Ins 6.61(9)
(9)
Special requirements for newly issued contracts. Each intermediary shall maintain records for a 3-year period giving the effective date of the coverage on all newly issued contracts.
Ins 6.61(10)
(10)
Special requirements for individually-issued life and accident and health contracts. Each intermediary shall maintain records for a 3-year period indicating that the necessary suitability inquiry and replacement procedures required by ss.
Ins 2.07,
2.14 (5) (f),
2.15 (9) (f),
3.27 (7), and
3.29 were followed for each individually-issued life and accident and health contract written or replaced or both.
Ins 6.61(11)
(11)
Special requirements for title insurance. Each intermediary who is employed by, or is, an affiliate of a producer of title insurance shall maintain records for 3 years for each application or order for title insurance accepted in this state. The records shall state whether the application or order was directly or indirectly referred as provided by s.
Ins 3.32 (5) by a producer of title insurance which is an affiliate as defined by s.
Ins 3.32 (3) (a),
(bm) and
(c) and the name of each producer of title insurance who is an affiliate and acts as broker, agent, lender, representative or attorney in the transaction which resulted in the application or order. Each intermediary who is an affiliate of a producer of title insurance shall maintain a record of gross revenue from operations in this state from title insurance by quarter calendar year which shall separately show gross revenue from operations in this state derived from applications or orders for title insurance directly or indirectly referred by the affiliate.
Ins 6.61(12)
(12)
Place of maintaining records. The intermediary shall maintain records required by subs.
(8),
(9),
(10) and
(11) at the business address of the intermediary or the insurer recorded with the commissioner of insurance, or at another location only if the intermediary provides written notice of the other location to the commissioner of insurance.
Ins 6.61(13)
(13)
Updating records. The intermediary shall update all intermediary records at reasonable intervals or as necessary and shall maintain all financial intermediary records according to accepted accounting principles.
Ins 6.61(14)
(14)
Maintaining policyholder records. The intermediary shall retain policyholder records for a period of at least 3 years after termination or lapse of the policy.
Ins 6.61(15)
(15)
Change of name or address. Each intermediary shall, within 30 days, notify the commissioner of insurance in writing in a manner prescribed by the commissioner of any change in the intermediary's name, residence address, contact email address, business address or mailing address.
Ins 6.61(16)
(16)
Notification of formal administrative actions, criminal proceedings and lawsuits. Each intermediary shall notify the commissioner in writing of the following within 30 days:
Ins 6.61(16)(a)
(a) Except for action taken by the Wisconsin office of the commissioner of insurance, any formal administrative action against the intermediary taken by any state's insurance regulatory agency, commission or board or other regulatory agency which licenses the person for any occupational activity. The notification shall include a description of the basis for the administrative action and any action taken as a result of the proceeding, a copy of the notice of hearing and other documents describing the problem, a copy of the order, consent to order, stipulation, final resolution and other relevant documents.
Ins 6.61(16)(b)
(b) Any initial pretrial hearing date related to any criminal prosecution of the intermediary taken in any jurisdiction, other than a misdemeanor charge related to the use of a motor vehicle or the violation of a fish and game regulation. The notification shall include a copy of the initial criminal complaint filed, the order resulting from the hearing and any other relevant legal documents.
Ins 6.61(16)(c)
(c) Any felony conviction or misdemeanor conviction in any jurisdiction, other than a misdemeanor conviction related to the use of a motor vehicle or the violation of a fish and game regulation. The notification shall include a copy of the initial criminal complaint or criminal charging document filed, the judgement of conviction, the sentencing document, the intermediary's explanation of what happened to cause criminal proceedings, the intermediary's reasons why no action should be taken regarding the intermediary's license and any other relevant legal documents.
Ins 6.61(16)(d)
(d) Any lawsuit filed against the licensee or the licensee's business in which there are allegations of misrepresentation, fraud, theft or embezzlement involving the licensee or the licensee's business. The notification shall include a copy of the initial suit documents, the intermediary's explanation of what happened to cause the civil proceedings, the intermediary's reasons why no action should be taken regarding the intermediary's license and any other relevant legal documents.
