This will be promulgated as a permanent rule, as such no finding of emergency will be provided.
2. Detailed Description of the Objective of the Rule
The Office intends to repeal and recreate s.
Ins 3.40, Wis. Admin. Code, to update the coordination of benefit definitions and provisions and more closely align with the current National Association of Insurance Commissioners (NAIC) model regulation. The last substantive revision occurred in 1989 rendering Wisconsin's current rule inconsistent with other states and lacking helpful guidance on recent state and federal law changes including coverage for dependents to age 26, coordination with dental coverage and inclusion of individual health coverage. Updating the rule will result in less administrative cost to insurers while maintaining order in the coordination of benefits for the protection of insureds.
3. Description of Existing Policies Relevant to the Rule and of New Policies Proposed to be Included in the Rule and an Analysis of Policy Alternatives; the History, Background, and Justification for the Proposed Rule
Section
Ins 3.40, Wis. Admin. Code, relates to coordinating benefits when a person is covered by two or more health, disability, automobile medical benefits insurance policies. The coordination rule assists in determining which plan is primary and pays first and which plan is secondary. Without coordination of benefits insureds could collect maximum benefits from both policies and make a profit on their sickness or injury. To curtail this, insurers could design their policies to pay only excess benefits. However, if both insurers took that position benefit payments could be delayed while insurers determined which company should provide primary coverage.
The NAIC initially responded to the rise of issues by drafting and adopting the Coordination of Benefits (COB) Guidelines in the early 70s and current NAIC Coordination of Benefits Model Regulation was adopted in 2005 and is currently in the final stages before adoption of newly updated COB model regulation which is anticipated to be completed by the end of August 2013.
Updates to the Model Regulation include limiting financial gain by insureds, permitting coordination of individual health policies, coordination of dependent coverage to age 26, consideration of high deductible health plans and expanded definitions of “allowable expense" and “plans."
4. Detailed Statutory Authority for the Rule (Including the Statutory Citation and Language)
The statutory authority for this rule is ss.
227.11 (2) (a) and
601.41 (3), Wis. Stats., that provides for the commissioner's rule making authority in general. Also, s.
631.23, Wis. Stats., states that the Commissioner may “promulgate authorized clauses by rule based upon a finding as articulated in s.
631.23 (1) (a) to
(d), Wis. Stats. The Commissioner has found that the coordination of benefits clauses are necessary to provide certainty of meaning and orderly and timely handling of claims. Regulation of contract forms will be more effective, litigation will be substantially reduced if there is uniformity regarding coordination of benefits provisions in health insurance policies, and costs incurred by insurers should decrease when the requirements for coordination of benefits more closely aligns with the NAIC model regulation.
5. Estimates of the Amount of Time that State Employees Will Spend to Develop the Rule and of Other Resources Necessary to Develop the Rule
200 hours and no other resources are necessary to develop the rule.
6. List with Description of all Entities that may be Impacted by the Rule
The rule applies to all insurers offering health care and disability insurance coverage including individual and group health and dental care coverage, medical benefits under automobile contracts, and Medicare and other federal governmental plans. Agents authorized to sell these types of insurance will need to be aware of the changes. Employers offering health care insurance may be impacted and benefit from updating coordination of coverage.
7. Summary and Preliminary Comparison of any Existing or Proposed Federal Regulation that is Intended to Address the Activities to be Regulated by the Rule
The Office is unaware of existing or proposed federal regulation intended to address the coordination of benefits.
8. Anticipated Economic Impact of Implementing the Rule (Note if The Rule is Likely to Have a Significant Economic Impact on Small Businesses)
The rule is not likely to have a significant impact on small businesses but to the extent there is an impact it will likely be positive through reduction in duplication. Insurers that meet the definition of small businesses will also likely experience a decrease in costs from reduced duplication of benefits. Additionally as the rule will implement the NAIC model regulation, insurers doing business in other states will be able to reduce costs since the coordination requirements will be uniform and not uniquely required by Wisconsin.
Significant economic impact on small businesses?
yes
X no
Local/statewide economic impact (choose one)
X minimal or none (< or = $50,000)
moderate ($50,000--$20,000,000)
significant (>$20,000,000)
9. Contact Person
Julie E. Walsh, Senior Attorney
Office of the Commissioner of Insurance
Insurance
This statement of scope was approved by the governor on July 1, 2013.
Rule No.
Relating to
Navigators and nonnavigator assisters and affecting small business.
Rule Type
Both Emergency and Permanent.
1. Finding/Nature of Emergency (Emergency Rule Only)
In accordance with Wis. Stat. s.
623.98, the commissioner may promulgate rules under this Wis. Stat. s.
227.24 (1) (a) and
(3), without providing evidence that promulgating a rule is necessary for the preservation of the public peace, health, safety, or welfare and without a finding of emergency. The commissioner intends to have the proposed rule published sufficiently in advance of October 1, 2013, to permit proper licensing, certification and training of navigators and nonnavigator assisters. The commissioner intends to promulgate permanent rules close in time to the emergency rules so not to create a gap in requirements.
2. Detailed Description of the Objective of the Proposed Rule
The proposed rule will implement newly amended and created state law relating to navigators and nonnavigator assisters including application counselors. The newly enacted law requires navigators to be licensed with the office and complete prelicensing and annual training as a condition of continued licensure. The proposed rule will establish criteria for licensing consistent with the law and similar to existing agent licensing requirements. Subchapter V of Wis. Stat. ch.
628 delineates requirements for navigators including; training, licensure examination and financial responsibility requirements that the commissioner will implement through the proposed rule. Additionally, the proposed rule will develop guidelines and procedures for registration and training requirements for nonnavigator assisters.
3. Description of Existing Policies Relevant to the Rule and of New Policies Proposed to be Included in the Rule and an Analysis of Policy Alternatives; the History, Background, and Justification for the Proposed Rule
The proposed rule implements the new law for individuals and entities not previously subject to oversight by the commissioner. The role navigators and nonnavigator assisters will have with Wisconsin consumers related to the regulation of insurance arose through recent changes in federal and state law. Since the law in some respects parallels requirements for agents, the proposed rule will likely parallel, to the extent possible and appropriate, existing requirements for licensed agents under Wis. Stat. ch.
628 and ch.
Ins 6, Wis. Admin. Code.
4. Detailed Statutory Authority for the Rule (Including the Statutory Citation and Language)
The office has authority to promulgate rules interpreting chapter 628, Stats., as amended relating to the oversight and licensing of navigators and nonnavigator assisters. The commissioner has general authority to promulgate rules necessary to administer and enforce chs.
600 to
655 Stats., under Wis. Stat. ss.
227.11 (2) (a) and
601.41 (3). Further under Wis. Stat. s.
628.98, the commissioner was permitted to promulgate any rules necessary to carry out the purposes of the subch. V of Wis. Stat. ch.
628.
5. Estimates of the Amount of Time that State Employees Will Spend to Develop the Rule and of Other Resources Necessary to Develop the Rule
200 hours and no other resources are necessary to develop the rule.
6. List with Description of all Entities that may be Impacted by the Rule
The proposed rule will likely affect individuals and organizations interested in serving the citizens of Wisconsin in obtaining insurance coverage through the federal Exchange. Nonnavigator assisters and application counselors frequently work within community outreach programs, health care facilities and public health education programs. The enacted law provides an exemption for governmental entities or persons acting on behalf of governmental entities. Existing insurance intermediaries may be affected by the proposed rule but the proposed rule anticipates paralleling requirements, so intermediaries should be minimally affected.
