601.72(1)(1)
General. Under procedures specified in s.
601.73, the commissioner is by law constituted attorney, except in cases in which the proceeding is to be brought by the state against an insurer or intermediary other than a risk retention group or risk purchasing group, in which event the department of financial institutions is by law constituted attorney, to receive service of summons, notices, orders, pleadings and all other legal process relating to any court or administrative agency in this state for all of the following:
601.72(1)(a)
(a)
Authorized insurers. All insurers authorized to do business in this state, while authorized to do business in this state, and thereafter in any proceeding arising from or related to any transaction having any connection with this state, provided the requirements under s.
601.715 (5) are satisfied.
601.72(1)(b)
(b)
Surplus lines insurers. All insurers as to any proceeding arising out of any contract that is permitted by s.
618.41, or out of any certificate, cover note or other confirmation of such insurance.
601.72(1)(c)
(c)
Unauthorized insurers. All insurers or other persons doing an unauthorized insurance business in this state, including but not limited to risk purchasing groups, as to any proceeding arising out of the unauthorized transaction.
601.72(1)(d)
(d)
Risk purchasing groups and nonresident intermediaries. All risk purchasing groups or nonresident intermediaries as to any proceeding arising out of insurance activities within this state or out of insurance activities related to policies on risks within this state.
601.72(2)
(2) Appointment of attorney. Except as provided in sub.
(2m), every licensed insurer by applying for and receiving a certificate of authority, every surplus lines insurer by entering into a contract subject to the surplus lines law, and every unauthorized insurer by doing an insurance business in this state, is deemed to have irrevocably appointed the commissioner and department of financial institutions as the insurer's attorneys in accordance with sub.
(1).
601.72(2m)
(2m) Risk retention groups and risk purchasing groups. A risk retention group or risk purchasing group may not do an insurance business or engage in any insurance activity in this state until it registers with the commissioner and designates the commissioner as its agent for the purposes described in sub.
(1). The commissioner may prescribe the form of registration under this subsection. If a risk retention group or risk purchasing group fails to designate the commissioner as required by this subsection, the commissioner is appointed agent for the risk retention group or risk purchasing group as provided in sub.
(2).
601.72(3)
(3) Others affected. The commissioner and department of financial institutions shall also be attorneys for the personal representatives, receivers, trustees, or other successors in interest of the persons specified in sub.
(1).
601.72(4)
(4) Fees. Litigants serving process on the commissioner under this section shall pay the fees specified in s.
601.31 (1) (p).
601.72(5)
(5) Ordinary means of service. The right to substituted service under this section does not limit the right to serve summons, notice, orders, pleadings, demands or other process upon any person in any manner provided by law.
601.72 History
History: 1995 a. 27,
396;
2001 a. 102.
601.72 Annotation
Legislative Council Note on sub. (1) (d), 1975: Under s. 628.04 (created by this act), Wisconsin takes an important step in liberalizing prevailing licensing laws by not requiring residence for unrestricted Wisconsin intermediaries' licenses. As a correlative measure, however, the reach of the Wisconsin courts and administrative agencies is extended to all such nonresidents. [Bill 16-S]
601.72 Annotation
The commissioner has the duty to accept service for all insurers, but does not have a duty to determine whether an insurer is a party to the action in which service is sought. Davies v. Heiman,
186 Wis. 2d 370,
520 N.W.2d 917 (Ct. App. 1994).
601.73
601.73
Procedure for service of process through state officer. 601.73(1)(1)
Requirements for effective service. Service upon the commissioner or department of financial institutions under s.
601.72 is service on the principal, if:
601.73(1)(a)
(a) Two copies of the process are left in the hands or office of the commissioner or department of financial institutions respectively; and
601.73(1)(b)
(b) The commissioner or department of financial institutions mails a copy of the process to the person served according to sub.
(2) (b).
601.73(2)(a)
(a)
Records. The commissioner and department of financial institutions shall give receipts for and keep records of all process served through them.
601.73(2)(b)
(b) Process mailed. The commissioner or department of financial institutions shall send immediately by certified mail to the person served, at the person's last-known principal place of business, residence or post-office address or at an address designated in writing by the person, one copy of any process received and shall retain the other copy.
601.73(2)(c)
(c)
Default judgment. No plaintiff or complainant is entitled to a judgment by default in any proceeding in which process is served under this section and s.
601.72 until the expiration of 45 days after the date of mailing of the process under par.