Ins 6.61(17)
(17)
Records maintained by insurers. An insurer shall inform its intermediaries in writing of the requirements of this section and may, by written agreement, assume the responsibility to maintain these records for an individual intermediary if the records can be made immediately available to the commissioner of insurance on demand.
Ins 6.61 History
History: Cr.
Register, March, 1977, No. 255, eff. 4-1-77; am.,
Register, March, 1979, No. 279, eff. 4-1-79; cr. (5),
Register, September, 1981, No. 309, eff. 10-1-81; cr. (2m),
Register, November, 1986, No. 371, eff. 12-1-86; r. and recr.
Register, December, 1987, No. 384, eff. 1-1-88; am. (16),
Register, August, 1988, No. 392, eff. 9-1-88; am. (16),
Register, April, 1992, No. 436, eff. 5-1-92; am. (15),
Register, January, 1999, No. 517, eff. 2-1-99;
CR 01-074; am. (3) (e), r. and recr. (16),
Register January 2002 No. 553, eff. 2-1-02;
CR 05-111: am. (3) (f)
Register October 2006 No. 610, eff. 11-1-06;
CR 09-022: am. (15)
Register August 2009 No. 644, eff. 9-1-09;
CR 19-025: am. (15)
Register August 2020 No. 776, eff. 9-1-20.
Ins 6.62
Ins 6.62
Filing requirements for multiple employer trusts and associations. Ins 6.62(1)(b)1.1. “Multiple employer trust or association," except as provided by subd.
2., means a trust, association or other person which provides or offers to provide health care benefits or coverage to employees of 2 or more employers and which is:
Ins 6.62(1)(b)1.c.
c. Located outside this state and is not organized and regulated as an insurer domiciled in the United States.
Ins 6.62(1)(b)2.
2. “Multiple employer trust or association" does not include a person which:
Ins 6.62(1)(b)2.a.
a. Provides benefits or coverage under or pursuant to a collective bargaining agreement;
Ins 6.62(1)(b)2.b.
b. Is, or which provides benefits or coverage which are fully insured by, an insurer licensed to do business in this state;
Ins 6.62(1)(b)2.c.
c. Provides health care benefits or coverage solely to employees of governmental units;
Ins 6.62(2)
(2) No intermediary may solicit, advertise, or market in this state or accept an application or place coverage for a person who resides in this state with a multiple employer trust or association unless prior to solicitation, advertising, marketing, acceptance of the application, or placing the coverage:
Ins 6.62(2)(a)
(a) The multiple employer trust or association files with the office the information required under sub.
(5); or
Ins 6.62(3)
(3) No multiple employer trust or association may solicit, advertise, or market in this state or accept an application for coverage from a person who is a resident, or who has employees who are residents, of this state unless prior to soliciting, advertising, marketing, or accepting an application it files with the office the information required under sub.
(5).
Ins 6.62(4)
(4) If subsequent to a filing under sub.
(2) or
(3) changes occur so that the information contained in the filing is no longer accurate, the multiple employer trust or association or intermediary which made the filing shall within 15 days of the date the change is effective make a filing under sub.
(5) with the correct information.
Ins 6.62(5)
(5) A multiple employer trust or association or intermediary required to file information under sub.
(2),
(3), or
(4) shall file a properly completed form prescribed by the commissioner and shall attach:
Ins 6.62(5)(a)
(a) A copy of any insurance policy or contract covering benefits or coverage offered by the multiple employer trust or association;
Ins 6.62(5)(b)
(b) A copy of the organizational documents of the multiple employer trust or association, including the articles of incorporation, bylaws or trust instrument; and
Ins 6.62(5)(c)
(c) A statement that the benefits or coverage are fully insured or a description of the extent to which they are not fully insured.
Ins 6.62(6)
(6) A violation of sub.
(2),
(3), or
(4) is an unfair and deceptive trade practice under s.
628.34 (12), Stats., constitutes a method or practice in the conduct of business which endangers the legitimate interests of customers and the public under s.
628.10 (2), Stats., and, if the multiple employer trust or association is an unauthorized insurer, establishes that the person violating the rule should have known that the multiple employer trust or association is an unauthorized insurer for the purpose of ss.
618.39 and
618.44, Stats.
Ins 6.62(7)
(7) This section is in addition to any provision of chs.
600 to
646, Stats.
Ins 6.62 Note
Note: This rule requires use of a reporting form “Multiple Employer Trust Filing" which may be obtained from the Office of the Commissioner of Insurance, 121 E. Wilson Street, P.O. Box 7873, Madison, Wisconsin, 53707-7873.
Ins 6.62 History
History: Emerg. cr. eff. 1-1-90; cr.
Register, May, 1990, No. 413, eff. 6-1-90.
Ins 6.63(1)(1)
The renewal fee to be paid biennially in a payment type prescribed by the commissioner, by each licensed individual intermediary-agent is:
Resident agent $ 35.00
Nonresident agent $ 70.00
Ins 6.63(2)
(2) Renewal fees are due on the last day of the intermediary's birth month every other year. OCI will send a renewal fee notice in a manner prescribed by the commissioner at least 60 days prior to the fee due date to each intermediary.
Ins 6.63(3)
(3) Any resident individual intermediary whose license is terminated for failing to pay renewal fees or failing to complete required continuing education or revoked for failing to pay unemployment insurance contributions or failing to pay delinquent taxes may, within 12 months from the termination or revocation date, apply to be relicensed for the same license without completing prelicensing education or passing a written examination. Resident licensees who are required to complete continuing education must have all previous requirements met. The application fee shall be as specified in s.
628.10 (5) (a), Stats. If a resident license has been terminated or revoked for more than 12 months, the intermediary shall, in order to be relicensed, satisfy the examination and licensing requirements established by s.
Ins 6.59.
Ins 6.63(4)
(4) Intermediaries with a Surplus Lines license shall pay an annual renewal fee of $100.00 on or before the assigned expiration date each year. OCI will send a renewal fee notice in a manner prescribed by the commissioner at least 60 days prior to the fee due date to each intermediary surplus lines agent at the address on file with the office of the commissioner of insurance. Any resident individual intermediary whose surplus lines license is terminated for failing to pay renewal fees or revoked for failing to pay unemployment insurance contributions or failing to pay delinquent taxes must apply to be relicensed.
Ins 6.63 History
History: Cr.
Register, December, 1977, No. 264, eff. 1-1-78; am. (1) to (3),
Register, September, 1981, No. 309, eff. 1-1-82; r. and recr. (4) to (6),
Register, October, 1981, No. 310, eff. 11-1-81; am. (1),
Register, November, 1995, No. 479, eff. 12-1-95;
CR 01-074: am. (3) to (5), r. (2),
Register January 2002 No. 553, eff. 2-1-02;
CR 05-111: r. and recr.
Register October 2006 No. 610, eff. 11-1-06;
CR 09-022: am. (1) (a), (2) and (3), r. (1) (b)
Register August 2009 No. 644, eff. 9-1-09; renumber of (1) (a) to (1) made under s.
13.92 (4) (b) 1., Stats.,
Register August 2009 No. 644;
CR 19-025: am. (2) to (4)
Register August 2020 No. 776, eff. 9-1-20.
Ins 6.66
Ins 6.66
Proper exchange of business. Ins 6.66(1)(1)
The purpose of this rule is to interpret s.
628.61, Stats., regarding the proper exchange of business between agent intermediaries.
Ins 6.66(2)
(2) Proper exchange of business means the forwarding of insurance business from one agent who cannot, after due consideration, place the business with any of the insurers for which the agent is listed because of capacity problems, the refusal of the company to accept the risk or the onerous conditions it imposes on the insured, to another agent licensed for those lines of insurance whose insurers are able to accommodate the risk under conditions more favorable to the insured. The agent forwarding the business is entitled to split the commission involved. Proper exchange of business is not the regular course of business and such forwarding of business is thereby distinguished from brokerage by its occasional and exceptional nature.