7. Summary and Preliminary Comparison of any Existing or Proposed Federal Regulation that is Intended to Address the Activities to be Regulated by the Rule
The federal law established minimum requirements and duties for navigators and nonnavigator assisters through law at
52 USC 18031 (i), as amended, and proposed regulation at 78 Fed. Reg. 66 (proposed, April 5, 2013).
8. Anticipated Economic Impact of Implementing the Rule (Note if the Rule is Likely to Have a Significant Economic Impact on Small Businesses)
yes
X no
local/statewide economic impact (choose one)
X minimal or none (< or = $50,000)
moderate ($50,000-$20,000,000)
significant (>$20,000,000)
9. Contact Person
Julie E. Walsh, Senior Attorney, julie.walsh@ wisconsin.gov, (608) 264-8101.
Public Instruction
Per the Dane County Circuit Court order issued in Coyne, et al. v. Walker, et al., Case No. 11-CV-4573, the Department of Public Instruction is not required to obtain the Governor's approval for this statement of scope.
Rule No.
Relating to
Driver education programs.
Rule Type
Permanent.
1. Finding/Nature of Emergency (Emergency Rule Only)
N/A.
2. Detailed Description of the Objective of the Proposed Rule
Section
PI 21.05 requires the Department of Public Instruction (DPI) to issue certificates. This will soon be unnecessary since the Department of Transportation (DOT) is going to issue on-line certificates which will apply to students in school driver education programs. This rule change will not take effect until DOT begins issuing these on-line certificates.
Additionally, s.
PI 21.04 requires DPI to approve driver education course plans. However, to be more efficient, DPI is modifying the way it reviews driver education course plans. The DPI proposes modifying s.
PI 21.04 to state that a public or private high school, county children with disabilities education board, or a CESA submitting on behalf of a district that it has contracted with to provide driver education instructional services, must submit an assurance stating they are complying with the program requirements in s.
PI 21.04 in order to receive DPI approval. This assurance will substitute for DPI actively approving the program. The DPI will continue to review each program's instructors to verify that their departmental driver education certification is current and valid.
3. Description of the Existing Policies Relevant to the Rule, New Policies Proposed to be Included in the Rule, and an Analysis of Policy Alternatives
These changes are designed to update the rule to reflect future practice. If these changes are not made, the rule may not align with agency practice.
4. Detailed Explanation of Statutory Authority for the Rule (Including the Statutory Citation and Language)
Under s.
227.11 (2) (a) (intro), Stats., “Each agency may promulgate rules interpreting the provisions of any statute enforced or administered by the agency, if the agency considers it necessary to effectuate the purpose of the statute, but a rule is not valid if the rule exceeds the bounds of correct interpretation." Under s.
115.28 (11), Stats., the DPI is required to approve driver education course plans that meet certain guidelines.
115.28 General duties. The state superintendent shall:
(11) Driver education courses. Approve driver education courses offered by school districts, county children with disabilities education boards, and technical college districts for the purposes of s.
343.16 (1) (c) 1. and establish minimum standards for driver education courses offered in private schools and tribal schools for the purposes of s.
343.16 (1) (c) 3. All driver education courses approved or for which standards are established under this subsection shall do all of the following:
(a) Acquaint each student with the hazards posed by farm machinery and animals on highways and provide instruction in safely dealing with such hazards.
(b) Provide at least 30 minutes of instruction relating to organ and tissue donation and organ and tissue donation procedures.
(c) Provide at least 30 minutes of instruction on motorcycle awareness, as approved by a recognized motorcycle safety and awareness organization, and pedestrian and bicycle awareness, as approved by a recognized pedestrian and bicycle safety and awareness organization.
(d) Include instruction relating to passing stopped emergency vehicles, tow trucks, and highway machinery equipment.
(e) Acquaint each student with the hazards posed by railroad highway grade crossings and provide at least 30 minutes of instruction in safely dealing with these hazards.
(f) Acquaint each student with the hazards posed by composing or sending electronic text messages or electronic mail messages while driving and with the provisions of s.
346.89 (3).
5. Estimate of Amount of Time that State Employees Will Spend Developing the Rule and of Other Resources Necessary to Develop the Rule
The amount of time needed for rule development by DPI staff and the amount of other resources necessary are minimal.
6. List with Description of all Entities that may be Affected by the Proposed Rule
