Wisconsin Administrative Code

Ins 3.37 Transitional treatment arrangements. (1) PURPOSE. This section implements s. 632.89 (4) (a), Stats. (2) APPLICABILITY. (a) This section applies to group and blanket disability insurance policies issued or renewed on and after November 1, 1992, and prior to December 1, 20…

Ins 3.375 Coverage of nervous and mental disorders and substance use disorders. (1) PURPOSE. This section interprets and implements s. 632.89, Stats. (2) APPLICABILITY. (a) This section applies to group health benefit plans as defined in s. 632.745 (9), Stats., health benefit pla…

Ins 3.38 Coverage of newborn infants. (1) PURPOSE. This section is intended to interpret and implement s. 632.895 (5), Stats. (2) INTERPRETATION AND IMPLEMENTATION. (a) Coverage of each newborn infant is required under a disability insurance policy if: 1. The policy provides cove…

Ins 3.39 Standards for disability insurance sold to the Medicare eligible. (1) PURPOSE. (a) This section establishes requirements for health and other disability insurance policies primarily sold to Medicare eligible persons. Disclosure provisions are required for other disabilit…

Ins 3.40 Coordination of benefits provisions in group and blanket disability insurance policies. (1) PURPOSE. (a) This section establishes authorized coordination of benefits provisions for group and blanket disability insurance policies pursuant to s. 631.23, Stats. It has been …

Ins 3.41 Individual conversion policies. (1) REAAn insurer provides reasonably similar coverage under s. 632.897 (4), Stats., to a terminated insured as defined in s. 632.897 (1) (f), Stats., if a person is offered individual coverage under the group policy or individual policy, …

Ins 3.42 Plans of conversion coverage. Pursuant to s. 632.897 (4) (b), Stats., the following plans of conversion coverage are established. (1) PLAN 1—BASIC COVERAGE. Plan 1 basic coverage consists of the following: (a) Hospital room and board daily expense benefits in a maximum d…

Ins 3.43 High limit comprehensive plan of benefits. (1) A policy form providing a high limit comprehensive plan of benefits may be approved as an individual conversion policy as provided by s. 632.897 (4) (b), Stats., if it provides comprehensive coverage of expenses of hospital,…

Ins 3.44 Effective date of s. 632.897, Stats. (1) Section 632.897, Stats., applies to group policies issued or renewed on or after May 14, 1980, or if a policy is not renewed within 2 years after the effective date of the act, s. 632.897, Stats., is effective at the end of 2 year…

Ins 3.45 Conversion policies by insurers offering group policies only. Section 632.897 (4) (d), Stats., (first sentence), establishes that an insurer offering group policies only is not required to offer individual coverage. Since the insurer has no individual conversion policies…

Ins 3.455 Long-term care, nursing home and home health care policies; loss ratios; rating practices; continuation and conversion, reserves. (1) FINDINGS. (a) The commissioner finds that long-term care policies and life insurance-long-term care coverage are offered and marketed to…

Ins 3.46 Standards for long-term care, nursing home and home health care insurance and life insurance-long-term care coverage. (1) FINDINGS. The findings under s. Ins 3.455 (1) are incorporated by reference. The commissioner finds that the adoption of minimum standards, compensat…

Ins 3.465 Wisconsin long-term care partnership program. (1) GENERAL APPLICABILITY. The provisions within s. Ins 3.46 regarding insurance transactions for long-term care and life insurance policies with long-term care provisions apply to insurance transactions described within thi…

Ins 3.47 Cancer insurance solicitation. (1) FINDINGS. Information on file in the office of the commissioner of insurance shows that significant misunderstanding exists with respect to cancer insurance. Consumers are not aware of the limitations of cancer insurance and do not know…

Ins 3.49 Wisconsin automobile insurance plan. (1) PURPOSE. This section interprets s. 619.01 (6), Stats., to continue a plan to make automobile insurance available to those who are unable to obtain it in the voluntary market by providing for the equitable distribution of applican…

Ins 3.51 Reports by individual practice associations. (1) DEFINITIONS. For the purpose of this section only: (a) XAccountantY means an independent certified public accountant who is duly registered to practice and in good standing Ins 3.51 under the laws of this state or a state …

