LRB-0172/2
TJD&PJK:nwn&kjf:md
2009 - 2010 LEGISLATURE
February 3, 2010 - Introduced by Representative Cullen, cosponsored by Senator
Taylor, by request of Commissioner of Insurance. Referred to Committee on
Insurance.
AB701,2,4
1An Act to repeal 14.83, 601.415 (11), 601.59, 611.33 (2) (b) 1., 611.33 (2) (b) 2.
2and 646.03 (2n);
to renumber 646.31 (1) (b);
to renumber and amend 615.10
3(5);
to amend 149.13 (1), 609.91 (1) (intro.), 609.91 (2), (3) and (4) (a), (b), (cm)
4and (d), 612.22 (3) (a), (4) and (6), 614.29 (1), 614.42 (1) (a), 615.03 (5), 628.10
5(5) (a), 632.32 (2) (at), 632.32 (2) (e) (intro.), 632.32 (2) (e) 2., 632.32 (2) (e) 3.,
6632.32 (2) (g) (intro.), 632.32 (2) (g) 1., 632.32 (4) (a) (intro.), 632.32 (4r) (a),
7632.32 (4r) (c), 645.69 (1), 646.13 (2) (d), 646.13 (4), 646.31 (4) (a), 646.31 (12),
8646.32 (1), 646.32 (2), 646.325 (1), 646.325 (2) (a) 1., 646.51 (3) (c), 646.51 (5) and
9646.51 (6); and
to create 49.45 (31) (e), 601.31 (1) (Lg), 609.91 (1p), 615.10 (5)
10(intro.), 615.10 (5) (b), 615.10 (5) (c), 615.10 (5) (d), 632.32 (2) (ag), 632.32 (2)
11(be), 632.32 (4) (d), 632.897 (11), 646.01 (1) (b) 19., 646.31 (1) (b) 2. and 646.325
12(4) of the statutes;
relating to: the Interstate Insurance Receivership
13Compact, investment guidelines for charitable gift annuity segregated
14accounts, Health Insurance Risk-Sharing Plan assessment participation,
1reciprocity for long-term care insurance policies, voting by fraternal members,
2the insurance security fund, modifications to motor vehicle insurance policy
3and umbrella and excess liability policy requirements, providing an exemption
4from emergency rule procedures, and granting rule-making authority.
Analysis by the Legislative Reference Bureau
This bill makes a number of changes to the insurance laws, including the
following:
1. The Interstate Insurance Receivership Compact was created to develop and
facilitate uniform insurer receivership laws. Receiverships are established to
oversee and distribute assets of insurers that have become insolvent. Although
enacted as part of Wisconsin law, the compact never became effective in this state and
now is dissolving. The bill repeals the compact.
2. Under current law, an issuer of a charitable gift annuity must keep its assets
in a segregated account. Issuers of charitable gift annuities are subject to the same
requirements for investing assets in their segregated accounts as are other annuity
insurers for investing their assets, including being limited to investing no more than
20 percent of the assets in common stock and shares of mutual funds and no more
than 3 percent in the common stock of a single corporation and its affiliates. The bill
increases, for charitable gift annuity segregated accounts, the amount of assets that
may be invested in common stock from 20 percent to 50 percent and the assets that
may be invested in the common stock of a single corporation and its affiliates from
3 percent to 10 percent. The bill also provides that, if the assets of a charitable gift
annuity segregated account are invested in a mutual fund, the investment will be
treated as if it consists of the same percentage of common stock or bonds as that held
by the mutual fund.
3. Under current law, the Health Insurance Risk-Sharing Plan is funded in
part by assessments paid by health insurers. The amount of the assessment paid by
each insurer is proportional to the amount of that insurer's health care coverage
revenue as compared to all health care coverage revenue for all health insurers in
this state. The Commissioner of Insurance (commissioner) may exempt an insurer
from paying the assessment if that insurer's assessment would be smaller than the
cost of collecting it. The bill allows the commissioner to exempt any insurer from the
fee assessment upon the request of the insurer and after holding a public hearing.
