635.23(1)(dp)
(dp) By rule determine whether employers participating in the plan may impose a probationary or waiting period on employes who become eligible for coverage after the commencement of the employer's coverage. The plan board may not allow for a probationary or waiting period that exceeds 90 days.
635.23(1)(dr)
(dr) By rule determine enrollment periods, if any, for employer or employe coverage under the plan.
635.23(1)(e)
(e) Annually submit a report to the chief clerk of each house of the legislature, for distribution under
s. 13.172 (3) to the appropriate standing committees, summarizing the activities of the plan board and the operation of the plan in the preceding year, and including but not limited to all of the following:
635.23(1)(e)1.
1. The number of small employers participating in the plan.
635.23(1)(e)2.
2. The number of employes and dependents participating in the plan.
635.23(1)(e)3.
3. An evaluation of the plan's operation and effectiveness.
635.23(1m)
(1m) The plan board may by rule establish plan features in addition to those specified in
sub. (1).
635.23(1r)
(1r) All aspects of the composition and operation of the plan that are established by the plan board shall be established by rule.
635.23(2)
(2) All rules promulgated by the plan board are subject to approval by the commissioner.
635.23(3)
(3) All final decisions of the plan board under this section concerning the formulation, supervision and modification of the plan shall be adopted by a vote of not less than 8 members of the plan board's current voting membership.
635.23(4)
(4) In the formulation of the plan, for the purpose of cost containment the plan board shall encourage the use, to the extent possible, of the services of health care providers other than physicians. The plan board shall report any recommendations on ways to encourage the use of the services of health care providers other than physicians to the chief clerk of each house of the legislature for distribution under
s. 13.172 (3) to the standing committees with jurisdiction over health insurance.
635.23(5)
(5) The plan board may submit any recommendations for legislation to improve the plan to the chief clerk of each house of the legislature for distribution under
s. 13.172 (3) to the standing committees with jurisdiction over health insurance.
635.23 History
History: 1991 a. 250.
635.25
635.25
Eligibility for participation in plan. 635.25(1)(a)(a) To be eligible to participate in the plan by purchasing a policy under this subchapter containing the basic benefits, an employer:
635.25(1)(a)2.
2. Must comply with any other eligibility requirements specified by the plan board.
635.25(1)(b)
(b) Except as provided in
ss. 645.43 and
646.35, an employer that purchases a policy under this subchapter containing the basic benefits and that ceases to be eligible to participate in the plan during a policy period shall retain coverage under the plan to the end of the policy period.
635.25(1m)
(1m) Notwithstanding
sub. (1), an employer is not eligible to participate in the plan if all of the individuals to be covered under the plan may be covered by a single policy providing individual or family coverage.
635.25(2)(a)(a) All eligible employes of an eligible employer that participates in the plan are eligible for coverage under the plan, subject to the policy terms.
635.25(2)(b)
(b) Any dependent of an eligible employe who is covered under the plan is eligible for coverage under the plan, subject to the policy terms.
635.25 History
History: 1991 a. 250.
635.254
635.254
Employer premium contribution. 635.254(1)
(1) An employer that participates in the plan shall pay a premium contribution of not less than 50% of the premium rate on behalf of an eligible employe with individual coverage and not less than 40% of the premium rate on behalf of an eligible employe with family coverage.
635.254(2)
(2) An employer under
sub. (1) shall withhold from the earnings of an employe with coverage under the plan the amount of premium not contributed by the employer under
sub. (1).
635.254(3)
(3) For an eligible employe who obtains coverage under the health insurance risk-sharing plan under
s. 619.12 (2) (e) 2., an employer under
sub. (1) shall pay a premium contribution to the health insurance risk-sharing plan that is equal to the amount that the employer would pay on behalf of the employe for coverage under the plan under this subchapter.
635.254 History
History: 1991 a. 250.
635.26
635.26
Guaranteed issue. 635.26(1)(1) Except as provided in
subs. (2m) to
(4), a small employer insurer shall provide coverage under the plan, regardless of health status or claims experience, to an eligible employer and to all of its eligible employes and their dependents if all of the following apply:
635.26(1)(a)
(a) The employer agrees to pay the premium required for coverage under the plan.
635.26(1)(b)
(b) The employer agrees to comply with all other plan provisions that apply generally to a policyholder or an insured without regard to health status or claims experience.
Effective date note
NOTE: Sub. (1) is shown as affected eff. 5-1-97 by
1995 Wis. Act 289. Prior to 5-1-97 it reads:
Effective date text
(1) (a) Except as provided in subs. (2m) to (4), a small employer insurer shall provide coverage under the plan, regardless of health status or claims experience, to an eligible employer and to all of its eligible employes and their dependents if all of the following apply:
635.26 Note
1. The employer agrees to pay the premium required for coverage under the plan.
635.26 Note
2. The employer agrees to comply with all other plan provisions that apply generally to a policyholder or an insured without regard to health status or claims experience.
635.26 Note
(b) Except as provided in subs. (2m) to (4), a small employer insurer shall provide coverage under the plan, regardless of health status or claims experience, to an eligible employe who becomes eligible for coverage after the commencement of the employer's coverage, and to the eligible employe's dependents, if all of the following apply:
635.26 Note
1. The employe applies for coverage under the plan before the expiration of any applicable enrollment period, if any, required under the plan.
635.26 Note
2. The employer agrees to pay the premium required for coverage of the employe under the plan.
635.26(1m)
(1m) A small employer insurer shall be in compliance with
sub. (1) if it issues a policy that complies with the plan and the minimum benefit standards determined by the plan board under
s. 635.23 (1) (c) but that includes only the basic benefits.
635.26(1s)
(1s) Nothing in
sub. (1) prohibits a small employer insurer that provides coverage under
sub. (1) from imposing preexisting condition provisions, waiting period requirements, or other provisions or requirements related to health status or claims experience, that are permitted or required under the plan.
635.26(2)
(2) A small employer insurer that provides coverage under
sub. (1) may impose payment security provisions reasonably related to the risk covered.
635.26(2m)
(2m) Nothing in
sub. (1) requires a small employer insurer to issue coverage that the small employer insurer is not authorized to issue under its bylaws, charter or certificate of incorporation or authority.
635.26(3)
(3) Subsection (1) does not apply to a small employer insurer if the commissioner determines that any of the following applies:
635.26(3)(a)
(a) It is inequitable to apply
sub. (1) to the small employer insurer due to its disproportionate share of groups with high claims experience.
635.26(3)(b)
(b) It is in the public interest to exempt the small employer insurer from the requirement under
sub. (1) because the small employer insurer is in financially hazardous condition.
635.26(4)
(4) A small employer insurer that offers health insurance coverage exclusively to a single category or limited categories of eligible employers is required to comply with
sub. (1) only as to that single category or those limited categories of eligible employers.
635.26(6)
(6) The commissioner may adopt rules that are reasonably necessary to accomplish the purpose of this section.
635.26 History
History: 1991 a. 250;
1995 a. 289.
635.272
635.272
Payments to health care providers. 635.272(1)
(1)
Contracting health care providers. A health care provider that contracts with a small employer insurer to provide services to individuals with coverage under the plan shall accept amounts payable under the contract for the basic benefits as payment in full for those services.
635.272 History
History: 1991 a. 250.
635.28
635.28
Liability of state and plan board. Neither the state nor the plan board is liable for any obligation arising under the plan. Plan board members are immune from civil liability for acts or omissions while performing their duties under this subchapter.
635.28 History
History: 1991 a. 250.
635.29
635.29
Exemption from required coverage. The health insurance mandates apply to the plan under this subchapter only to the extent determined by the plan board under
s. 635.23 (1) (b).
635.29 History
History: 1991 a. 250.
635.31
635.31
Chapters 600 to 655 applicable. Except as otherwise provided in this subchapter, the plan shall comply with and be administered in compliance with
chs. 600 to
655.
635.31 History
History: 1991 a. 250.
