Ins 6.55 Ins 6.55Discrimination based on sex, unfair trade practice.
Ins 6.55(1)(1)Purpose. The purpose of this rule is to eliminate the act of denying benefits or refusing coverage on the basis of sex, to eliminate unfair discrimination in underwriting criteria based on sex, and to eliminate any differences in rates based on sex which cannot be justified by credible supporting information. This rule interprets and implements s. 601.01 (3), Stats., and ch. 628, Stats.
Ins 6.55(2) (2)Definitions.
Ins 6.55(2)(a)(a) Insurer has the meaning defined in s. 600.03 (27), Stats., and in addition includes nonprofit service plans or service insurance corporations.
Ins 6.55(2)(b) (b) Contract means any insurance policy, plan, certificate, subscriber agreement, statement of coverage, binder, rider or endorsement offered by an insurer subject to Wisconsin insurance law.
Ins 6.55(3) (3)Applicability and scope.
Ins 6.55(3)(a)(a) This rule shall apply to all contracts delivered in Wisconsin, or issued for delivery in Wisconsin on or after the effective date of this rule and to all existing group contracts subject to Wisconsin insurance law which are amended or renewed on or after the effective date of this rule.
Ins 6.55(3)(b) (b) This rule shall not affect the right of fraternal benefit societies to determine eligibility requirements for membership.
Ins 6.55(4) (4)Availability requirements.
Ins 6.55(4)(a)(a) It is an unfair trade practice for an insurer to:
Ins 6.55(4)(a)1. 1. Refuse or cancel coverage or deny benefits on the basis of the sex of the applicant or insured;
Ins 6.55(4)(a)2. 2. Restrict, modify, or reduce the benefits, term, or coverage on the basis of the sex of the applicant or insured.
Ins 6.55(4)(b) (b) Examples of unfair trade practices defined by par. (a) and prohibited by this rule are:
Ins 6.55(4)(b)1. 1. Denying coverage to females gainfully employed at home, employed part-time, or employed by relatives when coverage is offered to males similarly employed;
Ins 6.55(4)(b)2. 2. Denying benefits offered by policy riders to females when the riders are available to males;
Ins 6.55(4)(b)3. 3. Denying, under group contracts, dependent coverage to husbands of female employees, when dependent coverage is available to wives of male employees;
Ins 6.55(4)(b)4. 4. Denying disability income coverage to employed women when coverage is offered to men similarly employed;
Ins 6.55(4)(b)5. 5. Treating complications of pregnancy differently from any other illness or sickness under a contract;
Ins 6.55(4)(b)6. 6. Restricting, reducing, modifying, or excluding benefits payable for treatment of the genital organs of only one sex;
Ins 6.55(4)(b)7. 7. Offering lower maximum monthly benefits to women than to men who are in the same underwriting, earnings or occupational classification under a disability income contract;
Ins 6.55(4)(b)8. 8. Offering more restrictive benefit periods and more restrictive definitions of disability to women than to men in the same underwriting, earnings or occupational classification under a disability income contract;
Ins 6.55(4)(b)9. 9. Establishing different conditions by sex under which the policyholder may exercise benefit options contained in the contract.
Ins 6.55(5) (5)Rates. When rates are differentiated on the basis of sex, the insurer must:
Ins 6.55(5)(a) (a) File a brief letter of explanation along with a rate filing.
Ins 6.55(5)(b) (b) Maintain written substantiation of such rate differentials in its home office.
Ins 6.55(5)(c) (c) Justify in writing to the satisfaction of the commissioner the rate differential upon request.
Ins 6.55(5)(d) (d) Base all such rates on sound actuarial principles or a valid classification system and actual experience statistics.
Ins 6.55(6) (6)Penalty. Violation of this rule shall subject the insurer to the penalties set forth in s. 601.64, Stats.
Ins 6.55 History History: Cr. Register, May, 1976, No. 245, eff. 6-1-76; emerg. am. (1), eff. 6-22-76; am. (1), Register, September, 1976, No. 249, eff. 10-1-76.
Ins 6.57 Ins 6.57Appointment of insurance agents by insurers.
Ins 6.57(1)(1) Submission of an application for an intermediary-agent appointment shall initiate the appointment of an agent in accordance with s. 628.11, Stats. The application shall be submitted to the office of the commissioner of insurance and entered in the OCI licensing system in a format specified by the commissioner within 15 days after the earlier of the date the agent contract is executed or the first insurance application is submitted and shall show the lines of authority being requested for that agent. An appointment is valid only for the lines of insurance requested. The effective date of a valid appointment is the date on which the appointment is submitted electronically in the format specified by the commissioner. The agent validation report is a computer-generated report prepared by the office of the commissioner of insurance. Billing for initial appointment shall be done annually at the same time and at the same rate as renewal appointments.