4. Under current law, insurers authorized to do business in this state, with a
number of exceptions, must participate in the insurance security fund (fund), which
protects insureds under certain kinds and lines of direct insurance in the event of a
liquidation of an insurer. This bill explicitly exempts from the types of insurance to
which the fund applies policies issued to individuals with coverage under Medicare
or the Medical Assistance program (MA) and contracts between the federal
government and an insurer to provide health care or prescription drug benefits.
Under current law, the fund has standing to appear in any court having
jurisdiction over an impaired or insolvent insurer. An impaired insurer, under
current law, is an insurer that is subject to the requirements of the fund that is placed
under an order of rehabilitation or conservation by a court of competent jurisdiction
but without a finding of insolvency. This bill eliminates the classification of impaired
insurer.
Under current law, for an insured with a net worth of over $10,000,000, with
some exceptions the fund need only pay claims that in the aggregate exceed 10
percent of the insured's net worth. This bill increases the minimum net worth to
$25,000,000 for which the fund can limit payment of claims to 10 percent of the
insured's net worth.
Under current law, a person with a claim against the fund whose claim is
reduced or declared ineligible may appeal that determination to the board of
directors of the fund (board). The person may not pursue a claim in court unless
appeal is first made to and decided by the board. This bill specifies that the board
may appoint a committee of the board or a hearing examiner to hear appeals, which
is currently allowed under the fund's procedures. This bill requires that a person
seeking review of the board's, committee's, or hearing examiner's decision in circuit
court petition the Dane County Circuit Court within 60 days of the decision.
Under current law, under certain circumstances the fund may recover the costs
of defending an insured if the insured has a net worth of more than $10,000,000 or
is an affiliate of an insurer in liquidation. This bill does not allow the fund to recover
costs unless the insured's net worth is more than $25,000,000. The bill also allows
the fund to recover reasonable attorney fees and costs plus interest.
Under current law, an insurer is assessed by the fund, and the insurer may
appeal the assessment to the board and then to the circuit court. This bill requires
that petitions for review by the circuit court be filed in the Dane County Circuit Court
within 60 days of the decision by the board.
Under current law, an insurer may be assessed up to $200 on a nonprorated
basis for administrative costs for the fund. The bill increases the maximum
nonprorated assessment to $500.
5. Under current law, MA disregards benefits paid under qualifying long-term
care insurance policies purchased under the Long-Term Care Partnership Program
in this state when considering the assets an applicant for MA has available. The bill
requires the Department of Health Services to disregard benefits paid under
qualifying long-term care insurance policies purchased by an MA applicant under
the same type of program in another state.
6. Under current law, a fraternal insurance organization may elect its directors
by mail. This bill allows fraternals to also conduct voting by electronic means or
another method approved by the fraternal's board of directors in the bylaws.
7. Under current law, an insurance intermediary whose license is revoked for
certain reasons may have the license reinstated if he or she satisfies certain
requirements and pays the application fee for original licensure. This bill requires
that an intermediary seeking reinstatement of a license pay twice the amount of the
license renewal fee as specified by rule.
8. This bill imposes a fee for filing an original electronic resident intermediary
license application following completion of prelicensing requirements.
9. Under current law, a person who is covered by a group health insurance
policy as or through an employee may continue that coverage if the employee's
employment ends.
2009 Wisconsin Act 11, among other things, allows the
commissioner to promulgate rules establishing standards requiring insurers to
provide continuation coverage to coordinate with provisions of the federal American
Recovery and Reinvestment Act. This bill allows the commissioner to promulgate
rules establishing standards requiring insurers to provide continuation coverage for
an individual covered under a group policy who is eligible under any federal program
that provides for a federal premium subsidy for individuals covered under
continuation of coverage under a group health insurance policy.
10. Under current law, certain enrollees and policyholders, including certain
recipients of Medical Assistance, are not liable for health care costs that are covered
under a policy providing prepaid health care. Under this bill, enrollees under a policy
issued under Part C or Part D of Medicare are not liable for health care costs that are
covered under such a policy providing prepaid or fee-for-service health care or drug
benefits.
11. Under current law, one or more town mutuals may merge with an
assessable or nonassessable domestic mutual, and all members of the merging
mutuals vote to approve the merger plan. This bill specifies that the members of the
merging town mutual or mutuals and the members of an assessable domestic mutual
have the right to vote on the merger plan.
