601.42(1g)(d)
(d) Statements, reports, answers to questionnaires or other information, or reports, audits or certification from a certified public accountant or an actuary approved by the commissioner, relating to the extent liabilities of a health maintenance organization insurer are or will be liabilities for health care costs for which an enrollee or policyholder of the health maintenance organization is not liable to any person under
s. 609.91.
601.42(1r)
(1r) Reports by individual practice associations. The commissioner may by rule require that an individual practice association submit to the commissioner information reasonably necessary to determine the financial condition of the individual practice association. The information required under this subsection may include, but is not limited to, financial statements of the individual practice association, except the commissioner may not require members of the individual practice association or other health care providers who contract with the individual practice association to submit individual financial statements.
601.42(2)
(2) Forms. The commissioner may prescribe forms for the reports under
subs. (1g) and
(1r) and specify who shall execute or certify such reports. The forms for the reports required under
sub. (1g) shall be consistent, so far as practicable, with those prescribed by other jurisdictions.
601.42(3)
(3) Accounting methods. The commissioner may prescribe reasonable minimum standards and techniques of accounting and data handling to ensure that timely and reliable information will exist and will be available to the commissioner.
601.42(4)
(4) Replies. Any officer, manager or general agent of any insurer authorized to do or doing an insurance business in this state, any person controlling or having a contract under which the person has a right to control such an insurer, whether exclusively or otherwise, any person with executive authority over or in charge of any segment of such an insurer's affairs, any individual practice association or officer, director or manager of an individual practice association, any insurance agent or other person licensed under
chs. 600 to
646, any provider of services under a continuing care contract, as defined in
s. 647.01 (2), any independent review organization certified or recertified under
s. 632.835 (4) or any health care provider, as defined in
s. 655.001 (8), shall reply promptly in writing or in other designated form, to any written inquiry from the commissioner requesting a reply.
601.42(5)
(5) Verification. The commissioner may require that any communication made to the commissioner under this section be verified.
601.42(6)(a)(a) In the absence of actual malice, no communication to the commissioner required by law or by the commissioner shall subject the person making it to an action for damages for defamation. This paragraph applies to communications received by the commissioner before May 11, 1990, or on or after June 1, 1994.
601.42(6)(b)
(b) In the absence of actual malice, no communication to the commissioner or office required by law or by the commissioner shall subject the person making it to an action for damages for the communication. This paragraph applies to communications received by the commissioner or office on or after May 11, 1990, and before June 1, 1994.
601.42(7)
(7) Experts. The commissioner may employ experts to assist the commissioner in an examination or in the review of any transaction subject to approval under
chs. 600 to
646. The person that is the subject of the examination, or that is a party to a transaction under review, including the person acquiring, controlling or attempting to acquire the insurer, shall pay the reasonable costs incurred by the commissioner for the expert and related expenses.
601.42 Cross-reference
Cross-reference: See also s.
623.02 as to standards for accounting rules.
601.42 Cross-reference
Cross-reference: See also ss.
Ins 6.61,
6.62, and
6.63, Wis. adm. code.
601.422
601.422
Commercial liability insurance reports. 601.422(1)(1)
Requirement. Each insurer authorized to write commercial liability insurance shall file an annual commercial liability insurance report complying with this section with the commissioner on or before May 1 of each year.
601.422(2)
(2) Contents. The report filed under
sub. (1) shall contain the name of the insurer and all of the following information, for each category or type of commercial liability insurance designated by the commissioner by rule and offered by the insurer, for policies covering insureds located in this state for each group of policies with effective dates within a particular calendar year:
601.422(2)(a)
(a) The total dollar amount of premiums written and earned for primary coverage and for excess coverage.
601.422(2)(c)
(c) The amount of reserves established for each of the following:
601.422(2)(e)
(e) Net investment gain or loss and other income gain or loss allocated to each category or type, computed by the formula used in the annual insurance expenses exhibit for allocation among lines of business.
601.422(2)(f)
(f) The actual expenses attributable to each category or type, reported separately as loss adjustment expenses and all other expenses.
601.422(3)
(3) Other insurance excluded. If commercial liability insurance coverage includes any insurance other than commercial liability insurance delivered as a part of a package with commercial liability insurance, only information relating to the commercial liability insurance portion of the coverage shall be included in the report filed under
sub. (1).
601.422(4)
(4) Period of report. The report filed under
sub. (1) shall provide all required information updated as of the last day of the calendar year preceding the year in which the report is filed. The report shall include required information for policies with effective dates within calendar years beginning with calendar year 1988 and ending with the calendar year preceding the year in which the report is filed. Effective with filings in 1999, the report shall exclude required information for policies with effective dates within any calendar year commencing more than 10 years prior to January 1 of the year in which the report is filed.
601.422(5)
(5) Summary. The commissioner shall provide a summary of the information contained in the 2 most recent filings of reports under
sub. (1) in the biennial report to the governor and the legislature under
s. 15.04 (1) (d).
601.422(6)
(6) Rules, adjustments and exclusions. The commissioner may, by rule, establish the form of the report filed under
sub. (1), including the manner of reporting the elements of the report. The commissioner may, by rule, require reports to include information in addition to that specified in this section. The commissioner may adjust the reporting requirements for any insurer for which the requirements of this section are burdensome. The commissioner may determine that no report need be filed if the commercial liability insurance issued by an insurer is of such a small amount that its reporting would be burdensome to the insurer or would be of no statistical significance.
601.422(7)
(7) No liability or cause of action. There shall be no liability on the part of and no cause of action shall arise against an insurer or an insurer's agents or employees for reporting in good faith under this section, or against the commissioner or employees of the office for any good faith act or omission under this section.
601.422 History
History: 1987 a. 27.
601.423
601.423
Social and financial impact reports. 601.423(1)
(1)
Definition. In this section, "health insurance mandate" means a statute of this state which requires an insurance policy, plan or contract to do any of the following:
601.423(1)(a)
(a) Permit a person insured under the policy, plan or contract to obtain treatment or services from a particular type of health care provider, including, but not limited to, requiring a health maintenance organization, preferred provider plan, limited service health organization or other plan to select a particular type of health care provider for participation in the plan.
601.423(1)(b)
(b) Provide coverage for the treatment of a particular disease, condition or other health care need.
601.423(1)(c)
(c) Provide coverage of a particular type of health care treatment or service, or of equipment, supplies or drugs used in connection with a health care treatment or service.
601.423(1)(d)
(d) Provide coverage for particular persons because of their relation to the insured or legal status with respect to the insured, or for any other reason.
601.423(2)
(2) Preparation of report. The commissioner shall submit a report on the social and financial impact of any health insurance mandate, contained in any bill affecting an insurance policy, plan or contract, to the presiding officer of that house of the legislature in which the bill is introduced. At the discretion of the presiding officer, any such report may be printed and distributed as are amendments.
601.423(3)(a)(a)
Social impact factors. Any report prepared under
sub. (2) shall assess to the extent possible all of the following social impact factors which are relevant to the type of health insurance mandate created, expanded or continued by the bill:
601.423(3)(a)1.
1. The portion of this state's residents who use the treatments or services covered by the health insurance mandate.
601.423(3)(a)2.
2. The extent to which individuals under
subd. 1. use these treatments or services.
601.423(3)(a)3.
3. The availability of insurance coverage for these treatments or services.
601.423(3)(a)4.
4. The number of persons who would be eligible for coverage under the health insurance mandate, and the availability of insurance coverage for these persons without the health insurance mandate.
601.423(3)(b)
(b)
Financial impact factors. Any report prepared under
sub. (2) shall assess to the extent possible all of the following financial impact factors which are relevant to the type of health insurance mandate created, expanded or continued by the bill:
601.423(3)(b)1.
1. Whether the health insurance mandate may increase or decrease the costs of the treatments or services covered by the health insurance mandate.
601.423(3)(b)2.
2. Whether the health insurance mandate would increase the use of the treatments or services covered by the health insurance mandate.
601.423(3)(b)3.
3. Whether any increased use under
subd. 2. would substitute for more expensive treatments or services.
601.423(3)(b)4.
4. The impact of the health insurance mandate on total costs of health care in this state.
601.423(3)(b)5.
5. Whether the health insurance mandate may increase the administrative costs to insurance companies and the premium costs to policyholders.
601.423 History
History: 1987 a. 177.
601.425
601.425
Product liability insurance reports. 601.425(1)(1)
Requirement. Each insurer authorized to write product liability insurance shall file an annual products liability insurance report complying with this section with the commissioner on or before May 1 of each year.
601.425(2)
(2) Contents. The report filed under
sub. (1) shall contain the name of the insurer and all of the following information for policies covering insureds located in this state for each group of policies with effective dates within a particular calendar year:
601.425(2)(a)
(a) The total dollar amount of premiums earned for product liability insurance coverage both for primary coverage and for excess coverage.
601.425(2)(b)
(b) The number of insureds from whom product liability insurance coverage premiums were collected.
601.425(2)(c)
(c) The number and amount of all reserves established for all of the following:
601.425(2)(e)
(e) Net investment gain or loss and other income gain or loss allocated to products liability insurance, computed by the formula used in the annual insurance expenses exhibit for allocation among lines of business.
601.425(2)(f)
(f) The actual expenses attributable to product liability insurance reported separately as loss adjustment expenses and all other expenses.
601.425(2)(k)
(k) Total number of verdicts or judgments for defendants.
601.425(2)(L)
(L) Total number of verdicts or judgments for plaintiffs.
601.425(3)
(3) Other insurance excluded. If product liability insurance coverage includes premises and operations insurance or any other insurance delivered as a part of a package with product liability insurance, only information relating to the product liability insurance portion of the coverage shall be included in the report filed under
sub. (1).
601.425(4)
(4) Period of report. The report filed under
sub. (1) shall provide all required information updated as of the last day of the calendar year preceding the year in which the report is filed. The report shall include required information for policies with effective dates within calendar years beginning with calendar year 1979 and ending with the 2nd calendar year preceding the year in which the report is filed. Effective with filings in 1991, the report shall exclude required information for policies with effective dates within any calendar year commencing more than 11 years prior to January 1 of the year in which the report is filed.
601.425(5)
(5) Summary. The commissioner shall provide a summary of the information contained in the 2 most recent filings of reports under
sub. (1) in the biennial report to the governor and the legislature under
s. 15.04 (1) (d).
601.425(6)
(6) Rules, adjustments and exclusions. The commissioner may, by rule, establish the form of the report filed under
sub. (1), including the manner of reporting the elements of the report. The commissioner may, by rule, require reports to include information in addition to that specified in this section. The commissioner may adjust the reporting requirements for any insurer for which the requirements of this section are burdensome. The commissioner may determine that no report need be filed if the product liability insurance issued by an insurer is of such a small amount that its reporting would be burdensome to the insurer or would be of no statistical significance.
601.425(7)
(7) Public records. Notwithstanding
subch. II of ch. 19, the commissioner shall make the reports filed under
sub. (1) available to the public in a manner that does not reveal the name of any person, manufacturer or seller involved.
601.425(8)
(8) No liability or cause of action. There shall be no liability on the part of and no cause of action shall arise against any insurer for reporting in good faith under this section or any insurer's agents or employees, or the commissioner for any good faith act or omission under this section.
601.425 History
History: 1985 a. 314.
601.427
601.427
Medical malpractice insurance reports. 601.427(1)(1)
Requirement. Each insurer authorized to write medical malpractice insurance shall file an annual medical malpractice insurance report complying with this section with the commissioner on or before May 1 of each year.
601.427(2)
(2) Contents. The report filed under
sub. (1) shall contain the name of the insurer and all of the following information for policies covering residents of this state for each group of policies with effective dates within a particular calendar year:
601.427(2)(a)
(a) The total dollar amount of premiums earned for medical malpractice insurance coverage both for primary coverage and for excess coverage.
601.427(2)(b)
(b) The number of insureds from whom medical malpractice insurance coverage premiums were collected.
601.427(2)(c)
(c) The number and amount of all reserves established for all of the following:
