Chapter 632, INSURANCE CONTRACTS IN SPECIFIC LINES
115 sections in this chapter.
Wis. Stat. § 632.697 Benefits subject to department’s right to recover
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632.697 Benefits subject to department’s right to recover. Death benefits payable under a life insurance policy or an annuity are subject to the right of the department of health services to recover under s. 46.27 (7g), 2017 stats., or s. 49.496, 49.682, or 49.849 an amount equal…
Wis. Stat. § 632.71 Estoppel from medical examination, assignability and change of beneficiary
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632.71 Estoppel from medical examination, assignability and change of beneficiary. Sections 632.47 to 632.50 apply to disability insurance policies. History: 1975 c. 373, 375, 422.
Wis. Stat. § 632.715 Reports of action against health care provider
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632.715 Reports of action against health care provider. Every insurer that has taken any action against a person who holds a license granted by the medical examining board or an affiliated credentialing board attached to the medical examining board shall notify the board or affil…
Wis. Stat. § 632.72 Medical benefits or assistance; assignment
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632.72 Medical benefits or assistance; assignment. (1g) In this section: (a) “Department or contract provider” means the department of health services, the county providing the medical benefits or assistance or a health maintenance organization that has contracted with the depart…
Wis. Stat. § 632.722 Assignment of dental benefits
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632.722 Assignment of dental benefits. (1) An insured may assign the right to receive reimbursement for dental care and related services under a policy, as defined under s. 632.873 (1) (b), directly to a provider of dental care or related services. An insured may revoke an assign…
Wis. Stat. § 632.725 Standardization of health care billing and insurance claim forms
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632.725 Standardization of health care billing and insurance claim forms. (1) DEFINITION. In this section, “health care provider” has the meaning given in s. 146.81 (1) (a) to (p). (2) RULES FOR STANDARDIZATION OF FORMS. The commissioner, in consultation with the department of he…
Wis. Stat. § 632.726 Current procedural terminology code changes
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632.726 Current procedural terminology code changes. (1) In this section, “current procedural terminology code” means a number established by the American Medical Association that a health care provider puts on a health insurance claim form to describe the services that he or she…
Wis. Stat. § 632.729 Prohibiting discrimination based on COVID19
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632.729 Prohibiting discrimination based on COVID19. (1) DEFINITIONS. In this section: (a) “COVID-19” means an infection caused by the SARSCoV-2 coronavirus. (b) “Health benefit plan” has the meaning given in s. 632.745 (11). (c) “Pharmacy benefit manager” has the meaning given i…
Wis. Stat. § 632.73 Right to return policy
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632.73 Right to return policy. (1) RIGHT OF RETURN. A policyholder may return an individual or franchise disability policy within 10 days after receipt. If the policyholder does so, the contract is void, and all payments made under it shall be refunded. This subsection does not a…
Wis. Stat. § 632.74 Reinstatement of individual or franchise disability insurance policies
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632.74 Reinstatement of individual or franchise disability insurance policies. (1) CONDITIONS OF REINSTATEMENT. If an insurer, after termination of an individual or franchise disability insurance policy for nonpayment of premium, within one year after the termination accepts with…
Wis. Stat. § 632.745 Coverage requirements for group and individual health benefit plans; definitions
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632.745 Coverage requirements for group and individual health benefit plans; definitions. In this section and ss. 632.746 to 632.7495: (1) “Affiliation period” means the period which, under the terms of health insurance coverage offered by a health maintenance organization, must …
Wis. Stat. § 632.746 Preexisting condition; portability; restrictions; and special enrollment periods
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632.746 Preexisting condition; portability; restrictions; and special enrollment periods. (1) (a) Subject to subs. (2) and (3), an insurer that offers a group health benefit plan may, with respect to a participant or beneficiary under the plan, impose a preexisting condition excl…
Wis. Stat. § 632.747 Guaranteed acceptance
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632.747 Guaranteed acceptance. (1) EMPLOYEE BECOMES ELIGIBLE AFTER COMMENCEMENT OF COVERAGE. Unless otherwise permitted by rule of the commissioner, if an insurer provides coverage under a group health benefit plan, the insurer shall provide coverage under the group health benefi…
Wis. Stat. § 632.748 Prohibiting discrimination
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632.748 Prohibiting discrimination. (1) (a) Subject to subs. (3) and (4), an insurer may not establish rules for the eligibility of any individual to enroll, or for the continued eligibility of any individual to remain enrolled, under a group health benefit plan based on any of t…
Wis. Stat. § 632.749 Contract termination and renewability
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632.749 Contract termination and renewability. (1) (a) Except as provided in subs. (2) to (4) and notwithstanding s. 631.36 (2) to (4m), an insurer that offers a group health benefit plan shall renew such coverage or continue such coverage in force at the option of the employer a…