Ins 6.66(3)
(3) No agent may properly exchange business with another agent, unless:
Ins 6.66(3)(a)
(a) The agent forwarding the business to a listed agent is licensed for the lines of business that are being exchanged;
Ins 6.66(3)(b)
(b) The agent who receives the business and agrees to place it is licensed in the line or lines of insurance involved in the exchange; and
Ins 6.66(3)(c)
(c) Both the agent forwarding the business and the agent who places the business with the insurer sign the insurance application, or if no application is completed, the names of the agents involved in the transaction appear on the policy issued.
Ins 6.66(4)
(4) No agent shall accept business solicited by another intermediary-agent which he or she knows, or has reason to know, is not exchanged in compliance with the provisions of this rule.
Ins 6.66(5)(a)(a) In the absence of evidence to the contrary, an intermediary-agent shall be presumed to have exceeded the occasional exchange of business if he or she places more than 5 insurance risks per calendar year with any single insurer with which he or she is not listed as an intermediary-agent, or exchanges in total more than 25 insurance risks per calendar year.
Ins 6.66(5)(b)
(b) The burden of showing that specialty lines, non-standard and professional liability business placed through surplus lines intermediaries in accordance with s.
618.41, Stats., or written on an excess rate or other individually rated risk basis beyond the limits prescribed for other exchanges of business in par.
(a) is occasional and otherwise in compliance with this rule, shall be upon the intermediary-agent soliciting and forwarding such business.
Ins 6.66(6)
(6) The exchange of business among intermediary-agents and participation by intermediaries in risk sharing plans approved according to ch.
619, Stats., shall not be limited in any way by this section.
Ins 6.66 History
History: Cr.
Register, March, 1979, No. 279, eff. 4-1-79; am. (4) (d),
Register, May, 1979, No. 281, eff. 6-1-79; am. (1), (2) (intro.) and (3), r. (2) (a) and (4), renum. (2) (b), to (d) to be (2) (a) to (c) and am.,
Register, September, 1982, No. 321, eff. 10-1-82; renum. (1) to (3) and (7) to be (2) to (4) and (6) and am. (6), cr. (1), r. (6),
Register, August, 1988, No. 392, eff. 9-1-88.
Ins 6.67
Ins 6.67
Unfair discrimination in life and disability insurance. Ins 6.67(1)(1)
Purpose. The purpose of this rule is to identify specific acts or practices in life and disability insurance found to be unfairly discriminatory under s.
628.34 (3) (b), Stats.
Ins 6.67 Note
Note: The need for a rule has arisen because of questions as to whether life and disability insurers are in all cases fairly “charging different premiums or offering different terms of coverage except on the basis of classifications related to the nature and degree of the risk covered." (s.
628.34 (3), Stats.) The main purpose of the rule is to make clear that life and disability insurers cannot classify individuals arbitrarily—without a rational basis for each decision.
Ins 6.67(2)
(2)
Applicability and scope. This rule shall apply to all life and disability insurance policies delivered or issued for delivery in Wisconsin on or after January 1, 1980 and to all existing life and disability group, blanket and franchise insurance policies subject to Wisconsin insurance law which are amended or renewed on or after January 1, 1980.
Ins 6.67(2m)(b)
(b) “Territorial classification" means an arrangement of persons into categories based upon geographic characteristics other than zip code.
Ins 6.67(3)
(3)
Specific examples. The following are specific examples of unfair discrimination under s.
628.34 (3) (b), Stats.
Ins 6.67(3)(a)
(a) Refusing to insure, or refusing to continue to insure, or limiting the amount, extent or kind of coverage available to an individual or charging a different rate for the same coverage solely because of physical or mental impairment, other than blindness or partial blindness, except where the refusal, limitation or rate differential is based on sound actuarial principles or is related to actual or reasonably anticipated experience.
Ins 6.67(3)(b)
(b) Except as provided in subds.
1. and
2., refusing to insure, or refusing to continue to insure, or limiting the amount, extent or kind of coverage available to an individual, or charging an individual a different rate for the same coverage solely because of blindness or partial blindness.
Ins 6.67(3)(b)1.
1. Individuals who are blind or partially blind may be subject to standards based on sound actuarial principles or actual or reasonably anticipated experience with respect to any other condition they may have, including a condition which is the cause of the blindness or partial blindness.
