Chapter Ins 6

Ins 6.80 History History: Cr. Register, June, 1981, No. 306, eff. 7-1-81; r. (6) under s. 13.93 (2m) (b) 16., Stats., Register, December, 1984, No. 348; correction in (8) made under s. 13.93 (2m) (b) 7., Stats., Register, May, 1987, No. 377; cr. (2) (b) 10., Register, November, 1993, No. 455, eff. 2-1-94; corrections in (3) made under s. 13.93 (2m) (b) 7., Stats., Register, February, 2000, No. 530; correction in (2) (b) 5. and 6. made under s. 13.93 (2m) (b) 7., Stats., Register January 2002 No. 553; correction in (2) (a) made under s. 13.92 (4) (b) 7., Stats., Register August 2014 No. 704.

Ins 6.85 Ins 6.85 Notification of a person’s right to file a complaint with the commissioner.

Ins 6.85(1) (1) Purpose. This section interprets and implements s. 631.28, Stats., by specifying the contents of a notice insurers must provide to insureds about their right to file a complaint with the office of the commissioner of insurance. This section also describes when and the manner in which such notice must be provided.

Ins 6.85(2) (2) Scope. This section applies to all policies or certificates in force, issued or renewed in Wisconsin on or after the effective date of this section.

Ins 6.85(3) (3) Definitions. For purposes of this section, “insured” means the policyholder for individual policies and both the group policyholder and certificate holder for group policies.

Ins 6.85(4) (4) Notice format. Every insurer shall disclose the insured’s right to contact the office of the commissioner of insurance regarding an insurance problem by providing a notice which shall:

Ins 6.85(4)(a) (a) Be in the form as prescribed in Appendix I or for policies subject to sub. (5) (d) in form as prescribed in Appendix 2;

Ins 6.85(4)(b) (b) Include the issuer’s address, toll free phone number, if available, and phone number in no less than 12-point type and bold print.

Ins 6.85 Note Note: The language in sub. (4) (b) applies to notices sent on or after March 1, 1995.

Ins 6.85(4)(c) (c) Be in no less than 10-point type; and

Ins 6.85(4)(d) (d) Have the phrase “KEEP THIS NOTICE WITH YOUR INSURANCE PAPERS,” “PROBLEMS WITH YOUR INSURANCE?” in Appendix I and the “OFFICE OF THE COMMISSIONER OF INSURANCE” in Appendices I and 2 capitalized and in bold lettering.

Ins 6.85(5) (5) Notice delivery.

Ins 6.85(5)(a) (a) For policies issued prior to the effective date of this section, except for policies included under pars. (c) and (d):

Ins 6.85(5)(a)1. 1. The notice shall be provided on or before the insured’s first renewal date after the effective date of this section or within one year after the effective date of this section, whichever is earlier, with a separate notice to the insured; or

Ins 6.85(5)(a)2. 2. For single premium policies, a separate notice shall be provided on or before the insured’s next anniversary date or within one year after the effective date of this section, whichever is earlier.

Ins 6.85(5)(b) (b) For policies or certificates issued on or after the effective date of this section, except for policies included under pars. (c) and (d), a separate notice shall be provided at the time the policy or certificate is issued.

Ins 6.85(5)(c) (c) For surety and title insurance policies the notice must be given as a separate notice to each claimant at the time a claim is denied.

Ins 6.85(5)(d) (d) For policies subject to s. 632.83, Stats., the insurer shall either give notice in the form as prescribed in Appendix 2 and as specified in pars. (a) and (b) or may include the language in Appendix 2 as part of the grievance procedure language in the policy and certificates issued after the effective date and, for policies issued prior to the effective date, provide a policy or certificate amendment on or before the first renewal date after the effective date or within one year after the effective date of this section, whichever is earlier.

