601.41(9)(b)
(b) If the federal government has not developed by July 1, 2003, a uniform claim processing form that must be used by all health care providers for submitting claims to insurers and by all insurers for processing claims submitted by health care providers, the commissioner shall develop, by December 31, 2003, a uniform claim processing form for that purpose.
601.41(10)
(10) Uniform application for individual health insurance policies. 601.41(10)(a)(a) The commissioner shall by rule prescribe uniform questions and the format for applications, which may not exceed 10 pages in length, for individual major medical health insurance policies.
601.41(10)(b)
(b) After the effective date of the rules promulgated under
par. (a), an insurer may use only the prescribed questions and format for individual major medical health insurance policy applications. The commissioner shall publish a notice in the Wisconsin Administrative Register that states the effective date of the rules promulgated under
par. (a).
601.41(10)(c)
(c) For purposes of this subsection, an individual major medical health insurance policy includes health coverage provided on an individual basis through an association.
601.41(11)(a)1.
1. “Instruction" means education, training, instruction, or other experience related to an occupation or profession.
601.41(11)(a)2.
2. “License" means a license, certificate, or permit issued by the commissioner under
chs. 601 to
655 for an occupation or profession.
601.41(11)(b)
(b) In connection with the issuance of a license, the commissioner shall count any relevant instruction that an applicant for a license has obtained in connection with military service, as defined in
s. 111.32 (12g), toward satisfying any requirements for instruction for that license, if the applicant demonstrates to the satisfaction of the commissioner that the instruction obtained by the applicant is substantially equivalent to the instruction required for the license.
601.41 Cross-reference
Cross-reference: See also
Ins, Wis. adm. code.
601.41 Annotation
Sub. (4) gives the commissioner the authority to issue not only prohibitory and mandatory orders, but also other orders as are necessary to secure compliance with the law. There is no limitation on the nature of the other orders except that they be necessary to secure compliance with the law. Sub. (4) permitted the order of refunds when the commissioner determined that a company violated the law by selling its contracts without a certificate of authority. Homeward Bound Services, Inc. v. Office of the Insurance Commissioner,
2006 WI App 208,
296 Wis. 2d 481,
724 N.W. 2d 380,
05-1781.
601.41 Annotation
Why process consumer complaints? A case study of the office of the commissioner of insurance of Wisconsin. Whitford, Kimball, 1974 WLR 639.
601.415
601.415
Miscellaneous duties. The duties listed in this section are in addition to other duties imposed under
chs. 600 to
655. Failure to list a specified power, duty or function of the commissioner in this section does not affect the validity of the power, duty or function.
601.415(1)
(1) Joint survey committee on retirement systems. The commissioner or an experienced actuary in the office designated by the commissioner shall serve as a member of the joint survey committee on retirement systems under
s. 13.50.
601.415(2)
(2) Group insurance board. The commissioner shall serve as a member of the group insurance board under
s. 15.165 (2).
601.415(3)
(3) Wisconsin retirement board. The commissioner or an experienced actuary in the office designated by the commissioner shall serve as a member of the Wisconsin retirement board under
s. 15.165 (3) (b).
601.415(5)
(5) Cooperation with department of administration. The commissioner shall cooperate with the department of administration in placing insurance under
s. 16.865 (4).
601.415(7)
(7) Determination of variable interest rate adjustments. The commissioner shall approve indexes for variable interest rate adjustments under
s. 138.055 (4) (c).
601.415(8)
(8) Long-Term Care Partnership Program. The commissioner shall provide the certifications required under
s. 49.45 (31) (b) 5. and shall cooperate with the department of health services in approving the training program under
s. 49.45 (31) (c) for agents who sell long-term care insurance policies.
601.415(9)
(9) Consumer credit law. The commissioner shall cooperate with the division of banking in the administration of
ch. 424, shall determine the method for computation of refunds under
s. 424.205, shall approve forms, schedules of premium rates and charges under
s. 424.209 and shall issue rules or orders of compliance to insurers under
s. 424.602.
601.415(10)
(10) Petroleum product storage remedial action program rules. The commissioner shall promulgate the rules required under
s. 292.63 (1m).
601.415(11)
(11) Amendments to Own Risk and Solvency Assessment Guidance Manual. The commissioner shall, in his or her discretion, adopt amendments made after April 18, 2014, by the National Association of Insurance Commissioners to the guidance manual, as defined in
s. 622.03 (1). Any such amendments made by the National Association of Insurance Commissioners become effective in this state if adopted by the commissioner by order after giving 30 days' notice to insurers of the changes proposed by the National Association of Insurance Commissioners. If one or more insurers request a hearing on the proposed changes during the 30-day period, the commissioner shall hold a hearing to determine whether the commissioner will, in his or her discretion, adopt one or more of the changes made by the National Association of Insurance Commissioners.
601.42
601.42
Reports and replies. 601.42(1g)
(1g)
Reports. The commissioner may require any of the following from any person subject to regulation under
chs. 600 to
655:
601.42(1g)(a)
(a) Statements, reports, answers to questionnaires and other information, and evidence thereof, in whatever reasonable form the commissioner designates, and at such reasonable intervals as the commissioner chooses, or from time to time.
601.42(1g)(b)
(b) Full explanation of the programming of any data storage or communication system in use.
601.42(1g)(c)
(c) That information from any books, records, electronic data processing systems, computers or any other information storage system be made available to the commissioner at any reasonable time and in any reasonable manner.
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.
601.423
601.423
Social and financial impact reports. 601.423(1)
(1)
Definition. In this section, “health insurance mandate" means a statute of this state that does any of the following:
601.423(1)(am)
(am) Requires an insurance policy, plan, or contract to do any of the following:
601.423(1)(am)1.
1. 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)(am)2.
2. Provide coverage for the treatment of a particular disease, condition or other health care need.
601.423(1)(am)3.
3. 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)(am)4.
4. 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(1)(bm)
(bm) Requires a particular benefit design under an insurance policy, plan, or contract for the treatment of a particular disease, condition, or other health care need, for a particular type of health care treatment or service, or for the provision of equipment, supplies, or drugs used in connection with a health care treatment or service.
601.423(1)(cm)
(cm) Imposes limits or conditions on a contract between an insurer and a health care provider, as defined in
s. 146.81 (1).
601.423(2)
(2) Preparation of report. The commissioner shall, in the manner provided under
s. 13.0966, submit a report on the social and financial impact of any health insurance mandate contained in any bill or amendment affecting an insurance policy, plan, or contract, or a written statement explaining the reason for not preparing the report, to the presiding officer of that house of the legislature in which the bill or amendment is introduced.
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 that are relevant to the type of health insurance mandate created, expanded, or continued by the bill or amendment:
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 that are relevant to the type of health insurance mandate created, expanded, or continued by the bill or amendment:
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;
2015 a. 288.
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.