12. The bill makes a number of changes to the current law provisions that relate
to motor vehicle insurance policies and umbrella and excess liability policies,
including the following:
a. Exempts from the requirements related to coverages and coverage limits,
policies insuring motor vehicles that are not owned by the insured or that are leased
by the insured for a term that is less than six months.
b. Excludes umbrella and excess liability policies from the uninsured,
underinsured, and medical payments coverage requirements that apply to motor
vehicle insurance policies. Insurers are still required to affirmatively offer
uninsured and underinsured coverages under umbrella and excess liability policies,
however.
c. Clarifies that only one named insured is required to reject or request
uninsured or underinsured coverage for an umbrella or excess liability policy and
that one named insured's rejection of or request for the coverage applies to all persons
insured under the policy.
d. Generally, excludes from the definitions of uninsured and underinsured
motor vehicles, motor vehicles that are owned by a governmental entity; excludes
from the definition of an uninsured motor vehicle, in addition to one that is owned
or operated by a person who has furnished proof of financial responsibility, one that
is owned or operated by a person who is self-insured under any other applicable
motor vehicle law; and includes in the definition of an underinsured motor vehicle,
one that is owned or operated by a person who has furnished proof of financial
responsibility or who is self-insured under any other applicable motor vehicle law
but with limits that are less than needed to compensate the insured for his or her
damages.
For further information see the state fiscal estimate, which will be printed as
an appendix to this bill.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
AB701, s. 1
1Section
1. 14.83 of the statutes is repealed.
AB701, s. 2
2Section
2. 49.45 (31) (e) of the statutes is created to read:
AB701,5,93
49.45
(31) (e) 1. Notwithstanding par. (b) (intro.), the department, when
4making a determination under par. (a) 1. or 2. with respect to an individual, shall
5disregard an amount equal to the insurance benefit payments that are made to or
6on behalf of the individual under a qualified long-term care insurance policy under
726 USC 7702B (b) that was purchased in a state that had a state plan amendment
8that provided for a qualified state long-term care partnership, as defined in
42 USC
91396p (b) (1) (C) (iii), at the time of the purchase of the policy.
AB701,5,1210
2. The department shall comply with standards established by the federal
11department of health and human services in accordance with section 6021 (b) of the
12federal Deficit Reduction Act of 2005.
AB701, s. 3
13Section
3. 149.13 (1) of the statutes is amended to read:
AB701,6,214
149.13
(1) Every insurer shall participate in the cost of administering the plan,
15except the commissioner may
by rule exempt as a class those insurers whose share
16as determined under sub. (2) would be so minimal as to not exceed the estimated cost
17of levying the assessment, at the request of an insurer and after holding a public
18hearing, exempt an insurer from participating in the cost of administering the plan.
1The commissioner shall advise the authority of the insurers participating in the cost
2of administering the plan.
AB701, s. 4
3Section
4. 601.31 (1) (Lg) of the statutes is created to read:
AB701,6,64
601.31
(1) (Lg) For filing an original electronic resident intermediary license
5application following successful completion of any required prelicensing education
6or examination under s. 628.04, $10.
AB701, s. 5
7Section
5. 601.415 (11) of the statutes is repealed.
AB701, s. 6
8Section
6. 601.59 of the statutes is repealed.
AB701, s. 7
9Section
7. 609.91 (1) (intro.) of the statutes is amended to read:
AB701,6,1410
609.91
(1) Immunity of enrollees and policyholders. (intro.) Except as
11provided in sub. (1m)
or (1p), an enrollee or policyholder of a health maintenance
12organization insurer is not liable for health care costs that are incurred on or after
13January 1, 1990, and that are covered under a policy or certificate issued by the
14health maintenance organization insurer, if any of the following applies:
AB701, s. 8
15Section
8. 609.91 (1p) of the statutes is created to read:
AB701,6,2116
609.91
(1p) Immunity for certain medicare recipients. An enrollee,
17policyholder, or insured under a policy issued by an insurer under Part C of Medicare
18under
42 USC 1395w-21 to
1395w-28 or Part D of Medicare under
42 USC
191395w-101 to
1395w-152 to provide prepaid health care, fee-for-service health
20care, or drug benefits to enrollees of Part C or Part D of Medicare is not liable for
21health care costs that are covered under the policy.