Ins 6.85 History History: Emerg. cr. eff. 2-1-93; cr. Register, February, 1993, No. 446, eff. 3-1-93; correction in (5) (d), Register, April, 1993, No. 448, eff. 5-1-93; am. (4) (b) and Appendix, Register, January, 1995, No. 469, eff. 2-1-95; correction in (5) (d) made under s. 13.93 (2m) (b) 7., Stats., Register January 2002 No. 553.

Ins 6.90 Ins 6.90 Prohibited uses of senior-specific designations.

Ins 6.90(1) (1) Purpose. The purpose of this rule is to set forth standards to protect consumers from advertising and trade practices that are deceptive, misleading, or restrain competition unreasonably, with respect to the use of senior-specific certifications and professional designations in the advertising, solicitation, sale or purchase of, or advice made in connection with, life or health insurance, or an annuity product.

Ins 6.90(2) (2) Authority.

Ins 6.90(2)(a) (a) This rule is adopted pursuant to the Office of the Commissioner of Insurance’s authority under ss. 601.42 (3) and 628.34 (12), Stats.

Ins 6.90(2)(b) (b) Nothing in this rule shall limit the commissioner’s authority to enforce existing provisions of law.

Ins 6.90(3) (3) Scope. This rule shall apply to any advertising, solicitation, or sale or purchase of, or advice made in connection with, a life or health insurance policy, or annuity product by an insurance producer.

Ins 6.90(4) (4) Definitions. In this section:

Ins 6.90(4)(a) (a) “Advertising” means all of the following:

Ins 6.90(4)(a)1. 1. Printed and published material, audio visual material and descriptive literature of an insurer or intermediary used in direct mail, newspapers, magazines, other periodicals, radio and television scripts, billboards and similar displays, excluding advertisements prepared for the sole purpose of recruiting employees, intermediaries or agencies.

Ins 6.90(4)(a)2. 2. Descriptive literature and sales aids of all kinds authored, issued, distributed or used by an insurer, intermediary or third party for presentation to members of the public, including circulars, leaflets, booklets, depictions, illustrations and form letters. Descriptive literature and sales aids do not include material in house organs of insurers, communications within an insurer’s own organization not intended for dissemination to the public, individual communications of a personal nature, and correspondence between a prospective group or blanket policyholder and an insurer in the course of negotiating a group or blanket policy, and general announcements from group or blanket policyholders to eligible individuals that a contract has been written.

Ins 6.90(4)(a)3. 3. Prepared sales talks, presentations and material for use by intermediaries and representations made by intermediaries in accordance therewith, excluding materials to be used solely by an insurer for the training and education of its employees or intermediaries; and

Ins 6.90(4)(a)4. 4. Packaging, including envelopes, used in connection with subds. 1., 2., and 3.

Ins 6.90(4)(a)5. 5. “Advertising” does not include a policy summary as defined in s. Ins 2.14 (3) (f), the “life insurance buyer’s guide” as set forth in s. Ins 2.14 (3) (d), an illustration as defined in s. Ins 2.17 (3) (i), a contract summary as defined in s. Ins 2.15 (4) (a), a preliminary contract summary as defined in s. Ins 2.15 (4) (b), and the “Wisconsin Buyer’s Guide to Annuities” as defined in s. Ins 2.15 (4) (c).

Ins 6.90(4)(b) (b) “Health insurance” includes any policy of individual or group sickness and accident insurance, long term care insurance, Medicare advantage, Medicare supplement, and Medicare part D.

Ins 6.90(4)(c) (c) “Insurance producer” means a person required to be licensed under chs. 600 to 655, Stats., to advertise, sell, solicit or negotiate insurance, including life insurance, health insurance and annuities.

Ins 6.90(5) (5) Prohibited uses of senior-specific certifications and professional designations.

Ins 6.90(5)(a) (a) It is an unfair and deceptive trade practice under s. 628.34 (12), Stats., for an insurance producer to use a senior-specific certification or professional designation that indicates or implies in such a way as to mislead a purchaser or prospective purchaser that the insurance producer has special certification or training in advising or providing services to seniors in connection with the advertising, solicitation, sale, or purchase of a life or health insurance policy, or annuity product or in the provision of advice as to the value of or the advisability of purchasing or selling a life or health insurance policy or annuity product, either directly or indirectly, through publications or writings, or by issuing or promulgating analyses or reports related to a life or health insurance policy or annuity product as follows:

Ins 6.90(5)(a)1. 1. Use of a certification or professional designation by an insurance producer who has not actually earned or is otherwise ineligible to use such certification or designation.

Ins 6.90(5)(a)2. 2. Use of a nonexistent or self-conferred certification or professional designation.

Ins 6.90(5)(a)3. 3. Use of a certification or professional designation that indicates or implies a level of occupational qualifications obtained through education, training or experience that the insurance producer using the certification or designation does not have.

Ins 6.90(5)(a)4. 4. Use of a certification or professional designation that was obtained from a certifying or designating organization that:

Ins 6.90(5)(a)4.a. a. Is primarily engaged in the business of instruction in sales or marketing; or

Ins 6.90(5)(a)4.b. b. Does not have reasonable standards or procedures for assuring the competency of its certificants or designees; or

Ins 6.90(5)(a)4.c. c. Does not have reasonable standards or procedures for monitoring and disciplining its certificants or designees for improper or unethical conduct; or

Ins 6.90(5)(a)4.d. d. Does not have reasonable continuing education requirements for its certificants or designees in order to maintain the certificate or designation.

Ins 6.90(5)(b) (b) There is a rebuttable presumption that a certifying or designating organization is not disqualified solely for the purposes of par. (a) 4., when the certification or designation issued from the organization does not primarily apply to sales or marketing and when the organization or the certification or designation in question has been accredited by:

Ins 6.90(5)(b)1. 1. The American National Standards Institute (ANSI);

Ins 6.90(5)(b)2. 2. The National Commission for Certifying Agencies; or

Ins 6.90(5)(b)3. 3. Any organization that is on the U.S. Department of Education’s list entitled “Accrediting Agencies Recognized for Title IV Purposes.”

Ins 6.90(5)(c) (c) In determining whether a combination of words or an acronym standing for a combination of words constitutes a certification or professional designation indicating or implying that a person has special certification or training in advising or servicing seniors, factors to be considered shall include:

Ins 6.90(5)(c)1. 1. Use of one or more words such as “senior,” “retirement,” “elder,” or like words combined with one or more words such as “certified,” “registered,” “chartered,” “advisor,” “specialist,” “consultant,” “planner,” or like words, in the name of the certification or professional designation; and

Ins 6.90(5)(c)2. 2. The manner in which those words are combined.

Ins 6.90(5)(d) (d)

Ins 6.90(5)(d)1. 1. For purposes of this section, a job title within an organization that is licensed or registered by a state or federal financial services regulatory agency is not a certification or professional designation, unless it is used in a manner that would confuse or mislead a reasonable consumer, when the job title:

Ins 6.90(5)(d)1.a. a. Indicates seniority or standing within the organization; or

Ins 6.90(5)(d)1.b. b. Specifies an individual’s area of specialization within the organization.

Ins 6.90(5)(d)2. 2. For the purpose of this paragraph, financial services regulatory agency includes an agency that regulates insurers, insurance producers, broker-dealers, investment advisers, or investment companies as defined under the Investment Company Act of 1940 (15 USC 2d).

Ins 6.90(6) (6) Penalties. A violation of this section is an unfair and deceptive trade practice under s. 628.34 (12), Stats., and shall subject the violator to ss. 601.41, 601.62, 601.64, 601.65 and 628.10, Stats.

Ins 6.90 History History: CR 09-038: cr. Register January 2010 No. 649, eff. 2-1-10.