Ins 3.53 HIV testing. (1) FINDINGS. The tests listed in sub. (4) (e) have been specified by the state epidemiologist in part B (4) of a report entitled XValidated positive, medically significant and sufficiently reliable tests to detect the presence of human immunodeficiency viru…

Ins 3.54 Home health care benefits under disability insurance policies. (1) PURPOSE. This section implements and interprets ss. 628.34 (1) and (12), 631.20 and 632.895 (1) and (2), Stats., for the purpose of facilitating the administration of claims for coverage of home health ca…

Ins 3.55 Benefit appeals under long-term care policies, life insurance-long-term care coverage. (1) PURPOSE. This section implements and interprets s. 632.84, Stats., for the purpose of establishing minimum requirements for the internal procedure for benefit appeals that insurers…

Ins 3.60 Disclosure of information on health care claim settlements. (1) PURPOSE. This section implements and interprets s. 628.34 (1) (a) and (12), Stats., for the purpose of allowing insureds and providers access to information on the methodology health insurers use to determin…

Ins 3.65 Standardized claim format. (1) PURPOSE; This section implements s. 632.725 (2) (a) and (b), Stats., by designating and establishing requirements for use of the forms that health care providers in this state shall use on and after July 1, 1993, for providing a health insu…

Ins 3.651 Standardized explanation of benefits and remittance advice format. (1) PURPOSE. This section implements s. 632.725 (2) (c), Stats., by prescribing the requirements for the following, to be used by insurers providing health care coverage to one or more residents of this …

Ins 3.67 Benefit appeals under certain policies. (1) DEFINITIONS. In this section: (a) XDefined network planY has the meaning provided under s. 609.01 (1b), Stats. (am) XExpedited requestY means a request where the standard resolution process may include any of the following: 1. …

Ins 3.75 Continuation of discontinued employer provided health group policy coverage for employees and their dependents. (1) PURPOSE. The purpose of this section is to allow assistance eligible individuals to elect continued coverage provided under s. 632.897, Stats., in circumst…

Ins 4.01 Interpretation and implementation of s. 632.05 (2), Stats. (1) SCOPE. Section 632.05, Stats., and this section apply to policies issued or renewed on or after November 29, 1979, which insure real property owned and occupied by the insured as a dwelling. (2) INTERPRETATIO…

Ins 4.08 Inland marine insurance exempt from filing requirements. (1) PURPOSE. In accordance with s. 625.04, Stats., the purpose of this section is to exempt from the filing requirements of s. 625.13, Stats., all classes of inland marine risks. (2) SCOPE. This section shall apply…

Ins 4.10 Wisconsin insurance plan. (1) PURPOSE. the chapter was last published. Ins 4.10 WISCONSIN ADMINISTRATIVE CODE upholstery cleaning; diaper service or infants[ apparel laundries; dry cleaning; laundries; linen supply. 2. Installation, servicing and repair—Electrical equipm…

Ins 40.01 Definitions.

Ins 40.02 Acquisition of control of or merger with domestic insurer or divestiture of the shares of a domestic insurer.

Ins 40.025 Acquisitions Involving Insurers Not Otherwise Covered.

Ins 40.03 Registration.

Ins 40.04 Standards for transactions within an insurance holding company system.

Ins 40.05 Privileged information.

Ins 40.07 Designation of the group-wide supervisor of internationally active insurance groups.

Ins 40.08 Duties of the group-wide supervisor.

Ins 40.09 Insurer[s duty to pay reasonable expenses. Subchapter II—Insurance Holding Company Systems—Reporting Forms

Ins 40.11 Instructions.

Ins 40.12 Forms—incorporation by reference, summaries and omissions.

Ins 40.13 Forms—extension of time to furnish.

Ins 40.14 Forms—additional information and exhibits.

Ins 40.15 Registration form.

Ins 40.16 Alternative and consolidated registrations.

Ins 40.17 Transactions subject to prior notice—notice filing.

Ins 40.18 Extraordinary dividends and other distributions.

Ins 40.19 Consent to jurisdiction.

Ins 40.20 Enterprise Risk Report.

Ins 40.21 Group capital calculation. Note: The annual registration requirements under this chapter first apply after December 31, 1993. (a) Premiums written in at least three countries. (b) The percentage of gross premiums written outside the United States is at least 10 percent …