(b). If the proceeding is to foreclose or otherwise enforce a lien or security interest, the plaintiff or complainant is not entitled to a judgment by default under this paragraph until the expiration of 20 days after the date of mailing of the process under par.
(b).
601.73(3)
(3) Proof of service. A certificate by the commissioner or the department of financial institutions, showing service made upon the commissioner or department of financial institutions, and attached to a copy of the process presented for that purpose is sufficient evidence of the service.
601.73 Annotation
Legislative Council Note, 1979: [Repeal of (1) (c)] In its original form, the procedures of ss. 601.72 and 601.73 for substituted service of process through the commissioner or secretary of state required, in s. 601.73 (1) (b), the serving party to also mail a copy of the process to the person served, as additional assurance that this substituted service would provide actual notice. Sub. (1) (c) then required filing of an affidavit of compliance with (1) (a) and (b) to make the service effective. It may have been cumbersome, but it was logical. Some time later, the requirement of mailing by the serving party was eliminated by an amendment (ch. 189, laws of 1971) that did not go through the Insurance Laws Revision Committee, and did not make the necessary collateral changes. It makes little sense for the serving party to have to provide an affidavit as to what the public official does under (1) (b). Moreover, under (1) (b) the service is not complete anyway unless the public official does perform the statutory duty. Thus, the affidavit seems unnecessary and, because service is not complete without mailing by the public official, no further requirement seems needed. The reasonable solution, therefore, is to repeal (1) (c). [Bill 146-S]
601.73 Annotation
Section 801.15 (5) does not extend the time for answering a complaint served by substitute service under this section. Leonard v. Cattahach,
214 Wis. 2d 236,
571 N.W.2d 444 (Ct. App. 1997),
96-3167.
HEALTHCARE STABILITY PLAN
601.80
601.80
Definitions; healthcare stability plan. In this subchapter:
601.80(1)
(1) “Affordable Care Act” means the federal Patient Protection and Affordable Care Act, P.L.
111-148, as amended by the federal Health Care and Education Reconciliation Act of 2010, P.L.
111-152, and any amendments to or regulations or guidance issued under those acts.
601.80(2)
(2) “Attachment point” means the amount set under s.
601.83 (2) for the healthcare stability plan that is the threshold amount for claims costs incurred by an eligible health carrier for an enrolled individual's covered benefits in a benefit year, beyond which the claims costs are eligible for reinsurance payments.
601.80(3)
(3) “Benefit year” means the calendar year for which an eligible health carrier provides coverage through an individual health plan.
601.80(4)
(4) “Coinsurance rate” means the rate set under s.
601.83 (2) for the healthcare stability plan that is the rate at which the commissioner will reimburse an eligible health carrier for claims incurred for an enrolled individual's covered benefits in a benefit year above the attachment point and below the reinsurance cap.
601.80(5)
(5) “Eligible health carrier” means an insurer, as defined in s.
632.745 (15), that offers an individual health plan and incurs claims costs for an enrolled individual's covered benefits in the applicable benefit year.
601.80(6)
(6) “Grandfathered plan” means a health plan in which an individual was enrolled on March 23, 2010, for as long as it maintains that status in accordance with the Affordable Care Act.
601.80(8)
(8) “Healthcare stability plan” means the state-based reinsurance program known as the Wisconsin Healthcare Stability Plan administered under s.
601.83 (1).
601.80(9)
(9) “Individual health plan” means a health benefit plan that is not a group health plan, as defined in s.
632.745 (10), or a grandfathered plan.
601.80(10)
(10) “Payment parameters” means the attachment point, reinsurance cap, and coinsurance rate for the healthcare stability plan.
601.80(12)
(12) “Reinsurance cap” means the threshold amount set under s.
601.83 (2) for the healthcare stability plan for claims costs incurred by an eligible health carrier for an enrolled individual's covered benefits, after which the claims costs for benefits are no longer eligible for reinsurance payments.
601.80(13)
(13) “Reinsurance payment” means an amount paid by the commissioner to an eligible health carrier under the healthcare stability plan.
601.80 History
History: 2017 a. 138.
601.83
601.83
Healthcare stability plan; administration. 601.83(1)(1)
Plan established; general administration. 601.83(1)(a)
(a) The commissioner shall administer a state-based reinsurance program known as the healthcare stability plan in accordance with the specific terms and conditions approved by the federal department of health and human services dated July 29, 2018. Before December 31, 2023, the commissioner may not request from the federal department of health and human services a modification, suspension, withdrawal, or termination of the waiver under
42 USC 18052 under which the healthcare stability plan under this subchapter operates unless legislation has been enacted specifically directing the modification, suspension, withdrawal, or termination. Before December 31, 2023, the commissioner may request renewal, without substantive change, of the waiver under
42 USC 18052 under which the health care stability plan operates in accordance with s.
20.940 (4) unless legislation has been enacted that is contrary to such a renewal request. The commissioner shall comply with applicable timing in and requirements of s.
20.940.
601.83(1)(c)
(c) If the federal government enacts into law Senate Bill 1835 of the 115th Congress or a similar bill providing support to states to establish reinsurance programs, the commissioner shall seek, if necessary, and receive federal moneys for the purpose of reinsurance programs that result from that enacted law to expend for the purposes of this subchapter.
601.83(1)(d)
(d) In accordance with sub.
(5) (c), the commissioner shall collect the data from an eligible health carrier as necessary to determine reinsurance payments.
601.83(1)(e)
(e) Beginning on a date determined by the commissioner, the commissioner shall require each eligible health carrier to calculate the rates the eligible health carrier would have charged for a benefit year if the healthcare stability plan had not been established and submit the calculated rates as part of its rate filing submitted to the commissioner. The commissioner shall consider the calculated rate information provided under this paragraph as part of the rate filing review.
601.83(1)(f)1.1. For each applicable benefit year, the commissioner shall notify eligible health carriers of reinsurance payments to be made for the applicable benefit year no later than June 30 of the calendar year following the applicable benefit year.
601.83(1)(f)2.
2. Quarterly during the applicable benefit year, the commissioner shall provide each eligible health carrier with the calculation of total amounts of reinsurance payment requests.
601.83(1)(f)3.
3. By August 15 of the calendar year following the applicable benefit year, the commissioner shall disburse all applicable reinsurance payments to an eligible health carrier.
601.83(1)(g)
(g) The commissioner may promulgate any rules necessary to implement the healthcare stability plan under this section, except that any rules promulgated under this paragraph shall seek to maximize federal funding for the healthcare stability plan and shall comply with this section and with the approval by the federal department of health and human services dated July 29, 2018. The commissioner may promulgate rules necessary to implement this section as emergency rules under s.
227.24. 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. An emergency rule promulgated by the commissioner under this paragraph before January 1, 2019, remains in effect until it is superseded by a subsequent permanent rule.
601.83(1)(h)
(h) In 2019 and in each subsequent year, the commissioner may expend no more than $200,000,000 from all revenue sources for the healthcare stability plan under this section, unless the joint committee on finance under s.
13.10 has increased this amount upon request by the commissioner. The commissioner shall ensure that sufficient funds are available for the healthcare stability plan under this section to operate as described in the approval of the federal department of health and human services dated July 29, 2018.
601.83(1)(i)
(i) The commissioner shall complete and submit any reports, provide any information, and participate in any oversight activities required by the federal department of health and human services to implement and maintain the healthcare stability plan under this subchapter.
601.83(2)
(2) Payment parameters. The commissioner, after consulting with an actuarial firm, shall design and adjust payment parameters with the goal to do all of the following:
601.83(2)(a)
(a) Stabilize or reduce premium rates in the individual market.
601.83(2)(b)
(b) Increase participation by health carriers in the individual market.
601.83(2)(c)
(c) Improve access to health care providers and services for individuals purchasing coverage in the individual market.
601.83(2)(d)
(d) Mitigate the impact high-risk individuals have on premium rates in the individual market.
601.83(2)(e)
(e) Take into account any federal funding available for the plan.
601.83(2)(f)
(f) Take into account the total amount available to fund the plan.
601.83(3)(a)
(a) The commissioner shall set the payment parameters as described under sub.
(2) by no later than March 30 of the calendar year before the applicable benefit year or, if the commissioner specifies a different date by rule, the date specified by the commissioner by rule.
601.83(3)(b)
(b) If the amount available for expenditure for the healthcare stability plan is not anticipated to be adequate to fully fund the payment parameters set under par.
(a) as of July 1 of the calendar year before the applicable benefit year, the commissioner shall adjust the payment parameters in accordance within the moneys available to expend for the healthcare stability plan. The commissioner shall allow an eligible health carrier to revise its rate filing based on the final payment parameters for the applicable benefit year.
