SB516: Bill Text

SB516,7,8 (3) Deductibles, copayments and premiums. Subsections (1) to (2) do not affect the liability of an enrollee, policyholder or insured for any deductibles, copayments or premiums owed under the policy or certificate issued by the health maintenance organization insurer or by the insurer described in sub. (1m) or (1p).

SB516,7,14 (4) (a) An agreement, other than a notice of election or termination of election in accordance with s. 609.92 or 609.925, entered into by the provider, the health maintenance organization insurer, the insurer described in sub. (1m) or (1p) or any other person, at any time, whether oral or written and whether implied or explicit, including an agreement that purports to hold the enrollee, policyholder or insured liable for health care costs.

SB516,7,19 (b) A breach of or default on an agreement by the health maintenance organization insurer, the insurer described in sub. (1m) or (1p) or any other person to compensate the provider, directly or indirectly, for health care costs, including health care costs for which the enrollee, policyholder or insured is not liable under sub. (1) or, (1m), or (1p).

SB516,8,2 (cm) The insolvency of the insurer described in sub. (1m) or (1p) or any person contracting with the insurer or provider, or the commencement or the existence of conditions permitting the commencement of insolvency, delinquency or bankruptcy proceedings involving the insurer or other person, including delinquency proceedings, as defined in s. 645.03 (1) (b), under ch. 645, despite whether the insurer or other person has agreed to compensate, directly or indirectly, the provider for health care costs for which the enrollee, policyholder or insured is not liable under sub. (1m) or (1p).

SB516,8,7 (d) The inability of the provider or other person who is owed compensation for health care costs to obtain compensation from the health maintenance organization insurer, the insurer described in sub. (1m) or (1p), or any other person for health care costs for which the enrollee, policyholder or insured is not liable under sub. (1) or, (1m), or (1p).

SB516, s. 10 Section 10. 611.33 (2) (b) 1. of the statutes is repealed.

SB516, s. 11 Section 11. 611.33 (2) (b) 2. of the statutes is repealed.

SB516, s. 12 Section 12. 612.22 (3) (a), (4) and (6) of the statutes are amended to read:

SB516,8,20 612.22 (3) (a) Each of the participating corporations shall file with the commissioner for approval a copy of the resolution and any explanatory material proposed to be issued to the members who have the right to vote on the merger under sub. (4), together with so much of the information under s. 611.13 (2) or 612.02 (4), whichever is appropriate, for the surviving or new corporation as the commissioner reasonably requires. The commissioner shall approve the plan unless he or she finds, after a hearing, that it would be contrary to the law, or that the surviving or new corporation would not satisfy the requirements for a certificate of authority under s. 611.20 or 612.02 (6), whichever is appropriate, or that the plan would be contrary to the interest of insureds or of the public.

SB516,9,2 (4) Approval by members of the mutuals. After being approved by the commissioner under sub. (3), the plan shall be submitted for approval to the members of the participating town mutual or mutuals for their approval and to the members of the participating domestic mutual if the domestic mutual is assessable. The members of each participating mutual who have the right to vote on the merger shall vote separately.

SB516,9,7 (6) Reports to commissioner. Each participating mutual, the members of which have the right to vote under sub. (4), shall file with the commissioner a copy of the resolution adopted under sub. (4), stating the number of members entitled to vote, the number of members voting, and the number of votes cast in favor of the plan, stating separately in each case the mail votes and the votes cast in person.

SB516, s. 13 Section 13. 614.29 (1) of the statutes is amended to read:

SB516,9,15 614.29 (1) Right to amend articles. The articles of a fraternal may provide for amendment by the supreme governing body or by the board of directors, and may provide also for amendment by the members by referendum. If amendment is by referendum, a majority of those members who vote must vote affirmatively. Votes cast within 60 days from the date of mailing of the first ballot ballots by the fraternal shall be counted. The timeliness of a vote is determined by the date of its mailing as proved by its postmark or other suitable evidence.

SB516, s. 14 Section 14. 614.42 (1) (a) of the statutes is amended to read:

SB516,9,24 614.42 (1) (a) Board of directors. A board with some directors elected directly by the members or by their representatives in intermediate assemblies under sub. (2), and other directors prescribed in the fraternal's laws. The elected directors shall constitute a majority in number and not less than the number of votes required to amend those articles or bylaws of the fraternal that can be amended without consent of the members. The board shall meet at least quarterly to conduct the business of the fraternal. The elected directors shall be elected on a plan that ensures equal weight to each fraternal member's vote. Voting may be conducted by mail, by electronic means, or by any other method or combination of methods approved by the board and prescribed in the fraternal's bylaws.

SB516, s. 15 Section 15. 615.03 (5) of the statutes is amended to read:

SB516,10,8 615.03 (5) Application of chapters 600 to 646. The commissioner may by rule or order impose on licensees under this chapter any other provisions of chs. 600 to 646 applicable to ch. 611 corporations, if necessary to protect the interests of annuitants or the public, except that the commissioner may not impose the provisions of s. 620.23 (1) (d), (2) (a), and (5) on a licensee under this chapter.

SB516, s. 16 Section 16. 615.10 (5) (intro.) of the statutes is created to read:

SB516,10,11 615.10 (5) (intro.) All of the following apply to the investment of the assets of a segregated account under this section:

SB516, s. 17 Section 17. 615.10 (5) of the statutes, as affected by 2009 Wisconsin Act 33, is renumbered 615.10 (5) (a) and amended to read:

SB516,10,15 615.10 (5) (a) Assets of a segregated account under this section shall be invested in accordance with ch. 881.

SB516, s. 18 Section 18. 615.10 (5) (b) of the statutes is created to read:

SB516,10,18 615.10 (5) (b) No more than 50 percent of the assets may be invested in common stock.

SB516, s. 19 Section 19. 615.10 (5) (c) of the statutes is created to read:

SB516,10,21 615.10 (5) (c) No more than 10 percent of the assets may be invested in the common stock of any single corporation and its affiliates.

SB516, s. 20 Section 20. 615.10 (5) (d) of the statutes is created to read:

SB516,11,2 615.10 (5) (d) Assets that are invested in a mutual fund or other investment company shall be treated as if the licensee directly owned, in proportion to the amount invested, the same types of assets and in the same proportional share as the assets owned by the mutual fund or other investment company.

SB516, s. 21 Section 21. 628.10 (5) (a) of the statutes is amended to read:

SB516,11,16 628.10 (5) (a) Reinstatement within 12 months. An intermediary who is a natural person and whose license is revoked under sub. (2) (a), (am), or (cm) may have his or her license reinstated within 12 months after the date on which the license was revoked without having to satisfy any prelicensing education or examination requirements under s. 628.04. To have his or her license reinstated, the intermediary must satisfy the requirement under sub. (2) (a), (am), or (cm) for which the license was revoked, satisfactorily complete a reinstatement application, and pay the application fee for original licensure twice the amount of the license renewal fee as specified by rule. The reinstatement is effective on the date on which the commissioner actually reinstates the license. If the intermediary is also a resident who is required to complete continuing education, the intermediary must have satisfied all previous continuing education requirements to have his or her license reinstated under this paragraph.

SB516, s. 22 Section 22. 632.32 (2) (ag) of the statutes is created to read:

SB516,11,18 632.32 (2) (ag) "Governmental unit" has the meaning given in s. 50.33 (1r).

SB516, s. 23 Section 23. 632.32 (2) (at) of the statutes, as affected by 2009 Wisconsin Act 28, is amended to read:

SB516,12,2 632.32 (2) (at) "Motor vehicle" means a self-propelled land motor vehicle designed for travel on public roads and subject to motor vehicle registration under ch. 341. It includes trailers and semitrailers A trailer or semitrailer that is designed for use with such vehicles. It and connected to a motor vehicle shall be considered a single unit with the motor vehicle. "Motor vehicle" does not include farm tractors, well drillers, road machinery, or snowmobiles.

SB516, s. 24 Section 24. 632.32 (2) (be) of the statutes is created to read:

SB516,12,5 632.32 (2) (be) "Owned motor vehicle" means a motor vehicle that is owned by the insured or that is leased by the insured for a term of 6 months or longer.

SB516, s. 25 Section 25. 632.32 (2) (e) (intro.) of the statutes, as created by 2009 Wisconsin Act 28, is amended to read:

SB516,12,10 632.32 (2) (e) (intro.) "Underinsured motor vehicle" means a motor vehicle, other than a motor vehicle owned by a governmental unit, to which all of the following apply:

SB516, s. 26 Section 26. 632.32 (2) (e) 2. of the statutes, as created by 2009 Wisconsin Act 28, is amended to read:

SB516,12,17 632.32 (2) (e) 2. A At the time of the accident, a bodily injury liability insurance policy applies to the motor vehicle at the time of the accident or the owner or operator of the motor vehicle has furnished proof of financial responsibility for the future under subch. III of ch. 344 and it is in effect or is a self-insurer under another applicable motor vehicle law.

SB516, s. 27 Section 27. 632.32 (2) (e) 3. of the statutes, as created by 2009 Wisconsin Act 28, is amended to read:

SB516,12,22 632.32 (2) (e) 3. The limits under the bodily injury liability insurance policy or with respect to the proof of financial responsibility or self-insurance are less than the amount needed to fully compensate the insured for his or her damages.

SB516, s. 28 Section 28. 632.32 (2) (g) (intro.) of the statutes, as created by 2009 Wisconsin Act 28, is amended to read:

SB516,13,9 632.32 (2) (g) (intro.) "Uninsured motor vehicle" means a motor vehicle, other than a motor vehicle owned by a governmental unit, that is involved in an accident with a person who has uninsured motorist coverage and with respect to which, at the time of the accident, a bodily injury liability insurance policy is not in effect and the owner or operator has not furnished proof of financial responsibility for the future under subch. III of ch. 344 and is not a self-insurer under any other applicable motor vehicle law. "Uninsured motor vehicle" also includes any of the following motor vehicles, other than a motor vehicle owned by governmental unit, involved in an accident with a person who has uninsured motorist coverage:

SB516, s. 29 Section 29. 632.32 (2) (g) 1. of the statutes, as created by 2009 Wisconsin Act 28, is amended to read:

SB516,13,15 632.32 (2) (g) 1. An insured motor vehicle, or a motor vehicle with respect to which the owner or operator is a self-insurer under any applicable motor vehicle law, if before or after the accident the liability insurer of the motor vehicle, or the self-insurer, is declared insolvent by a court of competent jurisdiction.

SB516, s. 30 Section 30. 632.32 (4) (a) (intro.) of the statutes, as affected by 2009 Wisconsin Act 28, is amended to read:

SB516,13,23 632.32 (4) (a) (intro.) Every Except as provided in par. (d), every policy of insurance subject to this section that insures with respect to any owned motor vehicle registered or principally garaged in this state against loss resulting from liability imposed by law for bodily injury or death suffered by any person arising out of the ownership, maintenance, or use of a motor vehicle shall contain therein or supplemental thereto provisions for all of the following coverages:

SB516, s. 31 Section 31. 632.32 (4) (d) of the statutes is created to read:

SB516,14,2 632.32 (4) (d) This subsection does not apply to umbrella or excess liability policies, which are subject to sub. (4r).

SB516, s. 32 Section 32. 632.32 (4r) (a) of the statutes, as created by 2009 Wisconsin Act 28, is amended to read:

SB516,14,13 632.32 (4r) (a) An insurer writing umbrella or excess liability policies that insure with respect to a an owned motor vehicle registered or principally garaged in this state against loss resulting from liability imposed by law for bodily injury or death suffered by a person arising out of the ownership, maintenance, or use of a motor vehicle shall provide written offers of uninsured motorist coverage and underinsured motorist coverage, which offers shall include a brief description of the coverage offered. An insurer is required to provide the offers required under this subsection only one time with respect to any policy in the manner provided in par. (b).

SB516, s. 33 Section 33. 632.32 (4r) (c) of the statutes, as created by 2009 Wisconsin Act 28, is amended to read:

SB516,14,22 632.32 (4r) (c) An applicant or a named insureds insured may reject one or both of the coverages offered, but must do so in writing. If the applicant or named insureds reject insured rejects either of the coverages offered, the insurer is not required to provide the rejected coverage under a the policy that is renewed to the person at renewal by that insurer unless an insured under the policy subsequently requests the rejected coverage in writing. The action of one named insured to reject or request coverage applies to all persons insured under the policy.

SB516, s. 34 Section 34. 632.897 (11) of the statutes is created to read:

SB516,15,7 632.897 (11) (a) Notwithstanding subs. (2) to (10), the commissioner may promulgate rules establishing standards requiring insurers to provide continuation of coverage for any individual covered at any time under a group policy who is a terminated insured or an eligible individual under any federal program that provides for a federal premium subsidy for individuals covered under continuation of coverage under a group policy, including rules governing election or extension of election periods, notice, rates, premiums, premium payment, application of preexisting condition exclusions, election of alternative coverage, and status as an eligible individual, as defined in s. 149.10 (2t).

SB516,15,15 (b) The commissioner may promulgate the rules under par. (a) as emergency rules under s. 227.24. Notwithstanding s. 227.24 (1) (c), emergency rules promulgated under this paragraph may remain in effect for one year and may be extended under s. 227.24 (2). Notwithstanding s. 227.24 (1) (a) and (3), the commissioner is not required to provide evidence that promulgating a rule under this paragraph as an emergency rule is necessary for the preservation of the public peace, health, safety, or welfare and is not required to provide a finding of emergency for a rule promulgated under this paragraph.

SB516, s. 35 Section 35. 645.69 (1) of the statutes is amended to read:

SB516,15,21 645.69 (1) A claim against a health maintenance organization insurer or an insurer described in s. 609.91 (1m) or (1p) for health care costs, as defined in s. 609.01 (1j), for which an enrollee, as defined in s. 609.01 (1d), policyholder or insured of the health maintenance organization insurer or other insurer is not liable under ss. 609.91 to 609.935.

SB516, s. 36 Section 36. 646.01 (1) (b) 19. of the statutes is created to read:

SB516,16,3 646.01 (1) (b) 19. A policy issued by an insurer to an enrollee under Title XVIII of the federal social security act, 42 USC 1395 to 1395ccc, or Title XIX of the federal social security act, 42 USC 1396 to 1396v, or a contract entered into by an insurer with the federal government or an agency of the federal government under Title XVIII or Title XIX of the federal social security act, to provide health care or prescription drug benefits to persons enrolled in Title XVIII or Title XIX programs.

SB516, s. 37 Section 37. 646.03 (2n) of the statutes is repealed.

SB516, s. 38 Section 38. 646.13 (2) (d) of the statutes is amended to read:

SB516,16,15 646.13 (2) (d) Have standing to appear in any liquidation proceedings in this state involving an insurer in liquidation, and have authority to appear or intervene before a court or agency of any other state having jurisdiction over an impaired or insolvent insurer, in accordance with the laws of that state, with respect to which the fund is or may become obligated or that has jurisdiction over any person or property against which the fund may have subrogation or other rights. Standing shall extend to all matters germane to the powers and duties of the fund, including proposals for reinsuring, modifying, or guaranteeing the policies or contracts of the impaired or insolvent insurer and the determination of the policies or contracts and contractual obligations.

SB516, s. 39 Section 39. 646.13 (4) of the statutes is amended to read:

SB516,16,21 646.13 (4) When duty to defend terminates. Any obligation of the fund to defend an insured ceases upon the fund's payment, by settlement releasing the insured or on a judgment, of an amount equal to the lesser of the fund's covered claim obligation limit or the applicable policy limit, subject to any express policy terms regarding tender of limits.

SB516, s. 40 Section 40. 646.31 (1) (b) of the statutes is renumbered 646.31 (1) (b) 1.

SB516, s. 41 Section 41. 646.31 (1) (b) 2. of the statutes is created to read:

SB516,16,25 646.31 (1) (b) 2. The claim does not arise out of business against which assessments are prohibited under any federal or state law.

SB516, s. 42 Section 42. 646.31 (4) (a) of the statutes is amended to read:

SB516,17,4 646.31 (4) (a) Except in regard to worker's compensation insurance and except as provided in par. (b), the obligation of the fund on a single risk, loss or life may not exceed $300,000, regardless of the number of policies or contracts.