Ins 6.57(2) (2) Notice of termination of appointment of individual intermediary in accordance with s. 628.11, Stats., shall be filed prior to or within 30 calendar days of the termination date with the office of the commissioner of insurance. Prior to or within 15 days of filing this termination notice, the insurer shall provide the agent written notice that the agent is no longer to be appointed as a representative of the company and that he or she may not act as its representative. This notice shall also include a formal demand for the return of all indicia of agency. “Termination date" means the date on which the insurer effectively severs the agency relationship with its intermediary-agent and withdraws the agent's authority to represent the company in any capacity.
Ins 6.57(2)(a) (a) If the reason for termination is one of the reasons listed as other criteria in s. Ins 6.59 (5) (d) or the insurer has knowledge the producer was found by a court, government body, or self-regulatory organization authorized by law to have engaged in any of the activities listed in s. Ins 6.59 (5) (d), the insurer must submit complete explanations and documentation in writing to OCI within 30 days of the termination.
Ins 6.57(2)(b) (b) If the insurer has knowledge of complaints received or problems experienced by the company involving company indebtedness, forgery, altering policies, fraud, misappropriation, misrepresentation, failure to promptly submit applications or premiums, poor policyholder service involving the intermediary being terminated, the insurer must submit complete explanations and documentation in writing to OCI within 30 days of the termination. This documentation need not prove violations, but should include situation where possible violations exist. The Office of the Commissioner of Insurance will investigate these situations and take appropriate action based upon the investigation.
Ins 6.57(2)(c) (c) The insurer or the authorized representative of the insurer shall promptly notify the insurance commissioner in writing if, upon further review or investigation, the insurer discovers additional information that would have been reportable to the insurance commissioner under par. (a) or (b) had the insurer then known of its existence.
Ins 6.57(3) (3) In addition each insurer shall pay once each year, in accordance with an assigned billing schedule and in a payment type prescribed by the commissioner, the annual appointment fee defined in sub. (4), within 30 days after the mailing of a payment notice to such insurer showing the amount due for all individuals serving as agent for such insurer, according to the commissioner's records as of the notice date. A billing schedule shall be adopted by the commissioner under which appointment notices shall be sent to insurers.
Ins 6.57(4) (4) Fees applicable for listing of insurance agents under s. 628.11, Stats.,
Resident individual intermediary-agents   $ 7.00
Nonresident individual intermediary-agents   $24.00
Ins 6.57 Note Note: 2009 Wis. Act 28, section 3135, changed the minimum appointment fees to $16 for residents and $50 for non-residents.
Ins 6.57(5) (5) No insurer shall accept business directly from any intermediary or enter into an agency contract with an intermediary unless that intermediary is a licensed agent appointed with that insurer.
Ins 6.57(6) (6) No intermediary shall submit an application for insurance directly to an insurer or solicit insurance on behalf of a particular insurer or enter into an agency contract unless the agent is appointed with that insurer.
Ins 6.57 Note Note: A free copy of each form referenced in this section may be obtained from the Office of the Commissioner of Insurance, P.O. Box 7872, Madison, WI 53707-7872 or on the office of the commissioner of insurance website at http://oci.wi.gov/.
Ins 6.57 History History: Cr. Register, December, 1976, No. 252, eff. 1-1-77; r. and recr. Register, March, 1978, No. 267, eff. 4-1-78; cr., (5) and (6), Register, March, 1979, No. 279, eff. 4-1-79; am. (1) and (3), Register, September, 1981, No. 309, eff. 1-1-82; am. (5), Register, December, 1984, No. 348, eff. 1-1-85; am. (1), Register, April, 1986, No. 364, eff. 5-1-86; am. (1) and (2), Register, January, 1992, No. 433, eff. 2-1-92; emerg. am. (4), eff. 10-9-95; am. (4), Register, February, 1996, No. 482, eff. 3-1-96; am. (4), Register, June, 2000, No. 534, eff. 7-1-00; CR 01-074: am. (1), (2), (5) and (6), cr. (2) (a) to (c), Register January 2002 No. 553, eff. 2-1-02; CR 05-111: am. (1), (2) (intro.) and (3) Register October 2006 No. 610, eff. 11-1-06; CR 09-022: am. (3), (5) and (6) Register August 2009 No. 644, eff. 9-1-09.
Ins 6.58 Ins 6.58Licensing of insurance intermediary firms as insurance agents.
Ins 6.58(1) (1)Purpose. The purpose of this rule is to establish procedures for licensure of insurance intermediary firms as insurance intermediaries, reinsurance intermediaries or managing general agents.
Ins 6.58(1m) (1m)Definition. In this section “firm" means a corporation, association, partnership, limited liability company, limited liability partnership, or other legal entity.
