Statement Packet
22-051
Life Settlement Provider Annual Statement
							 Packet
22-055
Employee Welfare Funds Annual Statement Packet
22-060
Health Maintenance Organization Insurer Annual
							 Statement Packet
22-065
Limited Service Health Organization Annual Statement
							 Packet
22-070
Town Mutual Annual Statement Packet
22-090
Mortgage Guaranty-Domestic Annual Statement
							 Packet
22-091
Mortgage Guaranty-Nondomestic Annual Statement
							 Packet
22-093
Mortgage Guaranty Insurers Report of Policyholders
							 Position-Quarterly Statement
22-510
Election of Exemption (Opt-Out)
22-520
Election to be Subject to Restrictions
							 (Opt-In)
22-530
Termination of Exemption (Termination of
							 Opt-Out)
22-540
Termination of Election to be Subject to Restrictions
							 (Termination of Opt-In)
26-003
Amendment to Articles of Organization (or
							 Incor-poration)-Town Mutual Insurance Companies
28-060
HMO Companies Compulsory and Security Surplus
							 Calculation-Quarterly
Wisconsin Administrative Code › Office of the Commissioner of Insurance › Chapter Ins 7 - Forms › Section Ins 7.04 - Division of regulation and enforcement

Current through June 24, 2024
(1) COMPLAINTS
			 SECTION.
Form Number
Title
51-011
Complaint Review Request Letter
51-013
Complaint Follow-up-Provide Information Within 5
							 days
51-020
Complaint Follow-up-Recontact the Complainant
(2)
			 BUREAU OF MARKET REGULATION.
Form Number
Title
11-042
Application for Life Settlement Business Entity
							 Broker License
11-049
Application for Life Settlement Individual Broker
							 License
26-004
Grievance Procedure Experience Reports
26-030
Rescission Reporting Form for Long-term Care
28-040
Medicare Supplement Experience Exhibit
28-042
Nursing Home Insurance Experience Exhibit
(3)
			 OFFICE OF RESEARCH AND PUBLIC INFORMATION.
Form Number
Title
17-020
Long-Term Care Report Form
17-500
Medicare Supplement Insurance Report Form
Wisconsin Administrative Code › Office of the Commissioner of Insurance › Chapter Ins 7 - Forms › Section Ins 7.06 - Commissioner

Current through June 24, 2024
Form Number
Title
28-053
Medical Malpractice Closed Claims Report
These forms and all other forms currently in use may be
				  obtained from the Office of the Commissioner of Insurance at its website at
http://oci.wi.gov/
, or by writing to
				  P.O. Box 7873, Madison, WI 53707-7878.
Wisconsin Administrative Code › Office of the Commissioner of Insurance › Chapter Ins 8 - Employee Welfare Funds; Employee Benefit Plan Administrators; Small Employer Health Insurance › Subchapter I - Employee Welfare Funds › Section Ins 8.07

Current through June 24, 2024
Example: A seller who spends 20% of the hours of employment
					 in Wisconsin and who works from a base of operations in Wisconsin would be
					 "employed in this state". A seller who spends 50% of the hours of employment in
					 Wisconsin but who works from a base of operations outside of Wisconsin would
					 not be "employed in this state". A seller whose service is performed primarily
					 in Wisconsin (service outside of the state is only occasional) is "employed in
					 this state" even though the base of operations is in another state or is
					 directed or controlled from another state.
Wisconsin Administrative Code › Office of the Commissioner of Insurance › Chapter Ins 8 - Employee Welfare Funds; Employee Benefit Plan Administrators; Small Employer Health Insurance › Subchapter I - Employee Welfare Funds › Section Ins 8.11 - County and school district self-insured employee health care benefits: excess or stop-loss insurance requirements

