Ins 9.13   Summary.

Ins 9.14   Nondomestic HMO.

Ins 9.15   Time period.

Subchapter III — Market Conduct Standards for Defined Network Plans, Preferred Provider Plans and Limited Service Health Organizations

Ins 9.20   Scope.

Ins 9.21   Limited exemptions.

Ins 9.25   Preferred provider plan same service provisions.

Ins 9.26   Preferred provider plan subject to defined network plan regulations.

Ins 9.27   Preferred provider plan requirements.

Ins 9.30   Group and blanket health insurers compliance.

Ins 9.31   Annual certification of access standards.

Ins 9.32   Defined network plan requirements.

Ins 9.33   Enrollee election of nonparticipating provider reimbursement.

Ins 9.35   Continuity of care.

Ins 9.36   Gag clauses.

Ins 9.37   Notice requirements.

Ins 9.38   Policy and certificate language requirements.

Ins 9.39   Disenrollment.

Ins 9.40   Required quality assurance and remedial action plans.

Ins 9.41   Right of the commissioner to request OCI complaints be handled as grievances.

Ins 9.42   Compliance program requirements.

Ch. Ins 9 Note Note: The revisions to ch. Ins 9 that are effective March 1, 2006, apply to newly issued policies or certificates of insurance on or after January 1, 2007, and to policies renewed on or after January 1, 2008.

subch. I of ch. Ins 9 Subchapter I — Definitions

Ins 9.01 Ins 9.01 Definitions. In this chapter, and for the purposes of applying ch. 609, Stats.:

Ins 9.01(1) (1) “Acceptable letter of credit” means a clean, unconditional, irrevocable letter of credit issued by a Wisconsin bank or any other financial institution acceptable to the commissioner which renews on an annual basis for a 3–year term unless written notice of nonrenewal is given to the commissioner and the limited service health organization at least 60 days prior to the renewal date.

Ins 9.01(2) (2) “Commissioner” means the “commissioner of insurance” of this state or the commissioner’s designee.

Ins 9.01(3) (3) “Complaint” means any expression of dissatisfaction expressed to an insurer by an enrollee, or an enrollee’s authorized representative, about the insurer or its participating providers.

Ins 9.01(3m) (3m) “Defined network plan” has the meaning provided under s. 609.01 (1b), Stats., and includes Medicare select policies and certificates, as defined in s. Ins 3.39 (3) (vm) and (ve), respectively, and health benefit plans that contract for use of participating providers.