600.03(25)(a)4.
4. Coverage, including stop-loss coverage, of an employer or plan sponsor relating to claims incurred under the employer's or plan sponsor's self-funded employee welfare benefit plan, as defined in
29 USC 1002 (1).
600.03 Cross-reference
Cross-reference: See also s.
Ins 15.01, Wis. adm. code.
600.03(26)
(26) "Insured" means any person to whom or for whose benefit an insurer makes a promise in an insurance policy. The term includes policyholders, subscribers, members and beneficiaries. This definition applies only to
chs. 600 to
655 and does not apply to the use of the word in insurance policies.
600.03(27)
(27) "Insurer" means any person or association of persons doing an insurance business as a principal, and includes, but is not limited to, fraternals, issuers of gift annuities, cooperative associations organized under
s. 185.981, insurers operating under
subch. I of ch. 616 and risk retention groups. It also includes any person purporting or intending to do an insurance business as a principal on his or her own account.
600.03(28)
(28) "Intermediary" means an insurance marketing intermediary as defined in
s. 628.02.
600.03(28g)
(28g) "Long-term care insurance policy" means a disability insurance policy or certificate advertised, marketed, offered or designed primarily to provide coverage for care that is provided in institutional and community-based settings and that is convalescent or custodial care or care for a chronic condition or terminal illness. The term does not include a medicare supplement policy or medicare replacement policy or a continuing care contract, as defined in
s. 647.01 (2).
600.03(28p)
(28p) "Medicare replacement policy" means to the extent permitted under federal law, any of the following:
600.03(28p)(a)
(a) A disability insurance policy or certificate issued to a resident of this state pursuant to a contract between the federal health care financing administration and a federally qualified health maintenance organization or a federally certified competitive medical plan to provide health care benefits to persons eligible for medicare under
42 USC 1395f,
1395x and
1395mm.
600.03(28p)(c)
(c) A plan, contract or policy that the commissioner by rule determines is similar to, or supplements or replaces, a program described in
par. (a) or
(b).
600.03(28r)
(28r) "Medicare supplement policy" means a disability insurance policy or certificate advertised, marketed or designed primarily to supplement benefits under medicare for the hospital, medical or surgical expenses of persons eligible for medicare.
600.03(29)
(29) "Member" means a person having membership rights in a corporation. Any person may be a member of a corporation unless the law specifically provides otherwise. See also "insured".
600.03(30)
(30) "Minimum capital" is the capital that a stock insurance corporation is required by statute or administrative determination to have and constantly to maintain. See
s. 611.19.
600.03(30m)
(30m) "Minimum permanent surplus" is the surplus that an insurance corporation is required by statute or administrative determination to have and constantly to maintain in accordance with
s. 611.19,
613.19 or
614.19.
600.03(31)
(31) "Mutual" means "mutual insurance corporation".
600.03(32)
(32) "Nondomestic insurer" means a foreign or alien insurer. Compare "domestic insurer".
600.03(34)
(34) "Office" means the office of the commissioner of insurance of this state.
600.03(35)
(35) "Policy" means any document other than a group certificate used to prescribe in writing the terms of an insurance contract, including endorsements and riders and service contracts issued by motor clubs.
600.03(37)
(37) "Policyholder" means the person who controls the policy by ownership, payment of premiums or otherwise. See also "insured".
600.03(38)
(38) "Premium" means any consideration for an insurance policy, and includes assessments, membership fees or other required contributions or consideration, however designated.
600.03(39)
(39) "Principal officers" of a corporation mean the officers designated under
s. 611.12 (3), or corresponding sections of other chapters.
600.03(40)
(40) "Proceedings" includes "actions" and "special proceedings" under
s. 801.01.
600.03(41)
(41) "Reciprocal" means any unincorporated association of persons, operating through an attorney in fact and exchanging insurance contracts with one another, which provide insurance coverage to each other thereunder.
600.03(41g)
(41g) "Security surplus" is the amount of assets in excess of liabilities needed by a particular insurer to satisfy
s. 623.12.
600.03(41m)
(41m) "Service insurance corporation" means any corporation organized or operating under
ch. 613.
600.03(42)
(42) "State" means the same as in
s. 990.01 (40) except that it also includes the Panama Canal Zone.
600.03(43)
(43) "Stock corporation" means "stock insurance corporation".
600.03(44)
(44) "Subsidiary" of a person means a stock corporation more than one-half the voting shares of which are owned by the person either alone or with its affiliates.
600.03(45)
(45) "Surplus" means the excess of assets over the sum of capital and liabilities.
600.03(46)
(46) "Town mutual" means a corporation organized or operating under
ch. 612 and is synonymous with "town mutual insurance corporation".
600.03(47)
(47) "Trustee" is synonymous with "director".
600.03(48)
(48) "Unauthorized insurer" means any insurer not holding a valid certificate of authority to do an insurance business in this state, and any insurer holding a valid certificate, with respect to business not authorized by the certificate. "Unauthorized insurer" includes a surplus lines insurer.
600.03(49)
(49) "Wholly owned subsidiary" of a person is a subsidiary all of the voting shares of which are owned by the person either alone or with its affiliates, except for the minimum number of shares required by the law of the subsidiary's domicile to be owned by directors or others.
600.03 History
History: 1971 c. 260;
1973 c. 22; Sup. Ct. Order,
67 Wis. 2d 585, 776 (1975);
1975 c. 223,
371,
374,
375,
421;
1977 c. 339;
1979 c. 89 ss.
383,
543;
1979 c. 102 ss.
49 to
53,
236 (22);
1979 c. 177;
1981 c. 38,
82;
1983 a. 120,
189,
274,
358;
1985 a. 29;
1987 a. 167,
247;
1989 a. 23,
31;
1989 a. 187 s.
29;
1993 a. 201;
1995 a. 225;
1999 a. 30;
2001 a. 65;
2003 a. 261;
2007 a. 170;
2009 a. 28.
600.03 Cross-reference
Cross-reference: See also ss.
Ins 3.13,
3.14,
3.15, and
3.23, Wis. adm. code.
600.03 Annotation
"Insurance" is not defined by sub. (25). Under s. 600.02 (2), statements that a term `includes' or `excludes' something else are not definitions. "Insurance" has a commonly understood meaning of being a contract that shifts the risk of loss in exchange for premiums. Sub. (25) was not unconstitutionally vague as applied to the facts of this case, nor was the use of the term "insurance" in other applicable sections of chs. 600 and 601. National Motorists Association v. Office of the Commissioner of Insurance, 2002 WI App 308,
259 Wis. 2d 240,
655 N.W.2d 179,
02-0511.
600.12(1)(1) Unless otherwise provided,
chs. 600 to
655 shall be liberally construed to achieve the purposes stated therein. Unless expressly provided otherwise or clearly appearing from the context the purposes stated shall constitute an aid and guide to interpretation but not an independent source of power.
600.12(2)
(2) If a provision of
chs. 600 to
655 conflicts with another statutory provision, the provision of
chs. 600 to
655 shall prevail.
600.13
600.13
Orders relaxing restrictions. 600.13(1)
(1)
Issuance. After notice under
sub. (2) and a hearing, the commissioner may issue an order freeing a person from any requirement of
chs. 600 to
647 otherwise applicable to the person if the commissioner finds that the interests of residents, as defined in
s. 647.01 (11), insureds, creditors and the public will not be endangered thereby.
600.13(2)
(2) Publication. Unless the order is issued under specific authorization of another section of
chs. 600 to
647, the notice preceding the hearing under
sub. (1) and any such order shall be published as a class 1 notice, under
ch. 985, in the official state newspaper before it is effective.