Current through June 24, 2024
(1) PURPOSE. This
				section interprets ss.
				59.52(11)
				(c) and
				120.13(2)
				(c), Stats., for the purpose of prescribing
				detailed requirements for excess or stop-loss insurance for self-insured
				employee health care benefit plans provided by counties or school
				districts.
(2) SCOPE. This section
				applies to any county or school district that alone or together with one or
				more counties or one or more school districts provides employee health care
				benefits on a self-insured basis to less than 1,000 covered
				employees.
(3) DEFINITIONS. In this
				section:
(a) "Aggregate claims" means total
				actual claim amounts incurred under the employee health care benefit plan
				during a benefit period.
(b)
				"Aggregate deductible" means the aggregate amount of liability specified in the
				excess or stop-loss insurance contract at or below which the county or school
				district remains liable for payments for eligible claims.
(c) "Benefit period" means a twelve-month
				accounting or reporting period of the employee health care benefit
				plan.
(d) "Coinsurance" means a
				fixed percentage of each claim established in the employee health care benefit
				plan which the county or school district is obligated to pay for each person
				covered in the plan.
(e) "Covered
				employees" means employees participating in an employee health care benefit
				plan.
(f) "Employees eligible to
				participate" means employees who are eligible to be covered employees under the
				terms of the employee health care benefit plan.
(g) "Employee health care benefit plan" means
				a self-insured plan established by one county or school district or jointly by
				2 or more counties or 2 or more school districts to provide health care
				benefits to employees eligible to participate in the plan.
(h) "Expected claims" means the most accurate
				actuarial estimate of aggregate claims during a benefit period.
(i) "Incurred" means to have provided or
				furnished a service or item to an employee or dependent covered under an
				employee health care benefit plan for which a charge for a covered expense is
				made.
(j) "Maximums" means the
				largest total amount of claims per person established by the employee health
				care benefit plan which the county or school district is obligated to
				pay.
(k) "Paid basis" means the
				application of a claim payment to the aggregate deductible for the benefit
				period in which the payment is actually made, regardless of when the claim is
				incurred.
(L) "Quota share
				reinsurance" means insurance purchased for the employee health care benefit
				plan which pays the plan a predetermined fixed percentage of each
				claim.
Wisconsin Administrative Code › Office of the Commissioner of Insurance › Chapter Ins 8 - Employee Welfare Funds; Employee Benefit Plan Administrators; Small Employer Health Insurance › Subchapter II - Employee Benefit Plan Administrators › Section Ins 8.22 - Definitions

Current through June 24, 2024
In this subchapter:
(1) "Administrator" has the meaning given in
				s.
				633.01(1),
				Stats.
(2) "Commissioner" means the
				commissioner of insurance.
(3)
				"Employee" has the meaning given in s.
				633.01(2),
				Stats.
(4) "Office" means the
				office of the commissioner.
(5)
				"Plan" has the meaning given in s.
				633.01(4),
				Stats.
(6) "Principal" has the
				meaning given in s.
				633.01(5),
				Stats.
Wisconsin Administrative Code › Office of the Commissioner of Insurance › Chapter Ins 8 - Employee Welfare Funds; Employee Benefit Plan Administrators; Small Employer Health Insurance › Subchapter II - Employee Benefit Plan Administrators › Section Ins 8.24 - Exemptions

Current through June 24, 2024
(1) Each of the following is exempt from ch.
				633, Stats., and this subchapter for the portion of its business subject to
				regulation under the specified sections:
(a)
				An administrator of one or more self-insured, partially insured or divided
				insurance worker's compensation plans subject to s.
				DWD
				80.60 or 80.61.
(b) A warrantor or warranty plan
				administrator, as defined in s.
				Ins 15.01(4) (c) or
				(e), that holds a valid certificate of
				authority under ch. Ins 15.
Wisconsin Administrative Code › Office of the Commissioner of Insurance › Chapter Ins 8 - Employee Welfare Funds; Employee Benefit Plan Administrators; Small Employer Health Insurance › Subchapter II - Employee Benefit Plan Administrators › Section Ins 8.28 - Performance bond requirements

