Ins 3.32 History History: Cr. Register, December, 1975, No. 240, eff. 1-1-76; emerg. am. (1), (2) and (3) (a), eff. 6-22-76; am. (1) (2), (3) (a) and (4) (o), Register, September, 1976, No. 249, eff. 10-1-76; am. (2) and (3) (a), Register, March, 1979, No. 279, eff. 4-1-79; am. (2), (3) (c) (intro.), (d), (4) (intro.), (e) to (p) and (r), renum. (3) (a) and (e) to be (3) (e) and (cm) and am., cr. (3) (intro.), (a), (am), (bm) and (c) 4., r. and recr. (3) (b), (4) (q) and (5), Register, November, 1986, No. 371, eff. 12-1-86; emerg. am. (4) (j), eff. 7-5-88; am. (4) (j), Register, October, 1988, No. 396, eff. 1-1-89; correction in (5) made under s. 13.93 (2m) (b) 7., Stats., Register December 2002 No. 564.
Ins 3.33 Ins 3.33 Individual uniform application for health insurance.
Ins 3.33(1)(1)Definitions. For purposes of this section:
Ins 3.33(1)(a) (a) “Individual major medical health insurance policy" means a comprehensive health care plan offered by an insurer authorized to write individual health or disability insurance for an individual or family. Individual major medical health insurance policies excludes limited-scope dental and vision policies, specified disease policies, short-term medical, hospital indemnity, and other limited-benefit individual insurance products and policies issued by an association plan under a group policy that may be underwritten on an individual basis.
Ins 3.33(1)(b) (b) “Individual uniform application" means the uniform questions and format for applications that are to be used by insurers offering individual major medical health insurance policies or certificates, including an individual major medical health insurance coverage provided through an association as individual coverage and underwritten on an individual basis and issued to individuals or families, as it appears as form OCI 26-503 in Appendix 1.
Ins 3.33(2) (2) Application format and requirements.
Ins 3.33(2)(a) (a) In accordance with s. 601.41 (10), Stats., insurers offering individual major medical health insurance policies or certificates must use the questions in the same format as in form OCI 26-503 contained in Appendix 1 as the individual uniform application. The contents of the individual uniform application must not vary, except as permitted in sub. (3) (b), from the text or format including bold character, line spacing, the use of boxes around text and must use a type size of at least 10 points.
Ins 3.33 Note Note: A copy of the individual uniform application form OCI 26-503 (c. 06/2010), required in par. (a), may be obtained at no cost from the Office of the Commissioner of Insurance, P.O. Box 7873, Madison, WI 53707-7873, or at the Office's web address: oci.wi.gov.
Ins 3.33(2)(b) (b) Insurers offering individual major medical health insurance policies or certificates must implement procedures and policies necessary to implement and utilize the individual uniform application.
Ins 3.33(2)(c) (c) Insurers offering individual major medical health insurance policies or certificates must treat and accept a paper copy of the individual major medical health insurance application as an original provided the application is received by the insurer within 45 days from the date the application form was originally signed.
Ins 3.33(3) (3) Web-based applications.
Ins 3.33(3)(a)(a) Insurers offering individual major medical health insurance policies or certificates that permit applicants to complete the application through the insurer's web site may not automatically populate or fill in answers to health questions on the application. An applicant shall answer each question. Insurers may change the order of questions but may not alter the content of any question from the individual uniform application. Insurers must separately request that the applicant respond to questions or information identified in sub. (5). Insurers must send a paper copy of the completed application to the applicant. The paper copy of the completed application must be in the same format as appears in form OCI 26-503 as contained in Appendix 1 and comply with sub. (6).
Ins 3.33(3)(b) (b) If the insurer requires additional or clarifying information related to a response provided on the individual uniform application, an insurer may ask those questions as part of gathering the information contained in sub. (5) or during a separate contact. Insurers must not gather information unrelated to responses requested on the individual uniform application. If an applicant discloses information that is not requested on the individual uniform application, an insurer must not use that information for purposes of underwriting or making a rescission or reformation decision.
Ins 3.33(4) (4) Telephonic applications.
Ins 3.33(4)(a) (a) Insurers offering individual major medical health insurance policies or certificates may permit applicants to complete the application verbally with an authorized, licensed intermediary or with an employee of the insurer asking the applicant the questions. The intermediary or employee must ask the applicant each question on the uniform individual applicant including each health question. Insurers may change the order of questions but may not alter the content of any question from the individual uniform application. Insurers must separately request that the applicant respond to questions or information identified in sub. (5). Insurers must send a paper copy of the completed application to the applicant. The paper copy of the completed application must be in the same format as appears in form OCI 26-503 as contained in Appendix 1 and comply with sub. (6).