Ins 6.67(3)(b)2.
2. Refusal to insure under sub.
(3) includes a denial of disability insurance on the basis that the policy presumes disability if the insured loses his or her eyesight. However, an insurer may exclude from coverage, or apply a waiting period, to coverage of treatment of blindness or partial blindness if that condition exists at the time the policy is issued.
Ins 6.67(4)
(4)
Insurer responsibility. An insurer has the burden of proof to show that an act, standard or practice of the insurer is based on sound actuarial principles or is related to actual or reasonably anticipated experience in any action to enforce s.
628.34 (3) (b), Stats. For the anticipated experience to be reasonable it must be based on medical or actuarial research on morbidity or mortality.
Ins 6.67(5)(a)(a) An insurer may not use sexual orientation in the underwriting process or in the determination of insurability, premium, terms of coverage, or nonrenewal.
Ins 6.67(5)(b)
(b) No insurer may include any inquiry about the applicant's or insured's sexual orientation in an application for disability or life insurance coverage or directly or indirectly investigate in connection with an application for disability or life insurance coverage the applicant's or insured's sexual orientation.
Ins 6.67(5)(c)
(c) No insurer may use the marital status, occupation, gender, medical history, beneficiary designation, or the zip code or territorial classification of an applicant or insured or any other factor to establish, or aid in establishing, the applicant's or insured's sexual orientation.
Ins 6.67 History
History: Cr.
Register, December, 1979, No. 288, eff. 1-1-80; r. (4) under s. 13.93 (2m) (b) 16., Stats.,
Register, December, 1984, No. 348; am. (1), r. and recr. (3), cr. (4),
Register, April, 1987, No. 376, eff. 5-1-87; correction in (2), (3) (b) 2. and (4) made under s. 13.93 (2m) (b) 14., 12. and 1., Stats.,
Register, April, 1987, No. 376; cr. (5),
Register, May, 1987, No. 377, eff. 6-1-87.
Ins 6.68
Ins 6.68
Unfair discrimination based on geographic location or age of risk. Ins 6.68(1)(1)
Purpose. The purpose of this rule is to identify specific acts or practices found to be unfair trade practices that are unfairly discriminatory under s.
628.34, Stats.
Ins 6.68(2)
(2)
Applicability and scope. This rule shall apply to property and casualty insurance contracts delivered or issued for delivery in Wisconsin on or after the effective date of the rule.
Ins 6.68(3)
(3)
Specific examples of unfair trade practices under s. 628.34, Stats. The following are hereby identified as specific acts or practices which are unfairly discriminatory.
Ins 6.68(3)(a)
(a) Making or permitting any unfair discrimination between individuals or risks of the same class and of essentially the same hazards by refusing to issue, refusing to renew, cancelling or limiting the amount of insurance coverage on a property or casualty risk because of the geographic location of the risk, unless:
Ins 6.68(3)(a)1.
1. The refusal, cancellation or limitation is for a business purpose which is not a mere pretext for unfair discrimination, or
Ins 6.68(3)(a)2.
2. The refusal, cancellation or limitation is required by law or regulatory mandate.
Ins 6.68 Note
Note: Paragraph (a) is intended to prohibit insurance underwriting shortcuts which unfairly label risks as poor risks because of their geographic location. A refusal, nonrenewal, cancellation or limitation of insurance coverage is prohibited if the reason for such refusal, nonrenewal, cancellation or limitation is the geographic location of the risk. An exception to this general rule is provided, however, in situations where the refusal, nonrenewal, cancellation or limitation is based upon a legitimate business need and the refusal, nonrenewal, cancellation or limitation is not a mere pretext for unfair discrimination. Examples of such situations include refusals to insure when the risk is located in areas prone to natural catastrophes, i.e., earthquakes, floods, hurricanes, and refusals to insure because the insurer already has a very high concentration of risks in a particular geographic area. It is intended that the person charged with a violation of this rule be given the burden of proof in establishing any “business purpose" exception. The burden of proving that a refusal, nonrenewal, cancellation or limitation of insurance coverage is not subterfuge for unfair discrimination should likewise fall upon the person charged with a violation of this rule.
