Mail: PO Box 7873
Madison, WI 53707-7873
Analysis Prepared by the Office of the Commissioner of Insurance
Statutes interpreted
Statutory authority
Explanation of agency authority
In accordance with s.
601.41 (8), Stats., the office of the commissioner of insurance is required to revise the uniform small employer application form at least once every two years in consultation with the health advisory council. The rule was initially promulgated in 2003, and due to federal changes and a request of the health advisory council the office of the commissioner of insurance proposes this rule.
Related statutes or rules
Section
635.10, Stats., requires use of the small employer uniform employee application for group health insurance.
Plain language analysis and summary of proposed rule
Additionally the federal government has also modified the Health Insurance Portability and Accountability Act (HIPAA) to include the requirement of additional descriptive information for persons who after a qualifying event are permitted the option of a special enrollment period to understand how to obtain and apply for coverage. The proposed rule contains the modifications to the waiver and health underwriting questions to comply with the Genetic Information Nondiscrimination Act of 2008 (GINA) and the Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA) as well mandated coverage for dependents.
Specifically, the modifications include several to the small employer uniform application for group health insurance. In section V of the application a sentence has been added in accordance with an amendment to CHIPRA that informs an employee how to obtain information on electing health insurance coverage through a special election period due to a qualifying event including Medicaid premium assistance. This information is to be provided at the time the employee waives the right to obtain health insurance through the small employer. Information is updated regarding the treatment of genetic information in the medical information section of the application. Additionally, modification were made to delete reference to a dependent needing to be a full-time student or financially dependent as both state and federal law mandate inclusion of dependents.
During the July 2009 meeting of the health advisory council, a motion was passed to request the office of the commissioner of insurance to modify the uniform application to comply with the GINA and CHIPRA changes pending federal rule promulgation due in February 2010. Subsequent to the state budget passage, the health advisory council revised its request to include modifications to comply with state law. The proposed rule incorporates the changes requested by the council in accordance with GINA and CHIPRA and mandated coverage of dependents to age 27. Failure to amend the current rule will result in insurers being non-compliant with federal and state requirements.
Comparison with federal regulations
There is no existing or proposed federal regulation related to a uniform employee application for small employer group health insurance.
Comparison of similar rules in adjacent states
Iowa:
Effective April 16, 2008, Iowa enacted 191-71.26 (513B) uniform health insurance application form to be used by small employer carriers. The uniform application is very similar to Wisconsin's form.
Illinois:
Recently enacted Public Act 95-857, requiring the development and use of uniform health applications for small group and individual health insurance. The applications are to be used beginning January 1, 2011. The applications are still being developed by the state.
Minnesota:
None as to the small employer uniform application for group health insurance.
Michigan:
None as to the small employer uniform application for group health insurance.
Summary of factual data and analytical methodologies
The office of the commissioner of insurance reviewed the GINA and CHIPRA regulations as well as newly enacted state mandates to ensure that the proposed modifications are necessary and will enable the application to be compliant with federal requirements.
Analysis and supporting documentation used to determine rule's effect on small businesses
There are no insurers that offer small employer group health insurance that qualify as small businesses in accordance with s.
227.114 (1), Wis. Stats. Intermediaries that solicit small employer group health insurance will be required to use the new form but since it is available at no cost from the office, the effect will be minimal.
Private Sector Fiscal Impact
There will be no significant fiscal effect on the private sector as the modifications are very minor and will assist in ensuring employees have information with which to make informed decisions and assist in coordinating benefits with the federal Medicare program.
Small Business Fiscal Impact
Pursuant to s.
227.114, Stats., the proposed rule may have an effect on small businesses. This rule will necessitate the use of the revised form by small businesses, however the effect is not significant.
The initial regulatory flexibility analysis is as follows:
Initial regulatory flexibility analysis
Types of small businesses affected:
Insurance agents and insurers authorized to offer small employer health insurance.
Description of reporting and bookkeeping procedures required:
None beyond those currently required.
Description of professional skills required:
None beyond those currently required.
Small business regulatory coordinator
The OCI small business coordinator is Eileen Mallow and may be reached at phone number (608) 266-7843 or at email address
eileen.mallow@wisconsin.gov
Fiscal Estimate
Assumptions used in arriving at fiscal estimate
The proposed modifications are critical for federal compliance but do not result in added cost to insurer, employer or consumer.
State fiscal effect
None.
Local government fiscal effect
None.
Long-range fiscal implications
None.
Agency Contact Person
Inger Williams, OCI
Public Information and Communications
Phone: (608) 264-8110
Address: 125 South Webster St – 2nd Floor
Madison WI 53703-3474
Mail: PO Box 7873, Madison, WI 53707-7873
Notice of Hearing
Insurance
NOTICE IS HEREBY GIVEN That pursuant to the authority granted under s.
601.41 (3), Stats., and the procedures set forth under s.
227.18, Stats., the Office of the Commissioner of Insurance (OCI) will hold a public hearing to consider the adoption of the proposed rulemaking order creating section
Ins 3.33, Wis. Adm. Code, relating to uniform questions and format for individual health insurance and affecting small business.
Hearing Information
Date: July 22, 2010
Time: 1:00 p.m., or as soon thereafter as the
matter may be reached
Location: OCI, Room 227
125 South Webster Street, 2nd Floor
Madison, WI
Submittal of Written Comments
Written comments can be mailed to:
Julie E. Walsh
Legal Unit - OCI Rule Comment for Rule Ins 333
Office of the Commissioner of Insurance
PO Box 7873
Madison WI 53707-7873
Written comments can be hand delivered to:
Julie E. Walsh
Legal Unit - OCI Rule Comment for Rule Ins 333
Office of the Commissioner of Insurance
125 South Webster St – 2nd Floor
Madison WI 53703-3474
Comments can be emailed to:
Julie E. Walsh
The deadline for submitting comments is 4:00 p.m. on the 14th day after the date for the hearing stated in this Notice of Hearing.
Copies of Proposed Rule and Fiscal Estimate
A copy of the full text of the proposed rule changes, analysis and fiscal estimate may be obtained from the Web site at:
http://oci.wi.gov/ocirules.htm or by contacting:
Inger Williams, OCI
Phone: (608) 264-8110