Ins 6.91 Ins 6.91 Definitions. In addition to the definitions in s. 628.90, Stats., for the purposes of ss. Ins 6.91 to 6.99 the following apply:

Ins 6.91(1) (1) “Business checking account” means any account utilized by a navigator, navigator entity, nonnavigator assister or nonnavigator assister entity in their capacity as a navigator, nonnavigator assister or related entity and in transacting of the business of insurance.

Ins 6.91(2) (2) “Cash disbursed record” means a record showing all monies paid out by the navigator, navigator entity, nonnavigator assister or nonnavigator assister entity in their capacity as a navigator, nonnavigator assister or related entity in transacting the business of insurance.

Ins 6.91(3) (3) “Cash receipts record” means a record showing all monies received by the navigator, navigator entity, nonnavigator assister or nonnavigator assister entity in their capacity as a navigator, nonnavigator assister or related entity and in transacting the business of insurance.

Ins 6.91(4) (4) “Certified application counselors” means a person who is a nonnavigator assister who is not an in-person assister and who is employed, supervised or affiliated with a registered nonnavigator assister entity.

Ins 6.91(5) (5) “Commissioner” means the commissioner of insurance.

Ins 6.91(6) (6) “Formal administrative action” includes consent decrees, cease and desist orders, stipulations, suspensions, revocations, license denials, fines, forfeitures, settlement agreements, navigator license restrictions or other actions limiting the navigator’s method of transacting the business of insurance.

Ins 6.91(7) (7) “Insurance agent” means an “intermediary” as defined in s. 628.02 (4), Stats.

Ins 6.91(8) (8) “Navigator entity” means an entity or organization that employs, supervises or is affiliated with, one or more licensed navigators; is designated by the exchange as a navigator, works on behalf of the exchange, and receives federal navigator grant funding; and is registered with the commissioner.

Ins 6.91(9) (9) “Nonnavigator assister entity” means an entity or organization that employs, supervises or is affiliated with one or more nonnavigator assisters including certified application counselors; is designated by and works on behalf of the exchange, enters into an agreement with the exchange; and is registered with the commissioner.

Ins 6.91(10) (10) “Personnel records” means those records pertaining to anyone who is employed by, supervised by or affiliated with a navigator entity or nonnavigator assister entity including independent contractors.

Ins 6.91(11) (11) “Policyholder records” means all records, applications, request for coverage changes, and coverage complaints associated with a policy generated by or through the navigator, navigator entity, certified application counselor or nonnavigator assister entity.

Ins 6.91 History History: EmR1314: emerg. cr. eff. 9-10-13; CR 13-113: cr. Register August 2014 No. 704, eff. 9-1-14.

Ins 6.92 Ins 6.92 Individual navigators.

Ins 6.92(1) (1) Purpose. This section protects insurance consumers by establishing procedures for the licensing of navigators when transacting the business of insurance, prescribing minimum standards and requirements to ensure timely and reliable information will exist and be available to the commissioner. This section implements and interprets ss. 628.095, 628.097, 628.10, 628.90 to 628.95, Stats., as applicable.

Ins 6.92(2) (2) Procedure.

Ins 6.92(2)(a) (a) Application for navigator license. An individual applying for a navigator license shall submit an application to the office in the form prescribed by the commissioner. A completed application shall include: the navigator’s name; the navigator’s residence; contact email address; mailing and business addresses; confirmation of successful completion of prelicensing training; fingerprints provided in a format specified by the commissioner to complete; an electronic confirmation of criminal history from the Wisconsin department of justice, crime information bureau, and the federal bureau of investigation completed not more than 180 days prior to the licensing examination date; payment of the nonrefundable fees to the testing vendor; an electronic photograph of the applicant taken by the test vendor at the time of testing; confirmation of previous navigator licensure in another state, if applicable; payment of the fee under s. 601.31 (1) (nm), Stats.; proof of financial responsibility under sub. (7); and any documentation required in answer to questions on the application.

Ins 6.92 Note Note: A copy of the navigator license application form OCI 11-090, required in par. (a), may be obtained at no cost from the Office of the Commissioner of Insurance at 125 S. Webster Street, Madison WI 53703, or at the Office’s web address: oci.wi.gov.