601.83(3)(c)
(c) If funding is not available to make all reinsurance payments to eligible health carriers in a benefit year, the commissioner shall make reinsurance payments in proportion to the eligible health carrier's share of aggregate individual health plan claims costs eligible for reinsurance payments during the given benefit year, as determined by the commissioner. The commissioner shall notify eligible health carriers if there are insufficient funds available to make reinsurance payments in full and the estimated amount of payment as soon as practicable after the commissioner becomes aware of the insufficiency.
601.83(4)
(4) Reinsurance payment calculation. 601.83(4)(a)(a) The commissioner shall calculate a reinsurance payment with respect to each eligible health carrier's incurred claims costs for an enrolled individual's covered benefits in the applicable benefit year. If the claims costs for an enrolled individual do not exceed the attachment point set under sub.
(2), the commissioner may not make a reinsurance payment with respect to that enrollee. If the claims costs for an enrolled individual exceed the attachment point, subject to par.
(b), the commissioner shall make a reinsurance payment that is calculated as the product of the coinsurance rate and whichever of the following is less:
601.83(4)(b)
(b) The commissioner shall ensure that any reinsurance payment made to an eligible health carrier does not exceed the total amount paid by the eligible health carrier for any claim. For purposes of this paragraph, the total amount paid of a claim is the amount paid by the eligible health carrier based upon the allowed amount less any deductible, coinsurance, or copayment paid by another person as of the time the data are submitted or made accessible under sub.
(5) (c).
601.83(5)(a)
(a) An eligible health carrier may request reinsurance payments from the commissioner when the eligible health carrier meets the requirements of this subsection and sub.
(4).
601.83(5)(b)
(b) An eligible health carrier shall make any requests for a reinsurance payment in accordance with any requirements established by the commissioner.
601.83(5)(c)
(c) Each eligible health carrier shall provide the commissioner with access to the data within the dedicated data environment established by the eligible health carrier under the federal risk adjustment program under
42 USC 18063. Each eligible health carrier shall submit to the commissioner attesting to compliance with the dedicated data environments, data requirements, establishment and usage of masked enrollee identification numbers, and data submission deadlines.
601.83(5)(d)
(d) Each eligible health carrier shall provide the access under par.
(c) for each applicable benefit year by April 30 of the calendar year following the end of the applicable benefit year.
601.83(5)(e)
(e) Each eligible health carrier shall maintain for at least 6 years documents and records, by paper, electronic, or other media, sufficient to substantiate a request for a reinsurance payment made under this section. An eligible health carrier shall make the documents and records available to the commissioner, upon request, for purposes of verification, investigation, audit, or other review of a reinsurance payment request.
601.83(5)(f)
(f) The commissioner may have an eligible health carrier audited to assess the health carrier's compliance with the requirements of this section. The eligible health carrier shall ensure that its contractors, subcontractors, or agents cooperate with any audit under this paragraph. Within 30 days of receiving notice that an audit results in a proposed finding of material weakness or significant deficiency with respect to compliance with any requirement of this section, the eligible health carrier may provide a response to the proposed finding. Within 60 days of the issuance of a final audit report that includes a finding of material weakness or significant deficiency, the eligible health carrier shall do all of the following:
601.83(5)(f)1.
1. Provide a written corrective action plan to the commissioner for approval.
601.83(5)(f)2.
2. Implement the corrective action plan under subd.
1. as approved by the commissioner.
601.83(5)(f)3.
3. Provide the commissioner with written documentation of the corrective action after implementation.
601.83(5)(g)
(g) The commissioner may recover from an eligible health carrier any overpayment of reinsurance payments as determined under the audit under par.
(f).
601.83(5)(h)
(h) A health carrier is not eligible to receive a reinsurance payment unless the health carrier agrees not to bring a lawsuit against the commissioner or a state agency or employee over any delay in reinsurance payments or any reduction in reinsurance payments in accordance with sub.
(3) (c).
601.83(6)
(6) Access to information. Information submitted by an eligible health carrier or obtained by the commissioner for purposes of the healthcare stability plan shall be used only for purposes of this subchapter and is proprietary and confidential under s.
601.465.
601.83 History
History: 2017 a. 138,
370.
601.85
601.85
Accounting, reports, and audits. 601.85(1)(1)
Accounting. The commissioner shall keep an accounting for each benefit year of all of the following:
601.85(1)(a)
(a) Funds appropriated for reinsurance payments and administrative and operational expenses.
601.85(1)(b)
(b) Requests for reinsurance payments received from eligible health carriers.
601.85(1)(c)
(c) Reinsurance payments made to eligible health carriers.
