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:
601.427(2)(d)
(d) The amounts paid in medical malpractice claims.
601.427(2)(e)
(e) Net investment gain or loss and other income gain or loss allocated to medical malpractice insurance, computed by the formula used in the annual insurance expenses exhibit for allocation among lines of business.
601.427(2)(f)
(f) The actual expenses attributable to medical malpractice insurance reported as loss adjustment expenses and all other expenses.
601.427(2)(k)
(k) Total number of verdicts or judgments for defendants.
601.427(2)(L)
(L) Total number of verdicts or judgments for plaintiffs.
601.427(2m)
(2m) Basis for reporting. The report filed under
sub. (1) shall contain the information required under
sub. (2) for each classification used for rating purposes, except that the information required by
sub. (2) (c) 3.,
(e) and
(f) shall be reported on a cumulative basis for all classifications.
601.427(3)
(3) Other insurance excluded. If medical malpractice insurance coverage includes premises and operations insurance or any other insurance delivered as a part of a package with medical malpractice insurance, only information relating to the medical malpractice insurance portion of the coverage shall be included in the report filed under
sub. (1).
601.427(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.
601.427(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).
601.427(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 medical malpractice 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.
601.427(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 involved.
601.427(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.
601.427(9)
(9) Commissioner's report. Within 2 years after May 25, 1995, and within 2 years thereafter, the commissioner shall submit a report to the legislature in the manner provided under
s. 13.172 (2). The reports shall compare the data for the year before May 25, 1995, with the data for the years after May 25, 1995, to evaluate the effects that
1995 Wisconsin Act 10 has had on the following:
601.427(9)(a)
(a) The number of health care providers practicing in Wisconsin.
601.427(9)(c)
(c) The premiums that health care providers pay for health care liability insurance.
601.428
601.428
Cancellation and rescission reports. Beginning in 2009, every insurer that issues individual health insurance policies shall annually report to the commissioner the total number of individual health insurance policies that the insurer issued in the preceding year and the total number of individual health insurance policies with respect to which the insurer initiated or completed a cancellation or rescission in the preceding year.
601.428 History
History: 2009 a. 28.
601.43
601.43
Examinations and alternatives. 601.43(1)(a)(a)
Insurers, other licensees and other persons subject to regulation. Whenever the commissioner deems it necessary in order to inform himself or herself about any matter related to the enforcement of
chs. 600 to
647, the commissioner may examine the affairs and condition of any licensee or permittee under
chs. 600 to
647 or applicant for a license or permit, of any person or organization of persons doing or in process of organizing to do an insurance business in this state, and of any advisory organization serving any of the foregoing in this state.
601.43(1)(b)
(b)
Collateral examinations. So far as reasonably necessary for an examination under
par. (a), the commissioner may examine the accounts, records, documents or evidences of transactions, so far as they relate to the examinee, of any of the following:
601.43(1)(b)1.
1. An officer, manager, general agent, employee, or person who has executive authority over or is in charge of any segment of the examinee's affairs.
601.43(1)(b)2.
2. A person controlling or having a contract under which the person has the right to control the examinee whether exclusively or with others.
601.43(1)(b)3.
3. A person who is under the control of the examinee, or a person who is under the control of a person who controls or has a right to control the examinee whether exclusively or with others.
601.43(1)(b)4.
4. An individual practice association which contracts with the examinee to provide health care services.
601.43(1)(c)
(c)
Availability of records. On demand every examinee under
par. (a) shall make available to the commissioner for examination any of its own accounts, records, documents or evidences of transactions and any of those of the persons listed in
par. (b). Failure to do so shall be deemed to be concealment of records under
s. 645.41 (8), except that if the examinee is unable to obtain accounts, records, documents or evidences of transactions, failure shall not be deemed concealment if the examinee terminates immediately the relationship with the other person.
601.43(1)(d)
(d)
Delivery of records to the office. On order of the commissioner any licensee or permittee under
chs. 600 to
647 shall bring to the office for examination such records as the order reasonably requires.
601.43(2)(a)(a)
Insurers and rate service organizations. The commissioner shall examine every domestic insurer and every licensed rate service organization.