Ins 6.58(2) (2)License. Any firm may obtain an insurance intermediary firm license under this section.
Ins 6.58(3) (3)Procedure.
Ins 6.58(3)(a)(a) Application for a permanent intermediary license, reinsurance intermediary license or managing general agent license for a corporation or partnership shall be made on application form 11-50 or, for residents of states that have signed a declaration of uniform treatment with Wisconsin, the NAIC Uniform Application for Business Entity Non-Resident License/Registration form and filed with the commissioner of insurance. The application shall be accompanied by:
Ins 6.58 Note Note: Copies of forms referenced in ss. Ins 6.58 and 6.59 can be obtained at the office of the commissioner of insurance.
Ins 6.58(3)(a)1. 1. A licensing fee of $100.00;
Ins 6.58(3)(a)2. 2. Certification that the articles of incorporation or association include the intent, in good faith, to do business as an intermediary, reinsurance intermediary or managing general agent;
Ins 6.58(3)(a)3. 3. Certification that the insurance intermediary firm will transact business in such a way that all acts that may only be performed by a licensed intermediary are performed exclusively by natural persons who are licensed under s. 628.04, Stats., and functioning within the scope of the license, and a list of such persons;
Ins 6.58(3)(a)4. 4. If the insurance intermediary firm is domiciled outside of Wisconsin, an agreement to be subject to the jurisdiction of the commissioner and the courts of this state on any matter related to the insurance intermediary firm's insurance activities in this state, on the basis of service of process under ss. 601.72 and 601.73, Stats.; and
Ins 6.58(3)(a)5. 5. A list of all partners, directors or principal officers or persons in fact having comparable power.
Ins 6.58(3)(a)6. 6. In the case of a corporation the application must be signed by an officer. In the case of a partnership the application must be signed by a partner.
Ins 6.58(3)(a)7. 7. Any bond, policy, designation or information required under s. Ins 47.02 (3) or (5).
Ins 6.58(3)(b) (b) Determination of the acceptance or rejection of a completed application shall be made within 84 days. A completed application consists of form OCI 11-50 or the NAIC Uniform Application for Business Entity Nonresident License/Registration form and other required material described in par. (a).
Ins 6.58(4) (4)Standards of competence and trustworthiness.
Ins 6.58(4)(a)(a) For partners, directors or principal officers who are licensed at the time of application under sub. (4) as insurance intermediaries, reinsurance intermediaries or managing general agents, those standards as set [forth] in s. Ins 6.59 (5) shall apply in lieu of the standards set forth in this section.
Ins 6.58 Note Note: A missing word is shown in brackets.
Ins 6.58(4)(b) (b) For partners, directors or principal officers who are not licensed at the time of application under sub. (4) as insurance intermediaries, reinsurance intermediaries or managing general agents, the following criteria may be used in assessing trustworthiness and competence:
Ins 6.58(4)(b)1. 1. `Criminal record.' The conviction for crimes which are substantially related to insurance.
Ins 6.58(4)(b)2. 2. `Accuracy of information.' Any material misrepresentation in the information submitted on form 11-50.
Ins 6.58(4)(b)3. 3. `Regulatory action.' Any regulatory action taken with regard to any license held, such as insurance licenses in other states, real estate licenses and security licenses.
Ins 6.58(4)(b)4. 4. Other criteria which the commissioner considers evidence of untrustworthiness or incompetence.
Ins 6.58(5) (5)Fees.
Ins 6.58(5)(a)(a) Biennially, at least 60 days prior to February 15 of even numbered years, a regulation fee notice of $35.00 for resident and $70.00 for nonresident insurance intermediary firms, reinsurance intermediaries and managing general agents will be sent to each entity by first class mail at the address on file with the office of the commissioner of insurance.
Ins 6.58(5)(b) (b) If payment of the biennial regulation fee is not made prior to February 15, in a payment type prescribed by the commissioner, the license will be revoked.
Ins 6.58(5)(c) (c) The license will be revoked if payment is not made within 60 days after February 15.
Ins 6.58(6) (6)Notification of changes. Each insurance intermediary firm licensed or applying for a license shall, within 30 days, notify the commissioner of insurance in writing of any change in its business mailing address, location of the business records, or a change in the name and address of the designated representative.
Ins 6.58 Note Note: Intermediary corporations and partnerships are subject to the recordkeeping requirements as set forth in s. Ins 6.61 (1).
Ins 6.58 Note A free copy of each form referenced in this section may be obtained from the office of the commissioner of insurance, P.O. Box 7872, Madison, WI 53707-7872 or on the office of the commissioner of insurance website at http://oci.wi.gov/.
Ins 6.58 History History: Cr. Register, August, 1980, No. 296, eff. 9-1-80; am. (5) (a), Register, September, 1981, No. 309, eff. 10-1-81; cr. (6), Register, September, 1981, No. 309, eff. 1-1-82; r. and recr. (2), r. (3) and (8), renum. (4) to (7) to be (3) to (6), Register, April, 1982, No. 316, eff. 5-1-82; r. form 11-50, Register, October, 1982, No. 322, eff. 11-1-82; am. (3) (a) to (f), Register, December, 1984, No. 348, eff. 1-1-85; correction in (5) made under s. 13.93 (am) (b) 7., Stats., Register, December, 1984, No. 348; emerg. am. (1), (3) (intro.), (a) 1. and 2., (4) (a), (b) (intro.) and 1., (5) (a) and (6), cr. (3) (a) 7., eff. 3-12-93; am (1), (3) (intro.), (a) 1. and 2., (4) (a), (b) (intro.) and 1., (5) (a) and (6), cr. (3) (a) 7., Register, July, 1993, No. 451, eff. 8-1-93; emerg. am. (5) (a), eff. 10-9-95; am. (5) (a), Register, February, 1996, No. 482, eff. 3-1-96; cons. and renum. (3) (intro.) and (a) (intro.) to be (3) (a) (intro.) and am., am. (3) (b), Register, January, 1999, No. 517, eff. 2-1-99; CR 01-074: am. (1), (2), (3) (a) 3. and 4., (5) and (6), Register January 2002 No. 553 eff. 2-1-02; CR 05-111: am. (3) (b) and (5) (a) Register October 2006 No. 610, eff. 11-1-06; CR 09-022: am. (5) (a) and (b) Register August 2009 No. 644, eff. 9-1-09.
Ins 6.59 Ins 6.59Licensing of individuals as agents, reinsurance intermediaries, or managing general agents (s. 628.04, Stats.).
Ins 6.59(1)(1)Purpose. The purpose of this rule is to establish procedures for original licensure and license enlargement of an individual as an insurance agent, reinsurance intermediary or managing general agent.
Ins 6.59(2) (2)Examination. An examination is required of each resident applicant for each kind of license authority listed in s. Ins 6.50, except a reinsurance intermediary license, managing general agent, variable life or variable annuity and the limited line travel, crop and surety insurance licenses. Each examination will test the applicant's basic knowledge of the kinds of insurance to be solicited or function to be performed and the applicant's basic understanding of the applicable laws and regulations.
Ins 6.59(3) (3)Fees. The following fee schedule is established for residents and non-residents:
Application for one line of authority   $75.00
Application for 2 lines of authority   $150.00
Application for 3 lines of authority   $225.00
Application for 4 lines of authority   $300.00
Application for 5 lines of authority   $375.00
Application for a Surplus Lines license   $100.00
Ins 6.59(4) (4)Procedure.
Ins 6.59(4)(a)(a) Application for resident intermediary agents. Application for a permanent resident agent license or an enlargement of authority requiring an examination shall be made on-line following successful completion of any required prelicensing education and the examination. A completed application consists of the agent's name, the current address for the residence of the applicant; the current mailing address for the applicant; an original exemption form as required under ch. Ins 26, if required by s. Ins 26.04 (3); an electronic confirmation of prelicensing education completion for the specific lines of authority; fingerprints to be provided in a format specified by the commissioner to complete, an electronic confirmation of criminal history from the Wisconsin department of justice, crime information bureau, and the federal bureau of investigation completed not more than 180 days prior to the test date; payment of the fees to the testing vendor, an electronic photograph of the applicant taken by the test service at the time of testing; confirmation of previous license in another state, if applicable; and any documentation required in answer to questions on the application.
Ins 6.59(4)(am) (am) Application for nonresident intermediary agents. Application for a permanent nonresident agent license or an enlargement of authority shall be made on-line or on form OCI 11-041N (rev.) or on the NAIC Uniform Application for Individual Nonresident License form and filed with the office of the commissioner of insurance. A completed application consists of payment of the fees; and any documentation required in answer to questions on the application. If confirmation of license status is not attainable from the National Insurance Producer Registry, an original certificate of licensing from the state of residence is required.
Ins 6.59(4)(an) (an) Application for Variable life and variable annuity products. Application for a permanent resident agent variable life and variable annuity products license or an enlargement of authority to include variable life and variable annuity products license shall be made on-line or on form OCI 11-041R (rev.) and filed with the office of the commissioner of insurance. A completed application consists of a completed form OCI 11-041R (rev.) giving the current address for the residence of the application; the current mailing address for the applicant; payment of the fees; any documentation required in answer to questions on the application; and verification of required registration by the Financial Industry Regulatory Authority (FINRA) registered for Series 6 or Series 7.
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Published under s. 35.93, Stats. Updated on the first day of each month. Entire code is always current. The Register date on each page is the date the chapter was last published.