SB516, s. 43 Section 43. 646.31 (12) of the statutes is amended to read:

SB516,17,11 646.31 (12) Net worth of insured. Except for claims under s. 646.35, payment of a first-party claim under this chapter to an insured whose net worth, as defined in s. 646.325 (1), exceeds $10,000,000 $25,000,000 is limited to the amount by which the aggregate of the insured's claims that satisfy subs. (1) to (7), (9) and (9m) plus the amount, if any, recovered from the insured under s. 646.325 exceeds 10% of the insured's net worth.

SB516, s. 44 Section 44. 646.32 (1) of the statutes is amended to read:

SB516,17,18 646.32 (1) Appeal. A claimant whose claim is reduced or declared ineligible shall promptly be given notice of the determination and of the right to object under this section. The claimant may appeal to the board within 30 days after the mailing of the notice. The board may appoint a committee of the board or a hearing examiner to decide any such appeal. The claimant may not pursue the claim in court except as provided in sub. (2).

SB516, s. 45 Section 45. 646.32 (2) of the statutes is amended to read:

SB516,17,22 646.32 (2) Review. Decisions of the board or its appointed committee or hearing examiner under sub. (1) are subject to judicial review in the circuit court for Dane County. A petition for judicial review shall be filed within 60 days of the decision.

SB516, s. 46 Section 46. 646.325 (1) of the statutes is amended to read:

SB516,18,10 646.325 (1) Definition. In this section, "net worth" means the amount of an insured's total assets less the insured's total liabilities at the end of the insured's fiscal year immediately preceding the date the liquidation order was entered, as shown on the insured's audited financial statement, and or other substantiated financial information acceptable to the fund in its sole discretion. "Net worth" includes the consolidated net worth of all of the corporate affiliates, subsidiaries, operating divisions, holding companies, and parent entities that are, and, if the insured is privately owned, natural persons who have an ownership interest, shown as insureds or additional insureds on the policy issued by the insurer. If the insured is a natural person, "net worth" means the insured's total assets less the insured's total liabilities on December 31 immediately preceding the date the liquidation order was entered.

SB516, s. 47 Section 47. 646.325 (2) (a) 1. of the statutes is amended to read:

SB516,18,13 646.325 (2) (a) 1. An insured whose net worth exceeds $10,000,000 $25,000,000.

SB516, s. 48 Section 48. 646.325 (4) of the statutes is created to read:

SB516,18,19 646.325 (4) Costs and fees. In addition to recovery under sub. (2), the fund may recover reasonable attorney fees, disbursements, and all other actual costs expended in pursuing recovery under sub. (2), plus interest calculated at the legal rate under s. 138.04, which shall begin to accrue on all amounts not paid within 30 days after the date of the fund's written notification to the insured of the amount due.

SB516, s. 49 Section 49. 646.51 (3) (c) of the statutes is amended to read:

SB516,18,25 646.51 (3) (c) Administrative assessments. The board may authorize assessments on a prorated or nonprorated basis to meet administrative costs and other expenses whether or not related to the liquidation or rehabilitation of a particular insurer. Nonprorated assessments may not exceed $200 $500 per insurer in any year.

SB516, s. 50 Section 50. 646.51 (5) of the statutes is amended to read:

SB516,19,6 646.51 (5) Collection. After the rate of assessment has been fixed, the fund shall send to each insurer a statement of the amount it is to pay. The fund shall designate whether the assessments shall be made payable in one sum or in installments. Assessments shall be collected by the same procedures as premium taxes or license fees under ch. 76.

SB516, s. 51 Section 51. 646.51 (6) of the statutes is amended to read:

SB516,19,13 646.51 (6) Appeal and review. Within 30 days after the fund sends the statement under sub. (5), an insurer, after paying the assessment under protest, may appeal the assessment to the board or a committee thereof. The decision of the board or committee on the appeal is subject to judicial review in the circuit court for Dane County. A petition for judicial review shall be filed within 60 days of the board's or committee's decision.

SB516, s. 52 Section 52. Initial applicability.