Ins 6.92(2)(b) (b) Prelicensing Training. An individual seeking a navigator license, in addition to any training requirements of the federal government, shall complete at least 16 hours of commissioner-approved navigator prelicensing training. Training required under this subsection must be approved by the commissioner and provided by an education provider that is approved by the commissioner.

Ins 6.92(2)(c) (c) Scheduling the navigator licensing examination. An applicant must schedule an examination with the testing vendor at least twenty-four hours prior to the desired navigator licensing examination date. The written examination will test the applicant’s knowledge of the duties and responsibilities of a navigator; the insurance laws and regulations of this state; and the state’s public assistance programs and eligibility. The written examination shall be approved by the commissioner and offered through a commissioner-approved testing vendor.

Ins 6.92(2)(d) (d) Exception.

Ins 6.92(2)(d)1. 1. An insurance agent who holds an active resident license with the accident and health line of authority and is in compliance with continuing education requirements may apply to be licensed as a navigator if the currently licensed insurance agent demonstrates all of the following:

Ins 6.92(2)(d)1.a. a. Compliance as set forth in s. 628.92 (1), Stats., including competence and trustworthiness.

Ins 6.92(2)(d)1.b. b. Satisfactory completion of 4 hours of navigator training specific to public assistance programs, including Medicaid, in addition to the completion of any federally required navigator training and compliance with federal restrictions and requirements including those set forth in 45 CFR 155.205 (d), 155.210, 155.215 (b) and (c), and 155.260 (b), as amended. The state training required under this subsection must be approved by the commissioner and provided by an education provider that is approved by the commissioner.

Ins 6.92(2)(d)2. 2. A currently licensed insurance agent who is in compliance with subd. 1. is exempt from passing the navigator examination and photograph requirements described in par. (a). The currently licensed insurance agent shall provide new fingerprints unless the office has received current, valid fingerprint results provided in a format specified by the commissioner and an electronic confirmation of criminal history from the Wisconsin department of justice, crime information bureau, and the federal bureau of investigation that were completed not more than 180 days prior to the date of the application. The currently licensed insurance agent shall submit a completed application as described in par. (a) and pay the licensing fee in accordance with s. 601.31 (1) (nm), Stats., to the commissioner.

Ins 6.92(2)(e) (e) Issuance of license. The commissioner shall issue a navigator license to an applicant who completes and satisfies the requirements in pars. (a) and (b), in addition to any federal training or requirements including the requirements set forth in 45 CFR 155.205 (d), 155.210, 155.215 (b) and (c), and 155.260 (b), as amended, has passed the commissioner-approved written examination with a satisfactory grade, and meets the standards of competence and trustworthiness as described in sub. (3). Examination scores are valid for 180 days. Failure to apply for a license within 180 days will require the applicant to re-take the examination. Determination of the acceptance or rejection of a completed application shall be made within 90 days of receipt by the commissioner of the completed application, which is tolled until receipt of any additional required or requested documentation.

Ins 6.92(3) (3) Competence and trustworthiness. The following criteria may be used by the commissioner in assessing trustworthiness and competence of a navigator; failure to meet trustworthiness and competence is cause for denial, suspension or revocation or a license:

Ins 6.92(3)(a) (a) Criminal record. The conviction for crimes which are substantially related to the circumstances of holding an insurance or navigator license, including a felony or misdemeanor conviction under the law of Wisconsin or any other state or under federal law.

Ins 6.92(3)(b) (b) Accuracy of information. Any material misrepresentation in the information submitted on the application form.

Ins 6.92(3)(c) (c) Regulatory action. Any formal regulatory action taken in any jurisdiction with regard to any occupational license held, such as insurance licenses in other states, real estate licenses and security licenses.

Ins 6.92(3)(d) (d) Other criteria. Other criteria which the commissioner considers evidence of untrustworthiness or incompetence, including: