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
Address: 125 South Webster St – 2nd Floor
Madison WI 53703-3474
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 (10), Stats., the commissioner is required to prescribe by rule uniform questions and format of an application that is to be exclusively used by insurers authorized to offer individual major medical health insurance coverage. Further the commissioner has rule-making authority pursuant to s.
601.41 (3), Stats.
Related statutes or rules
Section
601.41 (8), Stats., authorized the commissioner to develop a uniform application for health insurance to be used in the small employer market. Section
Ins 8.49, Wis. Adm. Code implemented the requirement for development of the uniform application for small employers. The commissioner used portions of the small employer application that is applicable to the individual health insurance application.
Plain language analysis and summary of proposed rule
The proposed rule was developed with the assistance of an advisory council charged with developing the uniform application questions and format to be used exclusively in the individual major medical health insurance market. The advisory council met six times between October 2009 and June 2010. The council members included intermediaries, public members, consumer advocates and representatives from the insurance industry.
As charged, the council recommended the proposed uniform application questions and format after reviewing applications used in the state for individual major medical health insurance and the model utilized by the State of Oregon.
The proposed rule requires insurers to develop policies and procedures to implement the new individual uniform application, restricts modifications, prescribes how the individual uniform application can be used when completed using internet access to the insurer or when the application is completed via telephone. The proposed rule prohibits insurers from automatically completing portion in the electronic version based on responses to various questions but does allow the insurer to rearrange the sequence as pull-down questions provided the printed form is in the required format as contained in Appendix 1.
Appendix 1 is the individual uniform application that once applicable, contains the only questions and format that can be used by insurers offering individual major medical health insurance.
Insurers will be permitted to add as separate forms that describe additional terms of the policy such as coinsurance, copayment and deductibles, payment mode, network selection. Additionally insurers will be permitted to add as a separate form the authorizations necessary to be compliant with Health Insurance Portability Accountability Act of 1996 (HIPAA) P.L.
104-191.
Comparison with federal regulations
There is no existing or proposed federal regulation related to uniform questions and format of an application for individual health insurance. Recently, the federal government passed P.L.
111-148 and P.L.
111-152, federal health care reform, that will place restrictions on individual health insurance products but the laws do not prescribe uniform questions and format for individual health insurance.
Comparison of similar rules in adjacent states
Iowa:
None as to the uniform questions and format for individual health insurance.
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 uniform questions and format for individual health insurance.
Michigan:
None as to the uniform questions and format for individual health insurance.
Summary of factual data and analytical methodologies
The commissioner in working with the advisory council sought the greatest common factor among insurers as to their current application and underwriting process to minimize changes that insurers will need to make to their underwriting process.
Analysis and supporting documentation used to determine rule's effect on small businesses