AB701, s. 9
22Section
9. 609.91 (2), (3) and (4) (a), (b), (cm) and (d) of the statutes are
23amended to read:
AB701,7,424
609.91
(2) Prohibited recovery attempts. No person may bill, charge, collect
25a deposit from, seek remuneration or compensation from, file or threaten to file with
1a credit reporting agency or have any recourse against an enrollee, policyholder or
2insured, or any person acting on their behalf, for health care costs for which the
3enrollee, policyholder or insured, or person acting on their behalf, is not liable under
4sub. (1)
or, (1m)
, or (1p).
AB701,7,8
5(3) Deductibles, copayments and premiums. Subsections (1) to (2) do not affect
6the liability of an enrollee, policyholder or insured for any deductibles, copayments
7or premiums owed under the policy or certificate issued by the health maintenance
8organization insurer or by the insurer described in sub. (1m)
or (1p).
AB701,7,14
9(4) (a) An agreement, other than a notice of election or termination of election
10in accordance with s. 609.92 or 609.925, entered into by the provider, the health
11maintenance organization insurer, the insurer described in sub. (1m)
or (1p) or any
12other person, at any time, whether oral or written and whether implied or explicit,
13including an agreement that purports to hold the enrollee, policyholder or insured
14liable for health care costs.
AB701,7,1915
(b) A breach of or default on an agreement by the health maintenance
16organization insurer, the insurer described in sub. (1m)
or (1p) or any other person
17to compensate the provider, directly or indirectly, for health care costs, including
18health care costs for which the enrollee, policyholder or insured is not liable under
19sub. (1)
or, (1m)
, or (1p).
AB701,8,220
(cm) The insolvency of the insurer described in sub. (1m)
or (1p) or any person
21contracting with the insurer or provider, or the commencement or the existence of
22conditions permitting the commencement of insolvency, delinquency or bankruptcy
23proceedings involving the insurer or other person, including delinquency
24proceedings, as defined in s. 645.03 (1) (b), under ch. 645, despite whether the insurer
25or other person has agreed to compensate, directly or indirectly, the provider for
1health care costs for which the enrollee, policyholder or insured is not liable under
2sub. (1m)
or (1p).
AB701,8,73
(d) The inability of the provider or other person who is owed compensation for
4health care costs to obtain compensation from the health maintenance organization
5insurer, the insurer described in sub. (1m)
or (1p), or any other person for health care
6costs for which the enrollee, policyholder or insured is not liable under sub. (1)
or, 7(1m)
, or (1p).
AB701, s. 10
8Section
10. 611.33 (2) (b) 1. of the statutes is repealed.
AB701, s. 11
9Section
11. 611.33 (2) (b) 2. of the statutes is repealed.
AB701, s. 12
10Section
12. 612.22 (3) (a), (4) and (6) of the statutes are amended to read:
AB701,8,2011
612.22
(3) (a) Each of the participating corporations shall file with the
12commissioner for approval a copy of the resolution and any explanatory material
13proposed to be issued to the members
who have the right to vote on the merger under
14sub. (4), together with so much of the information under s. 611.13 (2) or 612.02 (4),
15whichever is appropriate, for the surviving or new corporation as the commissioner
16reasonably requires. The commissioner shall approve the plan unless he or she finds,
17after a hearing, that it would be contrary to the law, or that the surviving or new
18corporation would not satisfy the requirements for a certificate of authority under
19s. 611.20 or 612.02 (6), whichever is appropriate, or that the plan would be contrary
20to the interest of insureds or of the public.
AB701,9,2
21(4) Approval by members of the mutuals. After being approved by the
22commissioner under sub. (3), the plan shall be submitted
for approval to the
23members of the participating
town mutual or mutuals
for their approval and to the
24members of the participating domestic mutual if the domestic mutual is assessable.
1The members of each participating mutual
who have the right to vote on the merger 2shall vote separately.
AB701,9,7
3(6) Reports to commissioner. Each participating mutual
, the members of
4which have the right to vote under sub. (4), shall file with the commissioner a copy
5of the resolution adopted under sub. (4), stating the number of members entitled to
6vote, the number of members voting, and the number of votes cast in favor of the plan,
7stating separately in each case the mail votes and the votes cast in person.
