632.897(11)(a)(a) Notwithstanding
subs. (2) to
(10), the commissioner may promulgate rules establishing standards requiring insurers to provide continuation of coverage for any individual covered at any time under a group policy who is a terminated insured or an eligible individual under any federal program that provides for a federal premium subsidy for individuals covered under continuation of coverage under a group policy, including rules governing election or extension of election periods, notice, rates, premiums, premium payment, application of preexisting condition exclusions, election of alternative coverage, and status as an eligible individual, as defined in
s. 149.10 (2t).
632.897(11)(b)
(b) The commissioner may promulgate the rules under
par. (a) as emergency rules under
s. 227.24. Notwithstanding
s. 227.24 (1) (c), emergency rules promulgated under this paragraph may remain in effect for one year and may be extended under
s. 227.24 (2). Notwithstanding
s. 227.24 (1) (a) and
(3), the commissioner is not required to provide evidence that promulgating a rule under this paragraph as an emergency rule is necessary for the preservation of the public peace, health, safety, or welfare and is not required to provide a finding of emergency for a rule promulgated under this paragraph.
632.897 Cross-reference
Cross-reference: See s.
49.45 (20) concerning exemption from continuation of group coverage.
632.897 Cross-reference
Cross-reference: See also ss.
Ins 3.41,
3.43,
3.44, and
6.51, Wis. adm. code.
632.897 Annotation
The federal employee retirement income security act (ERISA) preempts any state law that relates to employee benefit plans. General Split Corp. v. Mitchell,
523 F. Supp. 427 (1981).
632.897 Annotation
Wisconsin health insurance continuation/conversion law. Michal, WBB February 1982.
632.899
632.899
Medical savings accounts study. If the federal government enacts legislation providing for a federal income tax exemption for amounts deposited in a medical savings account and for any interest, dividends or other gain that accrues in the account if redeposited in the account, the commissioner shall conduct a study, to be completed within 4 years after the enactment of the federal legislation, of individuals and groups that had coverage under a high cost-share health plan, as defined in s.
632.898 (1) (c), 1995 stats., and that terminated that coverage in order to enroll in a health benefit plan that was not a high cost-share health plan, as defined in s.
632.898 (1) (c), 1995 stats. The commissioner shall submit a report of all findings, conclusions and recommendations to the appropriate standing committees in the manner provided under
s. 13.172 (3).
632.899 History
History: 1997 a. 27;
2007 a. 96.
FRATERNAL INSURANCE
Subch. VII of ch. 632 Cross-reference
Cross-reference: See also ch.
Ins 1, Wis. adm. code.
632.91
632.91
Definition. In this subchapter:
632.91(1)
(1) "Insured employee" means an employee of a fraternal or of a subsidiary or other affiliate of a fraternal who is provided insurance benefits by the fraternal under
s. 614.10 (2) (c) 2. but is not a member of the fraternal.
632.91(2)
(2) "Owner" means the owner of a policy or certificate issued by a fraternal in accordance with
s. 614.10.
632.93
632.93
The fraternal contract. 632.93(1)
(1)
Issuance of certificate. A fraternal shall issue to each owner a policy or certificate specifying the benefits provided and containing at least in substance all sections of the laws of the fraternal which might result in the termination of coverage or the reduction of benefits. The policy or certificate, any riders or endorsements attached thereto, the laws of the fraternal, and the application and declarations made in connection therewith and signed by the applicant, constitute the agreement between the fraternal and the owner, and the policy or certificate shall so state.
632.93(2)
(2) Changes in laws of fraternals. Except as provided in
s. 614.24 (1m), any changes in the laws of a fraternal made subsequent to the issuance of a policy or certificate bind the owner and any beneficiary under the policy or certificate as if they had been in force at the time of the application, so long as they do not destroy or diminish benefits promised in the policy or certificate.
632.93(3)
(3) Proof of terms. Copies of any documents mentioned in
subs. (1) and
(2), certified by the secretary or corresponding officer of the fraternal, are evidence of the terms and conditions of the contract.
632.93(5)
(5) Grace period. Every fraternal certificate shall contain a provision entitling the owner to a grace period of not less than one month, or 30 days at the fraternal's option, for the payment of any premium due except the first, during which the death benefit shall continue in force. A fraternal may specify in the grace period provision that the overdue premium will be deducted from the death benefit in the event of death before it is paid.
632.93(6)
(6) Compliance with other provisions. If a fraternal's laws provide for expulsion or suspension of a member for any reason other than nonpayment of premium or under
s. 632.46, the fraternal's insurance certificate shall contain a provision that if a member is expelled or suspended for any reason other than nonpayment of premium or under
s. 632.46, the expelled member, or other owner who was provided insurance benefits under
s. 614.10 on the application of the expelled member, has the right to maintain the policy in force by continuing payment of the required premium.
632.93(7)
(7) Scope of application. This section applies to all contracts made by a fraternal beginning 6 months after December 18, 1979. A fraternal may elect to have this section apply at an earlier date, so long as it applies simultaneously to all such contracts and the fraternal gives the commissioner at least 30 days' notice of intention to adopt this section.
632.95
632.95
Fraud in obtaining membership. Subject to
s. 632.46, any certificate of membership secured by misrepresentation in or with reference to any application for membership or documentary or other proof for the purpose of obtaining membership in or noninsurance benefit from the fraternal is void, if the fraternal relied on it and it is either material or fraudulent.
632.95 History
History: 1975 c. 373.
632.95 Annotation
Legislative Council Note, 1975: This section continues the contractual portion of s. 208.38, edited with a change in meaning, to include nonfraudulent but material misrepresentation, and also to subject the provision to the rule of incontestability provided in s. 632.46. [Bill 643-S]
632.96
632.96
Beneficiaries in fraternal contracts. 632.96(1)
(1) Any owner may designate as beneficiary any person permitted by the laws of the fraternal. Those laws shall authorize the designation of the estate of a member or insured employee as beneficiary.
632.96 Annotation
Legislative Council Note, 1975: Sub. (1) states a rule slightly more restrictive of the range of permitted beneficiaries than for commercial life insurance; this reflects the nature of the fraternal. Sub. (2) applies the general provision for life insurance, subject to sub. (1). [Bill 643-S]
MISCELLANEOUS
632.97
632.97
Application of proceeds of credit insurance policy. Payment to a creditor of any amounts insured under the terms of a credit insurance policy reduces the debt proportionately. This rule does not apply to an insurance policy on which the debtor pays no part of the premium, directly or indirectly.
632.97 History
History: 1975 c. 375.
632.98
632.98
Worker's compensation insurance. Sections 102.31,
102.315, and
102.62 apply to worker's compensation insurance.
632.99
632.99
Certifications of disability. For the purpose of insurance policies that they issue, every insurer doing a health or disability insurance business in this state shall afford equal weight to a certification of disability signed by a physician with respect to matters within the scope of the physician's professional license, to a certification of disability signed by a chiropractor with respect to matters within the scope of the chiropractor's professional license, and to a certification of disability signed by a podiatrist with respect to matters within the scope of the podiatrist's professional license. This section does not require an insurer to treat any certification of disability as conclusive evidence of disability.
632.99 History
History: 1981 c. 55;
2009 a. 113.