Ins 3.33(4)(b) (b) If the insurer requires additional or clarifying information related to a response provided on the individual uniform application, an insurer may ask those questions as part of gathering the information contained in sub. (5) or during a separate contact. Insurers must not gather information unrelated to responses requested on the individual uniform application. If an applicant discloses information that is not requested on the individual uniform application, an insurer must not use that information for purposes of underwriting or making a rescission or reformation decision.
Ins 3.33(5) (5) Additional requirements.
Ins 3.33(5)(a) (a) Insurers offering individual major medical health insurance policies or certificates must include a statement on the first page of the policy that the policy is guaranteed renewable except for the reasons stated s. 632.7495 (2), Stats.
Ins 3.33(5)(b) (b) Insurers must include authorizations, releases, and notices compliant with state and federal law filed with the office as separate forms that will be presented with the individual uniform application but not considered a part of the application.
Ins 3.33(5)(c) (c) Insurers may file a separate form information or election options for the applicant to select deductible, copayment, and coinsurance levels and elect, if applicable, provider networks. Additionally, insurers may include in the form premium payment options for the applicant to select.
Ins 3.33(6) (6) Underwriting. Insurers shall comply with the provisions of s. Ins 3.28, including the requirement to return an accepted application as described in s. Ins 3.28 (5) (d), when underwriting a submitted individual uniform application.
Ins 3.33 Note Note: This section first applies to policies issued after July 1, 2010.
Ins 3.33 History History: CR 10-068: cr. Register December 2010 No. 660, eff. 1-1-11. - See PDF for table PDF
This form is designed for an individual's initial application for coverage. Please contact the insurer with questions regarding this form.
Instructions: Please complete the entire application for each person for whom coverage is being sought. If a person is currently enrolled in Medicare, this application should not be completed for that enrolled individual. If additional pages are needed to fully complete this application, please attach, sign and date each page. - See PDF for table PDF
Primary Applicant/Insured Information:
* If you have a Social Security Number. - See PDF for table PDF
* If you have a Social Security Number. - See PDF for table PDF - See PDF for table PDF
Within the last Five (5) Years:
1. Infectious and Parasitic Diseases - See PDF for table PDF
2. Blood, Gland, Endocrine, Metabolic and Immune Disorders (other than HIV, ARC, AIDS) - See PDF for table PDF
3. Cancer, Cyst and Tumors - See PDF for table PDF
4. Mental/Nervous/Behavioral Disorders - See PDF for table PDF
5. Brain and Nervous System - See PDF for table PDF
6. Skin Disorders - See PDF for table PDF
7. Eyes, Ears, Nose - See PDF for table PDF
8. Mouth, Throat or Jaw - See PDF for table PDF
9. Heart or Circulatory System - See PDF for table PDF
10. Respiratory System - See PDF for table PDF
11. Digestive System - See PDF for table PDF
12. Urinary System - See PDF for table PDF
13. Male or Female Reproductive Systems - See PDF for table PDF
14. Pregnancy, Birth or Congenital Abnormalities - See PDF for table PDF
15. Muscular or Skeletal System - See PDF for table PDF
16. Miscellaneous - See PDF for table PDF
17. Other Injury, Illness, Treatment or Condition - See PDF for table PDF
18. Tobacco Use - See PDF for table PDF
19. Other Activities - See PDF for table PDF
ONLY complete this section if you need assistance with completing the medical information portion of this Application. Please note that this may require additional time to process your application. - See PDF for table PDF - See PDF for table PDF - See PDF for table PDF - See PDF for table PDF - See PDF for table PDF - See PDF for table PDF
Signature (or e-signature) of each listed child who has attained the age of 18 - See PDF for table PDF
Complete this section if someone assisted you in the completion of this Application - See PDF for table PDF
Individual Uniform Application Form
OCI 26-503 (c. 06/2010)
Ins 3.34 Ins 3.34 Coverage of dependent.
Ins 3.34(1)(1)Purpose. This section implements s. 632.885, Stats.
Ins 3.34(2) (2) Applicability.
Ins 3.34(2)(a)(a) This section applies to disability insurance policies as defined at s. 632.895 (1) (a), Stats., that are issued or renewed on or after January 1, 2010, including individual health and group health benefit plans. It applies to limited–scope plans including vision and dental plans but does not include hospital indemnity, income continuation, accident-only benefits, long-term care and Medigap policies. This section also applies to self-insured health plans as defined at s. 632.745 (24), Stats.