AB701, s. 13
8Section
13. 614.29 (1) of the statutes is amended to read:
AB701,9,159
614.29
(1) Right to amend articles. The articles of a fraternal may provide for
10amendment by the supreme governing body or by the board of directors, and may
11provide also for amendment by the members by referendum. If amendment is by
12referendum, a majority of those members who vote must vote affirmatively. Votes
13cast within 60 days from the date of mailing of the
first ballot ballots by the fraternal
14shall be counted. The timeliness of a vote is determined by the date of its mailing
15as proved by its postmark or other suitable evidence.
AB701, s. 14
16Section
14. 614.42 (1) (a) of the statutes is amended to read:
AB701,9,2417
614.42
(1) (a)
Board of directors. A board with some directors elected directly
18by the members or by their representatives in intermediate assemblies under sub.
19(2), and other directors prescribed in the fraternal's laws. The elected directors shall
20constitute a majority in number and not less than the number of votes required to
21amend those articles or bylaws of the fraternal that can be amended without consent
22of the members. The board shall meet at least quarterly to conduct the business of
23the fraternal. The elected directors shall be elected on a plan that ensures equal
24weight to each fraternal member's vote. Voting may be
conducted by mail
, by
1electronic means, or by any other method or combination of methods approved by the
2board and prescribed in the fraternal's bylaws.
AB701, s. 15
3Section
15. 615.03 (5) of the statutes is amended to read:
AB701,10,84
615.03
(5) Application of chapters 600 to 646. The commissioner may by rule
5or order impose on licensees under this chapter any other provisions of chs. 600 to
6646 applicable to ch. 611 corporations, if necessary to protect the interests of
7annuitants or the public
, except that the commissioner may not impose the
8provisions of s. 620.23 (1) (d), (2) (a), and (5) on a licensee under this chapter.
AB701, s. 16
9Section
16. 615.10 (5) (intro.) of the statutes is created to read:
AB701,10,1110
615.10
(5) (intro.) All of the following apply to the investment of the assets of
11a segregated account under this section:
AB701,10,1514
615.10
(5) (a) Assets
of a segregated account under this section shall be
15invested in accordance with ch. 881.
AB701, s. 18
16Section
18. 615.10 (5) (b) of the statutes is created to read:
AB701,10,1817
615.10
(5) (b) No more than 50 percent of the assets may be invested in common
18stock.
AB701, s. 19
19Section
19. 615.10 (5) (c) of the statutes is created to read:
AB701,10,2120
615.10
(5) (c) No more than 10 percent of the assets may be invested in the
21common stock of any single corporation and its affiliates.
AB701, s. 20
22Section
20. 615.10 (5) (d) of the statutes is created to read:
AB701,11,223
615.10
(5) (d) Assets that are invested in a mutual fund or other investment
24company shall be treated as if the licensee directly owned, in proportion to the
1amount invested, the same types of assets and in the same proportional share as the
2assets owned by the mutual fund or other investment company.
AB701, s. 21
3Section
21. 628.10 (5) (a) of the statutes is amended to read:
AB701,11,164
628.10
(5) (a)
Reinstatement within 12 months. An intermediary who is a
5natural person and whose license is revoked under sub. (2) (a), (am), or (cm) may have
6his or her license reinstated within 12 months after the date on which the license was
7revoked without having to satisfy any prelicensing education or examination
8requirements under s. 628.04. To have his or her license reinstated, the intermediary
9must satisfy the requirement under sub. (2) (a), (am), or (cm) for which the license
10was revoked, satisfactorily complete a reinstatement application, and pay
the
11application fee for original licensure twice the amount of the license renewal fee as
12specified by rule. The reinstatement is effective on the date on which the
13commissioner actually reinstates the license. If the intermediary is also a resident
14who is required to complete continuing education, the intermediary must have
15satisfied all previous continuing education requirements to have his or her license
16reinstated under this paragraph.
AB701, s. 22
17Section
22. 632.32 (2) (ag) of the statutes is created to read:
AB701,11,1818
632.32
(2) (ag) "Governmental unit" has the meaning given in s. 50.33 (1r).