Current through June 24, 2024
(1) A performance
				bond required under s.
				633.14(1) (b) or (2)
				(b), Stats., shall be continuous in form,
				shall be issued by an insurer authorized to do a surety business in this state
				and shall be in favor of the commissioner and payable to any resident of this
				state who is the beneficiary of an employee benefit plan administered by the
				administrator and to any such employee benefit plan on behalf of the residents
				of this state who are its beneficiaries in the event of injury caused by a
				failure of the administrator to fulfill its responsibilities as an
				administrator.
(2) If the
				administrator collects premiums or employee contributions on behalf of any
				principal, or commingles funds belonging to more than one principal, the
				performance bond shall be in the greater of the following amounts:
(a) $25,000.
(b) Ten percent of the total amount of
				projected premiums, charges and claim funds the administrator expects to handle
				on behalf of residents of this state during the fiscal year following the year
				for which a financial statement is submitted under s.
				Ins 8.26(1)
				(c). A bond under this paragraph need not
				exceed $500,000.
Wisconsin Administrative Code › Office of the Commissioner of Insurance › Chapter Ins 8 - Employee Welfare Funds; Employee Benefit Plan Administrators; Small Employer Health Insurance › Subchapter II - Employee Benefit Plan Administrators › Section Ins 8.30 - Notification to office

Current through June 24, 2024
An administrator shall notify the office in writing of any of
				  the following within 30 days after the date of the occurrence:
(1) The cessation of business activities as
				an administrator. A notification under this subsection shall include the name
				and address of the custodian of the administrator's business records and the
				location of those records.
(2) Any
				change in the administrator's business mailing address or the location of its
				business records.
(3) Formal
				administrative action in this state or another state by an agency that
				regulates the business of administrators, insurance, real estate, securities or
				financial institutions against the administrator or any officer, director,
				partner or other individual having comparable responsibilities in the
				corporation or partnership.
(4) The
				conviction in this state or another state of a felony or misdemeanor, other
				than a misdemeanor related to the use of a motor vehicle or the violation of a
				fish and game regulation, of the administrator or any of the officers,
				directors, partners or other persons having comparable responsibilities in the
				corporation or partnership.
Wisconsin Administrative Code › Office of the Commissioner of Insurance › Chapter Ins 8 - Employee Welfare Funds; Employee Benefit Plan Administrators; Small Employer Health Insurance › Subchapter II - Employee Benefit Plan Administrators › Section Ins 8.32 - Audit

Current through June 24, 2024
In order to determine whether the financial resources of an
				  administrator are adequate to safeguard the interests of the public and persons
				  covered by a plan, or to determine the appropriate bond amount under s.
				  Ins
				  8.28, the office may order the administrator to submit
				  financial statements that have been audited by a certified public
				  accountant.
Wisconsin Administrative Code › Office of the Commissioner of Insurance › Chapter Ins 8 - Employee Welfare Funds; Employee Benefit Plan Administrators; Small Employer Health Insurance › Subchapter III - Small Employer Health Insurance › Section Ins 8.40 - Purpose

Current through June 24, 2024
This subchapter interprets and implements ch. 635, Stats.,
				  and s. 149.12(2) (e), Stats.
Wisconsin Administrative Code › Office of the Commissioner of Insurance › Chapter Ins 8 - Employee Welfare Funds; Employee Benefit Plan Administrators; Small Employer Health Insurance › Subchapter III - Small Employer Health Insurance › Section Ins 8.42 - Definitions

Current through June 24, 2024
In addition to the definitions in s.
				  635.02, Stats., which
				  apply to this subchapter, in this subchapter:
(1) "Basic market share ratio" means the
				ratio of the number of risk characteristic basic health benefit plans in force
				to the total number of basic health benefit plans in force.
(2) "Commissioner" means the commissioner of
				insurance.
(3) "Initial enrollment
				period" means a period prior to issuance of a policy during which eligible
				employees, and dependents of eligible employees, are entitled to enroll in
				coverage under the policy.
(4)
				"Late enrollee" means an eligible employee, or dependent of an eligible
				employee, who does not request coverage under a policy during an enrollment
				period in which the individual is entitled to enroll in the policy, and who
				subsequently requests coverage under the policy, regardless of whether the
				enrollment period was held prior to, on or after the law's effective date.
				"Late enrollee" does not include an individual who is a new entrant under sub.
				(7) (b) or (c).
(5) "Law's
				effective date" means May 12, 1992, or the first renewal date of a policy which
				occurs on or after May 12, 1992, whichever is later.
(6) "Market share ratio" means the ratio of
				the number of risk characteristic basic health benefit plans in force to the
				total number of policies in force.
(7) "New entrant" means an eligible employee,
				or the dependent of an eligible employee, who:
(a) Becomes part of an employer group on or
				after the law's effective date and after commencement of an initial enrollment
				period;
(b) Is a spouse, minor or
				dependent under a covered employee's policy who a court orders be covered under
				the policy and who requests enrollment within 30 days after issuance of the
				court order; or
(c) Failed to
				request enrollment in the policy during an enrollment period which commenced
				prior to, on or after the law's effective date, during which the individual was
				entitled to enroll in the policy, if the individual:
2. Subsequently, and on or after February 1,
				1994, loses coverage under the qualifying coverage; and
3. Requests enrollment within 30 days after
				termination of the qualifying coverage.
Wisconsin Administrative Code › Office of the Commissioner of Insurance › Chapter Ins 8 - Employee Welfare Funds; Employee Benefit Plan Administrators; Small Employer Health Insurance › Subchapter III - Small Employer Health Insurance › Section Ins 8.44 - Applicability; exclusion

