628.347(4m)(a)
(a) An insurance intermediary may not solicit the sale of an annuity product unless the insurance intermediary has adequate knowledge of the product to recommend the annuity and the insurance intermediary is in compliance with the insurer's standards for product training. An insurance intermediary may rely on insurer-provided product-specific training standards and materials to comply with this paragraph.
628.347(4m)(b)1.a.a. An insurance intermediary who engages in the sale of annuity products shall complete a one-time training course approved by the commissioner and provided by an education provider approved by the commissioner.
628.347(4m)(b)1.b.
b. Insurance intermediaries who hold a life insurance line of authority on May 1, 2011, and who desire to sell annuities must complete the requirements of this paragraph within 6 months after May 1, 2011. Individuals who obtain a life insurance line of authority on or after May 1, 2011, may not engage in the sale of annuities until they have completed the annuity training course required under this paragraph.
628.347(4m)(b)2.
2. The minimum length of the training required under this paragraph shall be sufficient to qualify for at least 4 continuing education credits, but may be longer.
628.347(4m)(b)3.
3. The training required under this paragraph shall include information on all of the following topics:
628.347(4m)(b)3.d.
d. The application of income taxation of qualified and non-qualified annuities.
628.347(4m)(b)3.f.
f. Appropriate sales practices and replacement and disclosure requirements.
628.347(4m)(b)4.
4. Providers of annuity training courses intended to comply with this paragraph shall cover all of the topics listed under subd.
3. and may not present any marketing information or provide training on sales techniques or provide specific information about a particular insurer's products. Additional topics may be offered in conjunction with and in addition to those listed under subd.
3. 628.347(4m)(b)5.
5. A provider of an annuity training course intended to comply with this paragraph shall register as a continuing education provider in this state and comply with the rules and guidelines applicable to insurance intermediary continuing education courses as set forth in rules of the office governing intermediary continuing education requirements.
628.347(4m)(b)6.
6. Annuity training courses may be conducted and completed by classroom or self-study methods in accordance with rules of the office governing intermediary continuing education requirements.
628.347(4m)(b)7.
7. Providers of annuity training shall comply with the reporting requirements and shall issue certificates of completion in accordance with rules of the office governing intermediary continuing education requirements.
628.347(4m)(b)8.
8. Satisfaction of the training requirements of another state that are substantially similar to the requirements of this paragraph satisfies the training requirements of this paragraph in this state.
628.347(4m)(b)9.
9. An insurer shall verify that an insurance intermediary has completed the annuity training course required under this paragraph before allowing the intermediary to sell an annuity product for that insurer. An insurer may satisfy its responsibility under this subdivision by obtaining certificates of completion of the training course or obtaining reports provided by commissioner-sponsored database systems or vendors or from a reasonably reliable commercial database vendor that has a reporting arrangement with approved insurance education providers.
628.347(5)
(5)
Compliance; remedial measures. An insurer is responsible for compliance with this section. If a violation occurs, either because of the action or inaction of the insurer or its insurance intermediary, the commissioner may do any of the following:
628.347(5)(a)
(a) Order an insurer to take reasonably appropriate corrective action for any consumer harmed by a violation of this section by the insurer or the insurer's insurance intermediary.
628.347(5)(b)
(b) Order an insurance intermediary to take reasonably appropriate corrective action for any consumer harmed by a violation of this section by the insurance intermediary.
628.347(5)(c)
(c) Order a general agent or independent agency that employs or contracts with an insurance intermediary to sell, or solicit the sale of, annuities to consumers to take reasonably appropriate corrective action for any consumer harmed by a violation of this section by the insurance intermediary.
628.347(6)(a)(a) Any person who violates this section is subject to the penalties provided under s.
601.64, suspension or revocation of a license or certificate of authority, and an order under s.
601.41 (4).
628.347(6)(c)
(c) The commissioner may by rule provide for the reduction or elimination of a penalty under par.
(a) for a violation of this section if corrective action is taken for the consumer promptly after the violation is discovered or the violation is not part of a pattern or practice.
628.347(7)(a)(a) An insurer and an insurance intermediary, including a general agent and an independent agency, shall maintain, or be able to make available to the commissioner, records of the information collected from a consumer and other information used in making a recommendation that was the basis for an insurance transaction for 6 years after the insurance transaction is completed by the insurer, except as otherwise permitted by the commissioner by rule. An insurer may, but is not required to, maintain records on behalf of an insurance intermediary, including a general agent and an independent agency.
628.347(7)(b)
(b) Records that are required to be maintained under this section may be maintained in paper, photographic, microprocess, magnetic, or electronic media or by any process that accurately reproduces the actual document.
628.347(8)
(8)
Exemptions. This section does not apply to any of the following:
628.347(8)(a)
(a) Direct response solicitations in which no recommendation is made based on information collected from the consumer.
628.347(8)(b)
(b) Recommendations related to contracts used to fund any of the following:
628.347(8)(b)1.
1. An employee pension or welfare benefit plan that is covered by the federal Employee Retirement and Income Security Act.
628.347(8)(b)2.
2. A plan described in section
401 (a) or (k),
403 (b), or
408 (k) or (p) of the Internal Revenue Code, if the plan is established or maintained by an employer.
628.347(8)(b)3.
3. A government or church plan as defined in section
414 of the Internal Revenue Code, a government or church welfare benefit plan, or a deferred compensation plan of a state or local government or tax exempt organization under section
457 of the Internal Revenue Code.
628.347(8)(b)4.
4. A nonqualified deferred compensation arrangement established or maintained by an employer or plan sponsor.
628.347(8)(b)5.
5. A settlement or assumption of liability associated with personal injury litigation or any dispute or claim resolution process.
628.348
628.348
Sale of long-term care insurance. 628.348(1)(1)
Training requirement. On and after January 1, 2009, no person may solicit, negotiate, or sell long-term care insurance unless the person is a licensed intermediary and he or she has completed the initial training portion of the training program under s.
49.45 (31) (c) and completes the ongoing training under s.
49.45 (31) (c) every 24 months after completing the initial training.
628.348(2)
(2)
Insurer verification. Insurers providing long-term care insurance shall do all of the following:
628.348(2)(a)
(a) Obtain from intermediaries selling long-term care insurance on behalf of the insurer verification that the intermediary is in compliance with the training requirements under sub.
(1).
628.348(2)(b)
(b) Maintain records related to the verifications obtained under par.
(a).
628.348(2)(c)
(c) Make the records under par.
(b) available to the commissioner upon request.
628.348 History
History: 2007 a. 20,
226.
628.35
628.35
Prohibition of exclusive contracts. No insurer may make, enforce or participate in any contract or other arrangement for exclusive services of a health care provider that prevents or materially inhibits any other insurer authorized to do business in this state from entering into a contract or other arrangement with any health care provider of services that the other insurer has contracted to supply or for which it has promised indemnity under its insurance contracts, unless:
628.35(1)
(1) The health care provider is an individual who is an employee of the insurer;
628.35(2)
(2) The health care provider is a corporation owned by the insurer;
628.35(3)
(3) The health care provider uses the insurer's name under a franchise arrangement; or
628.35(4)
(4) The case is within a class for which the commissioner by rule establishes an exception after a finding that the contract or other arrangement does not seriously impede the effective operation of a legitimate insurance business by other insurers.
628.35 History
History: 1975 c. 223,
371,
422.
628.36
628.36
Limitations on corporations supplying health care services. 628.36(1)(1)
Payment methods. Any corporation operating a voluntary health care plan may pay health care professionals on a salary, per patient or fee-for-service basis to provide health care to policyholders or beneficiaries of the corporation.
628.36(2)
(2)
Discrimination against professionals. 628.36(2)(a)1.
1. “Health care plan" means an insurance contract providing coverage of health care expenses.
628.36(2)(a)2.
2. “Provider" means a health care professional, a health care facility or a health care service or organization.
628.36(2)(b)1.1. Except for health maintenance organizations, preferred provider plans and limited service health organizations, no health care plan may prevent any person covered under the plan from choosing freely among providers who have agreed to participate in the plan and abide by its terms, except by requiring the person covered to select primary providers to be used when reasonably possible.
