149.16
149.16
Plan administrator. 149.16(3)(a)(a) The plan administrator shall perform all eligibility and administrative claims payment functions relating to the plan.
149.16(3)(b)
(b) The plan administrator shall establish a premium billing procedure for collection of premiums from insured persons. Billings shall be made on a periodic basis as determined by the department.
149.16(3)(c)
(c) The plan administrator shall perform all necessary functions to assure timely payment of benefits to covered persons under the plan, including:
149.16(3)(c)1.
1. Making available information relating to the proper manner of submitting a claim for benefits under the plan and distributing forms upon which submissions shall be made.
149.16(3)(c)2.
2. Evaluating the eligibility of each claim for payment under the plan.
149.16(3)(c)3.
3. Notifying each claimant within 30 days after receiving a properly completed and executed proof of loss whether the claim is accepted, rejected or compromised.
149.16(3)(e)
(e) The plan administrator, under the direction of the department, shall pay claims expenses from the premium payments received from or on behalf of covered persons under the plan. If the plan administrator's payments for claims expenses exceed premium payments, the board shall forward to the department, and the department shall provide to the plan administrator, additional funds for payment of claims expenses.
149.16 History
History: 1997 a. 27 ss.
3030,
3031,
4882 to
4884c,
4886.
149.165
149.165
Reductions in premiums for low-income eligible persons. 149.165(2)
(2) If the household income, as defined in
s. 71.52 (5) and as determined under
sub. (3), of an eligible person is equal to or greater than the first amount and less than the 2nd amount listed in any of the following, the department shall reduce the premium for the eligible person to the rate shown after the amounts:
149.165(2)(a)
(a) If equal to or greater than $0 and less than $10,000, to 100% of the rate that a standard risk would be charged under an individual policy providing substantially the same coverage and deductibles as provided under the plan.
149.165(2)(b)
(b) If equal to or greater than $10,000 and less than $14,000, to 106.5% of the rate that a standard risk would be charged under an individual policy providing substantially the same coverage and deductibles as provided under the plan.
149.165(2)(c)
(c) If equal to or greater than $14,000 and less than $17,000, to 115.5% of the rate that a standard risk would be charged under an individual policy providing substantially the same coverage and deductibles as provided under the plan.
149.165(2)(d)
(d) If equal to or greater than $17,000 and less than $20,000, to 124.5% of the rate that a standard risk would be charged under an individual policy providing substantially the same coverage and deductibles as provided under the plan.
149.165(3)(a)(a) Subject to
par. (b), the department shall establish and implement the method for determining the household income of an eligible person under
sub. (2).
149.165(3)(b)
(b) In determining household income under
sub. (2), the department shall consider information submitted by an eligible person on a completed federal profit or loss from farming form, schedule F, if all of the following apply:
149.165 History
History: 1985 a. 29;
1987 a. 27;
1987 a. 312 s.
17;
1991 a. 39;
1997 a. 27 ss.
4889 to
4894; Stats. 1997 s. 149.165.
149.17
149.17
Contents of plan. The plan shall include, but is not limited to, the following:
149.17(2)
(2) A schedule of premiums, deductibles and coinsurance payments which complies with all requirements of this chapter.
149.17(3)
(3) Procedures for applicants and participants to have grievances reviewed by an impartial body.
149.17(4)
(4) Cost containment provisions established by the department by rule, including managed care requirements.
149.17 History
History: 1979 c. 313;
1983 a. 27;
1987 a. 27;
1991 a. 39;
1997 a. 27 ss.
4896 to
4900; Stats. 1997 s. 149.17.
149.175
149.175
Waiver or exemption from provisions prohibited. Except as provided in
s. 149.13 (1), the department may not waive, or authorize the board to waive, any of the requirements of this chapter or exempt, or authorize the board to exempt, an individual or a class of individuals from any of the requirements of this chapter.
149.175 History
History: 1991 a. 39;
1997 a. 27 s.
4901; Stats. 1997 s. 149.175.
149.18
149.18
Chapters 600 to 645 applicable. Except as otherwise provided in this chapter, the plan shall comply and be administered in compliance with
chs. 600 to
645.
149.18 History
History: 1979 c. 313;
1981 c. 314;
1997 a. 27 s.
4902; Stats. 1997 s. 149.18.
149.20
149.20
Rule-making in consultation with board. In promulgating any rules under this chapter, the department shall consult with the board.
149.20 History
History: 1997 a. 27.