Ins 3.34(2)(b) (b) For a disability insurance policy covering employees who are affected by a collective bargaining agreement this coverage under this section first applies as follows:
Ins 3.34(2)(b)1. 1. If the collective bargaining agreement contains provisions consistent with this law or that are silent on dependent eligibility, coverage under this section first applies the earliest of any of the following; the date the disability insurance policy is issued or renewed on or after January 1, 2010, or the date the self-insured health plan is established, modified, extended or renewed on or after January 1, 2010.
Ins 3.34(2)(b)2. 2. If the collective bargaining agreement contains provisions inconsistent with this law, the coverage under this section first applies on the date the health policy is first issued or renewed or a self-insured health plan is first established, modified, extended, or renewed on or after the earlier of the date the collectively bargained agreement expires, or the date the collectively bargained agreement it is modified, extended or renewed.
Ins 3.34(3) (3) Definitions. In this section and for purposes of applying s. 632.885, Stats.:
Ins 3.34(3)(a) (a) “Adult child" means a child of the applicant, enrollee or insured who meets the eligibility requirements of s. 632.885 (2), Stats., as applicable.
Ins 3.34(3)(b) (b) “Premium contribution" means the amount the adult child is required to pay for coverage under the adult child's employer-sponsored group health benefit plan or self-insured health plan.
Ins 3.34(3)(c) (c) “Premium amount" means the additional amount the applicant or insured is required to pay for inclusion of the adult child under the applicant's or insured's health insurance policy or self-insured plan.
Ins 3.34(4) (4) Premium Determination. To determine whether an adult child meets the eligibility standard in s. 632.885 (2) (a) 3., Stats., the insurer or self-insured health plan must use only the following:
Ins 3.34 Note Note: 2011 Wis. Act 32 repealed s. 632.885 (2) (a) 1. to 3., Stats. See s. 632.885 (2) (a), Stats.
Ins 3.34(4)(a) (a) The amount of the adult child's premium contribution.
Ins 3.34(4)(b) (b) The amount of the applicant's or insured's premium amount.
Ins 3.34(5) (5) Offer of coverage.
Ins 3.34(5)(a)(a) On or after January 1, 2010, an insurer and self-insured health plan shall offer coverage to an adult child of an applicant or insured as a new entrant when the applicant or insured requests enrollment of the adult child no later than 30 days after the date the adult child first becomes eligible according to this section. It is solely the applicant's or insured's decision whether or not to add eligible adult children to the plan to the extent permitted by law.
Ins 3.34(5)(b) (b) Insurers and self-insured health plans may not limit or otherwise restrict the offer of coverage to an eligible adult child by requiring any of the following:
Ins 3.34(5)(b)1. 1. The eligible adult child to have been previously covered as a dependent.
Ins 3.34(5)(b)2. 2. The eligible adult child to reside in this state.
Ins 3.34(5)(b)3. 3. The eligible adult child to demonstrate that he or she had previous creditable coverage.
Ins 3.34(5)(b)4. 4. The insured or applicant to have requested coverage for an eligible adult child the first time the child was eligible for coverage.
Ins 3.34(5)(c) (c) Insurers offering individual disability insurance may individually rate the eligible adult child and apply preexisting condition waiting periods consistent with s. 632.76 (2) (ac) 2., Stats., and may apply elimination riders to the eligible adult child, but may not do either of the following:
Ins 3.34(5)(c)1. 1. Deny coverage to an eligible adult child when the applicant or insured requests coverage.
Ins 3.34(5)(c)2. 2. Otherwise limit coverage if such limitation results in coverage that is illusory.
Ins 3.34(5)(d) (d) Insurers offering group disability insurance policies and self-insured health plans shall comply with all of the following:
Ins 3.34(5)(d)1. 1. May not deny coverage of an eligible adult child when coverage is requested by the applicant or insured.
Ins 3.34(5)(d)2. 2. Shall apply portability rights to an eligible adult child so long as the adult child has not had a break in creditable coverage longer than 62 days.
Ins 3.34(5)(d)3. 3. Shall comply with s. 632.746, Stats., as applicable.
Ins 3.34(5)(d)4. 4. May request documentation of the adult child's creditable coverage for determining portability. The pre-existing condition waiting period applicable to the eligible adult child shall be applied to the adult child in the same manner as applied to any other applicant or eligible dependent.
Ins 3.34(6) (6) Eligible adult child.
Ins 3.34(6)(a)(a) For purposes of this section and implementation of s. 632.885 (2), Stats., an adult child is eligible for coverage as a dependent if either of the following is met:
Ins 3.34(6)(a)1. 1. For an adult child who has not been called to federal active duty in the national guard or in a reserve component of the U.S. armed forces, either of the following:
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Published under s. 35.93, Stats. Updated on the first day of each month. Entire code is always current. The Register date on each page is the date the chapter was last published.