Ins 3.34(5)(a) (a) On or after January 1, 2010, an insurer and self-insured health plan shall offer coverage to an adult child of an applicant or insured as a new entrant when the applicant or insured requests enrollment of the adult child no later than 30 days after the date the adult child first becomes eligible according to this section. It is solely the applicant’s or insured’s decision whether or not to add eligible adult children to the plan to the extent permitted by law.

Ins 3.34(5)(b) (b) Insurers and self-insured health plans may not limit or otherwise restrict the offer of coverage to an eligible adult child by requiring any of the following:

Ins 3.34(5)(b)1. 1. The eligible adult child to have been previously covered as a dependent.

Ins 3.34(5)(b)2. 2. The eligible adult child to reside in this state.

Ins 3.34(5)(b)3. 3. The eligible adult child to demonstrate that he or she had previous creditable coverage.

Ins 3.34(5)(b)4. 4. The insured or applicant to have requested coverage for an eligible adult child the first time the child was eligible for coverage.

Ins 3.34(5)(c) (c) Insurers offering individual disability insurance may individually rate the eligible adult child and apply preexisting condition waiting periods consistent with s. 632.76 (2) (ac) 2., Stats., and may apply elimination riders to the eligible adult child, but may not do either of the following:

Ins 3.34(5)(c)1. 1. Deny coverage to an eligible adult child when the applicant or insured requests coverage.

Ins 3.34(5)(c)2. 2. Otherwise limit coverage if such limitation results in coverage that is illusory.

Ins 3.34(5)(d) (d) Insurers offering group disability insurance policies and self-insured health plans shall comply with all of the following:

Ins 3.34(5)(d)1. 1. May not deny coverage of an eligible adult child when coverage is requested by the applicant or insured.

Ins 3.34(5)(d)2. 2. Shall apply portability rights to an eligible adult child so long as the adult child has not had a break in creditable coverage longer than 62 days.

Ins 3.34(5)(d)3. 3. Shall comply with s. 632.746, Stats., as applicable.

Ins 3.34(5)(d)4. 4. May request documentation of the adult child’s creditable coverage for determining portability. The pre-existing condition waiting period applicable to the eligible adult child shall be applied to the adult child in the same manner as applied to any other applicant or eligible dependent.

Ins 3.34(6) (6) Eligible adult child.

Ins 3.34(6)(a) (a) For purposes of this section and implementation of s. 632.885 (2), Stats., an adult child is eligible for coverage as a dependent if either of the following is met:

Ins 3.34(6)(a)1. 1. For an adult child who has not been called to federal active duty in the national guard or in a reserve component of the U.S. armed forces, either of the following:

Ins 3.34(6)(a)1.a. a. An adult child who meets s. 632.885 (2) (a) 1., 2., and 3., Stats.

Ins 3.34 Note Note: 2011 Wis. Act 32 repealed s. 632.885 (2) (a) 1. to 3., Stats. See s. 632.885 (2) (a), Stats.

Ins 3.34(6)(a)1.b. b. An adult child who meets s. 632.885 (2) (a) 1. and 2., Stats., and who is not eligible for his or her employer sponsored coverage or whose employer does not offer health insurance to its employees is an eligible adult child.

Ins 3.34 Note Note: 2011 Wis. Act 32 repealed s. 632.885 (2) (a) 1. to 3., Stats. See s. 632.885 (2) (a), Stats.

Ins 3.34(6)(a)2. 2. For an adult child who has been called to federal active duty in the national guard or in a reserve component of the U.S. armed forces and who meet s. 632.885 (2) (b) 1., 3., and 4., Stats., all of the following:

Ins 3.34(6)(a)2.a. a. The adult child must apply to an institution of higher education as a full-time student within 12 months from the date the adult child has fulfilled his or her active duty obligation.

Ins 3.34(6)(a)2.b. b. When an adult child is called to active duty more than once within a four-year period of time, the insurer and self-insured health plan must use the adult child’s age when first called to active duty for determining eligibility under this section.

Ins 3.34 History History: EmR0930: emerg. cr. eff. 10-31-09; CR 09-076: cr. Register May 2010 No. 653, eff. 6-1-10; corrections in (title) and (6) (a) 1. b. made under s. 13.92 (4) (b) 2. and 7., Stats., Register May 2010 No. 653; correction in (6) (a) 2. made under s. 13.92 (4) (b) 7., Stats., Register March 2017 No. 735.

Ins 3.35 Ins 3.35 Colorectal cancer screening coverage.

Ins 3.35(1) (1) Applicability.

Ins 3.35(1)(a) (a) This section applies to disability insurance policies as defined at s. 632.895 (1) (a), Stats., unless otherwise excepted in s. 632.895 (16m) (c), Stats., that are issued or renewed on or after December 1, 2010. This section applies to Medicare supplement and cost plans but does not include limited –scope plans including vision and dental, hospital indemnity, income continuation, accident-only benefits, and long-term care policies. This section also applies to self-insured health plans as defined at s. 632.745 (24), Stats.

Ins 3.35(1)(b) (b) For a disability insurance policy and a self-insured health plan covering employees who are affected by a collective bargaining agreement the coverage under this section first applies as follows: