Ins 8.62Ins 8.62Small employer insurers shall offer an open enrollment for individuals excluded prior to enactment or application of the small employer health insurance law.
Ins 8.62(1)(1)A small employer insurer shall provide an enrollment period during which underwritten individuals who were excluded or denied coverage prior to the law’s effective date are entitled to enroll in coverage under the policy currently held by the small employer. Notice of the enrollment period shall [be] given as required under sub. (4).
Ins 8.62(2)(2)A small employer insurer may require an individual who requests enrollment under this section to sign a statement indicating that the individual sought coverage under a policy issued to the employer, other than as a late enrollee, and that the coverage was not offered to the individual. If the individual provides the statement it is presumed that the individual is an underwritten individual and entitled to enroll under this section.
Ins 8.62(3)(3)The enrollment period required under this section shall comply with all of the following:
Ins 8.62(3)(a)(a) It shall commence no later than 45 days after December 1, 1993, and shall last for a period of at least 90 days.
Ins 8.62(3)(b)(b) Underwritten individuals who are provided an opportunity to enroll under this section shall be treated as new entrants.
Ins 8.62(3)(c)(c) The terms of coverage offered to an underwritten individual under sub. (1) may exclude coverage for preexisting medical conditions only if the policy currently held by the small employer contains such an exclusion, the exclusion complies with s. 635.17 (1), Stats., and the exclusion period is reduced by the number of days between the date the individual was excluded or denied coverage and the date coverage is provided to the individual under this section.
Ins 8.62 NoteNote: 1995 Wis. Act 289 repealed s. 635.17, Stats. See s. 632.746 (1), Stats.
Ins 8.62(4)(4)A small employer insurer shall provide written notice of the right to enroll under this section to each small employer insured under a policy offered by the insurer. The notice shall be mailed at least 30 days before commencement of the enrollment period and shall clearly describe the rights granted under this section and the process for enrollment of the underwritten individuals in the policy. The insurer shall provide the employer with sufficient copies of the notice to distribute to each eligible employee and shall ask the employer to promptly distribute a copy to each eligible employee. The small employer insurer shall make reasonable efforts to obtain from the small employer certification that the notice was promptly distributed to all eligible employees.
Ins 8.62(5)(5)A small employer insurer may assess a risk load to the premium rate associated with an underwritten individual, consistent with the requirements of s. 635.05, Stats., and s. Ins 8.52 (3) (d).
Ins 8.62(6)(6)The requirement under sub. (1) to offer an enrollment period applies regardless of whether the small employer insurer required to make the offer was the insurer of the employer when the individual was originally excluded or denied coverage.
Ins 8.62 HistoryHistory: Cr. Register, November, 1993, No. 455, eff. 12-1-93.
Ins 8.63Ins 8.63Small employer insurers shall offer coverage to late enrollees.
Ins 8.63(1)(1)A small employer insurer shall provide under a policy for an enrollment period during which a late enrollee is entitled to enroll in coverage under the policy. The small employer insurer shall provide an enrollment period of at least 30 days after the date the late enrollee requests coverage and is notified of the opportunity to enroll.
Ins 8.63(2)(2)A small employer insurer may exclude coverage of a late enrollee who elects coverage for no more than 18 months or provide for up to an 18-month preexisting condition exclusion, but if both a period of exclusion from coverage and a preexisting condition exclusion are applied by the small employer insurer under the policy the combined period may not exceed 18 months from the date the individual applies for coverage under the policy. A small employer insurer may require that the late enrollee remain continuously employed by, or remain a dependent of an eligible employee continuously employed by, the small employer for the entire period of exclusion permitted under this subsection. A small employer insurer may not impose a preexisting condition exclusion under s. 635.17 (1), Stats., in addition to an exclusion permitted under this subsection.
Ins 8.63 NoteNote: 1995 Wis. Act 289 repealed s. 635.17, Stats. See s. 632.746 (1), Stats.
Ins 8.63(3)(3)A small employer insurer may assess a risk load to the premium rate associated with a late entrant, consistent with the requirements of s. 635.05, Stats., and s. Ins 8.52 (3) (d).
Ins 8.63 HistoryHistory: Cr. Register, November, 1993, No. 455, eff. 2-1-94.
Ins 8.64Ins 8.64Small employer insurers may not participate with a small employer to coerce, or discriminate among, eligible employees or dependents.
Ins 8.64(1)(1)A small employer insurer may not accept a waiver of coverage, if the insurer, or an insurance intermediary for the insurer, reasonably should know that the small employer pressured or unfairly induced the eligible employee or dependent of an eligible employee to decline coverage due to the individual’s risk characteristics.
Ins 8.64(2)(2)An insurance intermediary shall notify a small employer insurer in writing, prior to submitting an application for coverage with the insurer on behalf of a small employer, or prior to transmittal of a waiver, of any circumstances that would indicate that the small employer pressured or unfairly induced an eligible employee or dependent of an eligible employee to decline coverage due to the individual’s risk characteristics.
Ins 8.64 HistoryHistory: Cr. Register, November, 1993, No. 455, eff. 2-1-94.
Ins 8.65Ins 8.65A small employer insurer shall require small employers to provide documentation to establish that waivers of coverage are voluntary and permitted.
Ins 8.65(1)(1)A small employer insurer shall require each small employer that applies for a policy, as part of the application process, to provide a complete list of eligible employees and dependents of eligible employees of the small employer. The small employer insurer shall require the small employer to provide appropriate supporting documentation, such as the state unemployment or worker’s compensation quarterly reporting forms, to verify the information required under this subsection.
Ins 8.65(2)(2)A small employer insurer shall secure a waiver signed by the eligible employee on behalf of the employee or the dependent of the employee with respect to each eligible employee, and each dependent of an eligible employee, who declines an offer of coverage under a policy, whether during an initial enrollment period, as a new entrant or as an underwritten individual. The small employer insurer shall include on the waiver and require:
Ins 8.65(2)(a)(a) A certification that the individual who declined coverage was informed of the availability of coverage under the policy;
Ins 8.65(2)(b)(b) That the reason for declining coverage be stated; and
Ins 8.65(2)(c)(c) A written warning of the consequences which may be imposed on late enrollees.
Ins 8.65(3)(3)A small employer insurer shall obtain, with respect to each individual who submits a waiver under sub. (2) in connection with an initial enrollment period, information sufficient to establish that the waiver may be accepted under s. Ins 8.60 (1).