Current through June 24, 2024
(1) Chapter 635, Stats., and this subchapter
				apply to a policy issued to, or renewal for, an employer if the number of
				eligible employees in this state was not less than 2 nor more than 25 during at
				least 50% of the number of weeks the employer was actively engaged in the
				business enterprise during the 12 months preceding the date of application or
				the policy renewal date.
(2) A
				small employer insurer shall notify each employer in writing when a policy is
				issued that if the employer employs less than 2 or more than 25 eligible
				employees during at least 50% of the number of weeks in any 12-month period, or
				moves the business enterprise outside this state, the protections provided
				under ch. 635, Stats., and this subchapter will cease to apply to the employer
				on renewal of its health benefit plan.
(3) In addition to the types of policies
				excluded under s.
				635.02(3m),
				ch. 635, Stats., and this subchapter do not apply to policies providing only
				specified disease coverage or to hospital indemnity policies, as defined in s.
				632.895(1)
				(c), Stats.
Wisconsin Administrative Code › Office of the Commissioner of Insurance › Chapter Ins 8 - Employee Welfare Funds; Employee Benefit Plan Administrators; Small Employer Health Insurance › Subchapter III - Small Employer Health Insurance › Section Ins 8.46 - Required policy provisions

Current through June 24, 2024
Each policy shall include all of the following:
(1) On the face page or first page, a
				statement that the policy is guaranteed renewable except for the reasons stated
				in the policy, which shall be consistent with s. 635.07(1) and (2), Stats.
Note: 1995 Wis. Act 289 repealed s. 635.07, Stats. See ss.
				  632.749(2)
				  and
				  635.19(3),
				  Stats.
(2) A statement of
				the minimum number of eligible employees required in order to keep the policy
				in effect, expressed either as a schedule or as a percentage of eligible
				employees or both. The small employer insurer shall state the method for
				determining the minimum number required in the policy or employer agreement.
				For purposes of this subsection, "eligible employee" does not include any
				person who has continued coverage under s.
				632.897(2)
				(b) 2, Stats., under a small employer's group
				policy and the number of individuals in a group shall not include individuals
				with other qualifying coverage except as permitted under s. 635.17(2) (c) 2,
				Stats. A small employer insurer may not impose more stringent requirements than
				the following:
Note: 1995 Wis. Act 289 repealed s. 635.17, Stats. See s.
				  632.749(2),
				  Stats.
(a) For a small employer with
				more than 10 eligible employees, 70% of the group.
(b) For a small employer with 10 eligible
				employees, 6 eligible employees.
(c) For a small employer with 8 or 9 eligible
				employees, 5 eligible employees.
(d) For a small employer with 7 eligible
				employees, 4 eligible employees.
(e) For a small employer with 5 or 6 eligible
				employees, 3 eligible employees.
(f) For a small employer with 2 to 4 eligible
				employees, 2 eligible employees.
Wisconsin Administrative Code › Office of the Commissioner of Insurance › Chapter Ins 8 - Employee Welfare Funds; Employee Benefit Plan Administrators; Small Employer Health Insurance › Subchapter III - Small Employer Health Insurance › Section Ins 8.48 - Solicitation; disclosure requirements

Current through June 24, 2024
(1) AGENTS. Before
				completing an application for a policy, an agent shall provide the small
				employer or representative of the small employer or the individual applicant
				with a form stating the information required under s.
				635.11(1m),
				Stats. The agent shall sign and date the form certifying that he or she made
				the required disclosure and shall obtain the signature of the small employer or
				representative of the small employer or the individual applicant on the form.
				The agent shall give one copy of the completed form to the person who signed
				it. The agent or small employer insurer shall retain one copy of the completed
				form.
(2) SMALL EMPLOYER INSURERS.
				A small employer insurer that does not use agents to solicit or sell policies
				shall, with any solicitation material, provide the small employer or individual
				applicant with a form stating the information required under s.
				635.11(1m),
				Stats. The small employer insurer shall secure with or as part of each
				application a form signed by the small employer, a representative of the small
				employer or individual applicant stating that he or she has received the
				information. The small employer insurer shall provide a copy to the person who
				signed the form no later than the date the policy is issued.
Wisconsin Administrative Code › Office of the Commissioner of Insurance › Chapter Ins 8 - Employee Welfare Funds; Employee Benefit Plan Administrators; Small Employer Health Insurance › Subchapter III - Small Employer Health Insurance › Section Ins 8.49 - Uniform employee application form

Current through June 24, 2024
(1)
(a) In accordance with s.
				635.10,
				Stats., small employer insurers shall use the small employer uniform employee
				application form as the only acceptable form when small employers apply for
				coverage from small employer insurers. Small employer insurers shall implement
				procedures and policies necessary to use the small employer uniform employee
				application form.
(b) Small
				employer insurers shall treat and accept a copy of the uniform employee
				application as an original.
(c) The
				contents of the uniform small employer application shall not vary, except as
				permitted in par. (d), from the text or format including bold character, line
				spacing, the use of boxes around text and shall use a type size of at least 10
				points as delineated in form OCI 26-501.
(d) Small employer insurers and licensed
				intermediaries may pre-print the name of the small employer insurer on the
				uniform employee application provided that the form contains at least 3
				additional spaces to insert the names of insurers to whom the uniform
				applications may be sent and the form complies with par. (c).
Note: A copy of the uniform employee application form OCI
				  26-501 (c. 2/2004), required in par. (a), may be obtained at no cost from the
				  Office of the Commissioner of Insurance, P.O. Box 7873, Madison WI 53707-7873,
				  or at the Office's web address: oci.wi.gov.
Wisconsin Administrative Code › Office of the Commissioner of Insurance › Chapter Ins 8 - Employee Welfare Funds; Employee Benefit Plan Administrators; Small Employer Health Insurance › Subchapter III - Small Employer Health Insurance › Section Ins 8.50 - Underwriting restriction

Current through June 24, 2024
In determining whether to issue or continue to provide
				  coverage to a small employer, a small employer insurer may not consider the
				  occupation of the employees of the small employer or the type of business in
				  which the small employer is engaged.
Wisconsin Administrative Code › Office of the Commissioner of Insurance › Chapter Ins 8 - Employee Welfare Funds; Employee Benefit Plan Administrators; Small Employer Health Insurance › Subchapter III - Small Employer Health Insurance › Section Ins 8.52 - Regulation of rates and rate changes

Current through June 24, 2024
(1) IDENTIFICATION
				OF THE SET OF MIDPOINT RATES.
(a) Each small
				employer insurer shall identify a set of rates applicable to all combinations
				of case characteristics and benefit design characteristics that serves as the
				set of midpoint rates for policies issued to small employers. These rates shall
				be represented by any combination of rates and rating factors that satisfy the
				following:
1. All differences among rates in
				the set shall be in accordance with the insurer's rate manual or rating
				procedures and shall be based on the actuarially determined values of the
				differences in case characteristics and benefit design
				characteristics.
2. The differences
				among the rates may not reflect any differences due to such factors as the
				claim experience, health status and duration of coverage of an individual
				policy or a collection of policies grouped according to anything other than
				case characteristics or benefit design.