628.36(2)(b)2.
2. No provider may be required to participate exclusively in a health care plan as a condition of participation in it.
628.36(2)(b)3.
3. Except as provided in subd.
4., no provider may be denied the opportunity to participate in a health care plan, other than a health maintenance organization, a limited service health organization or a preferred provider plan, under the terms of the plan.
628.36(2)(b)4.
4. Any health care plan may exclude a provider from participation in the health care plan for cause related to the practice of his or her profession.
628.36(2)(b)5.
5. All health care plans, including health maintenance organizations, limited service health organizations and preferred provider plans are subject to s.
632.87 (3).
628.36(2m)(a)2m.
2m. “Pharmaceutical services" do not include the administration of a drug product or device or vaccine under s.
450.035.
628.36(2m)(e)1.1. A health maintenance organization, limited service health organization or preferred provider plan that provides coverage of pharmaceutical services when performed by one or more pharmacists who are selected by the organization or plan but who are not full-time salaried employees or partners of the organization or plan shall provide an annual period of at least 30 days during which any pharmacist registered under ch.
450 may elect to participate in the health maintenance organization, limited service health organization or preferred provider plan under its terms as a selected provider for at least one year.
628.36(2m)(e)2.
2. Except as provided in subd.
3., subd.
1. applies to health maintenance organizations on and after May 10, 1984. Except as provided in subd.
4., subd.
1. applies to limited service health organizations and preferred provider plans on or after April 28, 1990.
628.36(2m)(e)3.
3. If compliance with the requirements of subd.
1. during the period specified in subd.
2. would impair any provision of a contract between a health maintenance organization and any other person, and if the contract provision was in existence prior to May 10, 1984, then immediately after the expiration of all such contract provisions the health maintenance organization shall comply with the requirements of subd.
1. 628.36(2m)(e)4.
4. If compliance with the requirements of subd.
1. during the period specified in subd.
2. would impair any provision of a contract between a limited service health organization or preferred provider plan and any other person, and if the contract was in existence prior to April 28, 1990, then immediately after the expiration of all such contract provisions the limited service health organization or preferred provider plan shall comply with the requirements of subd.
1. 628.36(3)
(3)
Exemption by rule. By rule the commissioner may exempt from the application of any part of subs.
(1) to
(2m) plans which provide innovative approaches to the delivery of health care or which are designed to contain health care costs, and which cannot operate successfully consistent with all of the provisions in subs.
(1) to
(2m). The commissioner may promulgate such a rule only if on a finding that the interests of the public require such plans as an experiment, to supply health care services that are not otherwise available in adequate quantity or quality, or to contain health care costs. The promulgated rule shall be as narrow as is compatible with the success of the plans.
628.36(4)
(4)
Facilitating cost-effective provision of health care services. 628.36(4)(a)(a) The commissioner shall provide information and assistance to the department of employee trust funds, employers and their employees, providers of health care services and members of the public, as provided in par.
(b), for the following purposes:
628.36(4)(a)1.
1. To facilitate the development and implementation of health care plans that provide innovative approaches to the delivery of health care services or that are designed to contain health care costs.
628.36(4)(a)2.
2. To increase the awareness and understanding among employers and their employees, providers of health care services and members of the public regarding the availability and nature of innovative or cost-effective health care plans.
628.36(4)(b)
(b) The commissioner's responsibilities in accomplishing the purposes set forth in par.
(a) shall include all of the following:
628.36(4)(b)1.
1. Assisting the department of employee trust funds in the development of health care plans under s.
40.51 (7).
628.36(4)(b)2.
2. Providing employers and their employees with information regarding the availability and nature of health care coverage that may be obtained under s.
40.51 (7).
628.36(4)(b)3.
3. Providing information to employers regarding how to proceed under s.
40.51 (7) to obtain health care coverage for their employees.
628.36(4)(b)4.
4. Providing information to employers and their employees and members of the public regarding the availability and nature of various kinds of health care plans, including their distinct and contrasting characteristics.
628.36(4)(b)5.
5. Providing information to employers and their employees, providers of health care services and members of the public regarding the relative effectiveness of various kinds of health care plans in containing health care costs.
