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.
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.
601.43
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.
601.43(2)(b)
(b)
On request. Whenever the commissioner is requested by verified petition signed by 25 persons interested as shareholders, policyholders or creditors of an insurer alleging that there are grounds for formal delinquency proceedings, the commissioner shall forthwith examine the insurer as to any matter alleged in the petition. Whenever the commissioner is requested to do so by the board of directors of a domestic insurer, the commissioner shall examine the insurer as soon as reasonably possible.
601.43(2)(c)
(c)
Specific requirements. The commissioner shall examine insurers as otherwise required by law.
601.43(3)
(3) Audits or actuarial or other evaluations. In lieu of all or part of an examination under
subs. (1) and
(2), or in addition to it, the commissioner may order an independent audit by certified public accountants or an actuarial or other evaluation by actuaries or other experts approved by the commissioner of any person subject to the examination requirement. Any accountant, actuary or other expert selected is subject to rules respecting conflicts of interest promulgated by the commissioner. Any audit or evaluation under this section is subject to
s. 601.44, so far as appropriate.
601.43(4)
(4) Alternatives to examination. In lieu of all or part of an examination under this section, the commissioner may accept the report of an audit already made by certified public accountants or of an actuarial or other evaluation already made by actuaries or other experts approved by the commissioner, or the report of an examination made by the insurance department of another state or of the examination by another government agency in this state, the federal government or another state.
601.43(5)
(5) Purpose and scope of examination. An examination may but need not cover comprehensively all aspects of the examinee's affairs and condition. The commissioner shall determine the exact nature and scope of each examination, and in doing so shall take into account all relevant factors, including but not limited to the length of time the examinee has been doing business, the length of time the examinee has been licensed in this state, the nature of the business being examined, the nature of the accounting records available and the nature of examinations performed elsewhere. The examination of an alien insurer shall be limited to insurance transactions and assets in the United States unless the commissioner orders otherwise after finding that extraordinary circumstances necessitate a broader examination.
