SB516, s. 35 16Section 35. 645.69 (1) of the statutes is amended to read:
SB516,15,2117 645.69 (1) A claim against a health maintenance organization insurer or an
18insurer described in s. 609.91 (1m) or (1p) for health care costs, as defined in s. 609.01
19(1j), for which an enrollee, as defined in s. 609.01 (1d), policyholder or insured of the
20health maintenance organization insurer or other insurer is not liable under ss.
21609.91 to 609.935.
SB516, s. 36 22Section 36. 646.01 (1) (b) 19. of the statutes is created to read:
SB516,16,323 646.01 (1) (b) 19. A policy issued by an insurer to an enrollee under Title XVIII
24of the federal social security act, 42 USC 1395 to 1395ccc, or Title XIX of the federal
25social security act, 42 USC 1396 to 1396v, or a contract entered into by an insurer

1with the federal government or an agency of the federal government under Title
2XVIII or Title XIX of the federal social security act, to provide health care or
3prescription drug benefits to persons enrolled in Title XVIII or Title XIX programs.
SB516, s. 37 4Section 37. 646.03 (2n) of the statutes is repealed.
SB516, s. 38 5Section 38. 646.13 (2) (d) of the statutes is amended to read:
SB516,16,156 646.13 (2) (d) Have standing to appear in any liquidation proceedings in this
7state involving an insurer in liquidation, and have authority to appear or intervene
8before a court or agency of any other state having jurisdiction over an impaired or
9insolvent insurer, in accordance with the laws of that state, with respect to which the
10fund is or may become obligated or that has jurisdiction over any person or property
11against which the fund may have subrogation or other rights. Standing shall extend
12to all matters germane to the powers and duties of the fund, including proposals for
13reinsuring, modifying, or guaranteeing the policies or contracts of the impaired or
14insolvent insurer and the determination of the policies or contracts and contractual
15obligations.
SB516, s. 39 16Section 39. 646.13 (4) of the statutes is amended to read:
SB516,16,2117 646.13 (4) When duty to defend terminates. Any obligation of the fund to
18defend an insured ceases upon the fund's payment, by settlement releasing the
19insured
or on a judgment, of an amount equal to the lesser of the fund's covered claim
20obligation limit or the applicable policy limit, subject to any express policy terms
21regarding tender of limits.
SB516, s. 40 22Section 40. 646.31 (1) (b) of the statutes is renumbered 646.31 (1) (b) 1.
SB516, s. 41 23Section 41. 646.31 (1) (b) 2. of the statutes is created to read:
SB516,16,2524 646.31 (1) (b) 2. The claim does not arise out of business against which
25assessments are prohibited under any federal or state law.
SB516, s. 42
1Section 42. 646.31 (4) (a) of the statutes is amended to read:
SB516,17,42 646.31 (4) (a) Except in regard to worker's compensation insurance and except
3as provided in par. (b), the obligation of the fund on a single risk, loss or life may not
4exceed $300,000, regardless of the number of policies or contracts.
SB516, s. 43 5Section 43. 646.31 (12) of the statutes is amended to read:
SB516,17,116 646.31 (12) Net worth of insured. Except for claims under s. 646.35, payment
7of a first-party claim under this chapter to an insured whose net worth, as defined
8in s. 646.325 (1), exceeds $10,000,000 $25,000,000 is limited to the amount by which
9the aggregate of the insured's claims that satisfy subs. (1) to (7), (9) and (9m) plus the
10amount, if any, recovered from the insured under s. 646.325 exceeds 10% of the
11insured's net worth.
SB516, s. 44 12Section 44. 646.32 (1) of the statutes is amended to read:
SB516,17,1813 646.32 (1) Appeal. A claimant whose claim is reduced or declared ineligible
14shall promptly be given notice of the determination and of the right to object under
15this section. The claimant may appeal to the board within 30 days after the mailing
16of the notice. The board may appoint a committee of the board or a hearing examiner
17to decide any such appeal.
The claimant may not pursue the claim in court except as
18provided in sub. (2).
SB516, s. 45 19Section 45. 646.32 (2) of the statutes is amended to read:
SB516,17,2220 646.32 (2) Review. Decisions of the board or its appointed committee or hearing
21examiner
under sub. (1) are subject to judicial review in the circuit court for Dane
22County. A petition for judicial review shall be filed within 60 days of the decision
.
SB516, s. 46 23Section 46. 646.325 (1) of the statutes is amended to read:
SB516,18,1024 646.325 (1) Definition. In this section, "net worth" means the amount of an
25insured's total assets less the insured's total liabilities at the end of the insured's

1fiscal year immediately preceding the date the liquidation order was entered, as
2shown on the insured's audited financial statement, and or other substantiated
3financial information acceptable to the fund in its sole discretion. "Net worth"

4includes the consolidated net worth of all of the corporate affiliates, subsidiaries,
5operating divisions, holding companies, and parent entities that are, and, if the
6insured is privately owned, natural persons who have an ownership interest,
shown
7as insureds or additional insureds on the policy issued by the insurer. If the insured
8is a natural person, "net worth" means the insured's total assets less the insured's
9total liabilities on December 31 immediately preceding the date the liquidation order
10was entered.
SB516, s. 47 11Section 47. 646.325 (2) (a) 1. of the statutes is amended to read:
SB516,18,1312 646.325 (2) (a) 1. An insured whose net worth exceeds $10,000,000
13$25,000,000.
SB516, s. 48 14Section 48. 646.325 (4) of the statutes is created to read:
SB516,18,1915 646.325 (4) Costs and fees. In addition to recovery under sub. (2), the fund may
16recover reasonable attorney fees, disbursements, and all other actual costs expended
17in pursuing recovery under sub. (2), plus interest calculated at the legal rate under
18s. 138.04, which shall begin to accrue on all amounts not paid within 30 days after
19the date of the fund's written notification to the insured of the amount due.
SB516, s. 49 20Section 49. 646.51 (3) (c) of the statutes is amended to read:
SB516,18,2521 646.51 (3) (c) Administrative assessments. The board may authorize
22assessments on a prorated or nonprorated basis to meet administrative costs and
23other expenses whether or not related to the liquidation or rehabilitation of a
24particular insurer. Nonprorated assessments may not exceed $200 $500 per insurer
25in any year.
SB516, s. 50
1Section 50. 646.51 (5) of the statutes is amended to read:
SB516,19,62 646.51 (5) Collection. After the rate of assessment has been fixed, the fund
3shall send to each insurer a statement of the amount it is to pay. The fund shall
4designate whether the assessments shall be made payable in one sum or in
5installments. Assessments shall be collected by the same procedures as premium
6taxes or license fees under ch. 76.
SB516, s. 51 7Section 51. 646.51 (6) of the statutes is amended to read:
SB516,19,138 646.51 (6) Appeal and review. Within 30 days after the fund sends the
9statement under sub. (5), an insurer, after paying the assessment under protest, may
10appeal the assessment to the board or a committee thereof. The decision of the board
11or committee on the appeal is subject to judicial review in the circuit court for Dane
12County. A petition for judicial review shall be filed within 60 days of the board's or
13committee's decision
.
SB516, s. 52 14Section 52. Initial applicability.
SB516,19,1815 (1) The treatment of sections 646.32 (2) and 646.51 (6) of the statutes first
16applies to decisions of the board of directors of the insurance security fund or its
17appointed committee or hearing examiner that are issued on the effective date of this
18subsection.
SB516,19,2119 (2) The treatment of sections 646.31 (12) and 646.325 (2) (a) 1. of the statutes
20first applies to liquidations for which an order of liquidation is issued on the effective
21date of this subsection.
SB516,20,422 (3) If a motor vehicle insurance policy or an umbrella or excess liability policy
23that is in effect on the effective date of this subsection contains a provision that is
24inconsistent with the treatment of section 632.32 (2) (ag), (at), (be), (e) (intro.), 2., or
253., (g) (intro.) or 1., (4) (a) (intro.) or (d), or (4r) (a) or (c) of the statutes, the treatment

1of section 632.32 (2) (ag), (at), (be), (e) (intro.), 2., or 3., (g) (intro.) or 1., (4) (a) (intro.)
2or (d), or (4r) (a) or (c) of the statutes, whichever is applicable, first applies to that
3motor vehicle insurance policy or umbrella or excess liability policy on the date on
4which it is renewed.
SB516,20,55 (End)
Loading...
Loading...