Wis. Stat. § 632.7495 Guaranteed renewability of individual health insurance coverage
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632.7495 Guaranteed renewability of individual health insurance coverage. (1) (a) Except as provided in subs. (2) to (4) and notwithstanding s. 631.36 (2) to (4m), an insurer that provides individual health benefit plan coverage shall renew such coverage or continue such coverage…
Wis. Stat. § 632.7497 Modifications at renewal
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632.7497 Modifications at renewal. (1) In this section, “individual major medical or comprehensive health benefit plan” includes coverage under a group policy that is underwritten on an individual basis and issued to individuals or families. (2) An insurer that issues an individu…
Wis. Stat. § 632.75 Prohibited provisions for disability insurance
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632.75 Prohibited provisions for disability insurance. (1) DEATH PRESUMED FROM EXTENDED ABSENCE. Section 813.22 (1) applies to any disability insurance policy providing a death benefit. (2) DIVIDENDS CONDITIONED ON CONTINUATION OF POLICY OR PAYMENT OF PREMIUMS. Except on the firs…
Wis. Stat. § 632.755 Public assistance and early intervention services
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632.755 Public assistance and early intervention services. (1g) (a) A disability insurance policy may not exclude a person or a person’s dependent from coverage because the person or the dependent is eligible for assistance under ch. 49 or because the dependent is eligible for ea…
Wis. Stat. § 632.76 Incontestability for disability insurance
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632.76 Incontestability for disability insurance. (1) AVOIDANCE FOR MISREPRESENTATIONS. No statement made by an applicant in the application for individual disability insurance coverage and no statement made respecting the person’s insurability by a person insured under a group p…
Wis. Stat. § 632.77 Permitted provisions for disability insurance policies
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632.77 Permitted provisions for disability insurance policies. If any provisions are contained in a disability insurance policy dealing with the following subjects, they shall conform to the requirements specified: (1) CHANGE OF OCCUPATION. Any provision respecting change of occu…
Wis. Stat. § 632.775 Effect of power of attorney for health care
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632.775 Effect of power of attorney for health care. (1) INSURER MAY NOT REQUIRE. An insurer may not require an individual to execute a power of attorney for health care under ch. 155 as a condition of coverage under a disability insurance policy. (2) EFFECT ON DISABILITY POLICIE…
Wis. Stat. § 632.78 Required grace period for disability insurance policies
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632.78 Required grace period for disability insurance policies. Every disability insurance policy shall contain clauses providing for a grace period of at least 7 days for weekly premium policies, 10 days for monthly premium policies and 31 days for all other policies, for each p…
Wis. Stat. § 632.79 Notice of termination of group hospital, surgical or medical expense insurance coverage due to cessation of business or default in payment of premiums
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632.79 Notice of termination of group hospital, surgical or medical expense insurance coverage due to cessation of business or default in payment of premiums. (1) SCOPE. This section shall apply to every group hospital, surgical or medical expense insurance policy or service plan…
Wis. Stat. § 632.793 Notice of loss of primary insurance coverage due to age
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632.793 Notice of loss of primary insurance coverage due to age. (1) NOTICE TO INSURED AND EMPLOYER. If an individual who is covered under a group disability insurance policy, as defined in s. 632.895 (1) (a), that is purchased by or on behalf of an employer to provide coverage f…
Wis. Stat. § 632.795 Open enrollment upon liquidation
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632.795 Open enrollment upon liquidation. (1) DEFINITION. In this section, “liquidated insurer” means an insurer ordered liquidated under ch. 645 or under similar laws of another jurisdiction. (2) COVERAGE FOR GROUP MEMBERS. Except as provided in sub. (5) and unless otherwise pro…
Wis. Stat. § 632.797 Disclosure of group health claims experience
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632.797 Disclosure of group health claims experience. (1) (a) Except as provided in subs. (2) and (3), an insurer shall provide the policyholder of a group or blanket disability insurance policy, or an employer that provides health care coverage to its employees through a multipl…
Wis. Stat. § 632.798 Out-of-pocket costs
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632.798 Out-of-pocket costs. (1) DEFINITIONS. In this section: (a) “Disability insurance policy” has the meaning given in s. 632.895 (1) (a). (b) “Health care provider” has the meaning given in s. 146.903 (1) (c) and includes a hospital, as defined in s. 50.33 (2). (c) “Insured” …
Wis. Stat. § 632.80 Restrictions on medical payments insurance
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632.80 Restrictions on medical payments insurance. The provisions of this subchapter do not apply to medical payments insurance when it is a part of or supplemental to liability, steam boiler, elevator, automobile or other insurance covering loss of or damage to property, provide…
Wis. Stat. § 632.81 Minimum standards for certain disability policies
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632.81 Minimum standards for certain disability policies. The commissioner may by rule establish minimum standards for benefits, claims payments, marketing practices, compensation arrangements and reporting practices for medicare supplement policies, medicare replacement policies…
Wis. Stat. § 632.82 Renewability of long-term care insurance policies
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632.82 Renewability of long-term care insurance policies. Notwithstanding s. 631.36 (2) to (5), the commissioner shall, by rule, require long-term care insurance policies that are issued on an individual basis to include a provision restricting the insurer’s ability to terminate …
Wis. Stat. § 632.825 Midterm termination of long-term care insurance policy by insured
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632.825 Midterm termination of long-term care insurance policy by insured. (1) PERMITTED CANCELLATION AND REFUND. (a) No insurer that provides coverage under a longterm care insurance policy may prohibit the insured under the policy from canceling the policy before the expiration…
Wis. Stat. § 632.83 Internal grievance procedure
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632.83 Internal grievance procedure. (1) In this section, “health benefit plan” has the meaning given in s. 632.745 (11), except that “health benefit plan” includes the coverage specified in s. 632.745 (11) (b) 10. and includes a policy, certificate or contract under s. 632.745 (…
Wis. Stat. § 632.835 Independent review of coverage denial determinations
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632.835 Independent review of coverage denial determinations. (1) DEFINITIONS. In this section: (a) “Adverse determination” means a determination by or on behalf of an insurer that issues a health benefit plan to which all of the following apply: 1. An admission to a health care …
Wis. Stat. § 632.84 Benefit appeals under certain policies
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632.84 Benefit appeals under certain policies. DEFINITIONS. In this section: (1) (a) “Nursing home” has the meaning given in s. 50.01 (3). (b) “Nursing home insurance policy” means an individual or group insurance policy which provides coverage primarily for confinement or care i…
Wis. Stat. § 632.845 Prohibiting refusal to cover services because liability policy may cover
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632.845 Prohibiting refusal to cover services because liability policy may cover. (1) In this section, “health care plan” has the meaning given in s. 628.36 (2) (a) 1. (2) An insurer that provides coverage under a health care plan may not refuse to cover health care services that…
Wis. Stat. § 632.85 Coverage without prior authorization for treatment of an emergency medical condition
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632.85 Coverage without prior authorization for treatment of an emergency medical condition. (1) In this section: (a) “Emergency medical condition” means a medical condition that manifests itself by acute symptoms of sufficient severity, including severe pain, to lead a prudent l…
Wis. Stat. § 632.853 Coverage of drugs and devices
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632.853 Coverage of drugs and devices. A health care plan, as defined in s. 628.36 (2) (a) 1., or a self-insured health plan, as defined in s. 632.85 (1) (c), that provides coverage of only certain specified prescription drugs or devices shall develop a process through which a ph…
Wis. Stat. § 632.855 Requirements if experimental treatment limited
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632.855 Requirements if experimental treatment limited. (1) DEFINITIONS. In this section: (a) “Health care plan” has the meaning given in s. 628.36 (2) (a) 1. (b) “Self-insured health plan” has the meaning given in s. 632.85 (1) (c). (2) DISCLOSURE OF LIMITATIONS. Subject to s. 6…
Wis. Stat. § 632.857 Explanation required for restriction or termination of coverage
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632.857 Explanation required for restriction or termination of coverage. If an insurer restricts or terminates an insured’s coverage for the treatment of a condition or complaint and, as a result, the insured becomes liable for payment for all of his or her treatment for the cond…
Wis. Stat. § 632.861 Prescription drug charges
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632.861 Prescription drug charges. (1) DEFINITIONS. In this section: (a) “Disability insurance policy” has the meaning given in s. 632.895 (1) (a). (b) “Enrollee” means an individual who is covered under a disability insurance policy or a self-insured health plan. (c) “Pharmacy b…
Wis. Stat. § 632.865 Pharmacy benefit managers
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632.865 Pharmacy benefit managers. (1) DEFINITIONS. In this section: (ae) “Health benefit plan” has the meaning given in s. 632.745 (11). (ak) “Health care provider” has the meaning given in s. 146.81 (1). (aw) “Pharmacist” has the meaning given in s. 450.01 (15). (b) “Pharmacy” …
Wis. Stat. § 632.866 Step therapy protocols
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632.866 Step therapy protocols. (1) DEFINITIONS. In this section: (a) “Clinical practice guideline” means a systematically developed statement to assist decision making by health care providers and patients about appropriate health care for specific clinical circumstances and con…
Wis. Stat. § 632.867 Oral and injected chemotherapy
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632.867 Oral and injected chemotherapy. (1) DEFINITIONS. In this section: (a) “Chemotherapy” means drugs and biologics that kill cancer cells directly, including antineoplastics, biologic response modifiers, hormone therapy, and monoclonal antibodies, and that are used to do any …
Wis. Stat. § 632.87 Restrictions on health care services
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632.87 Restrictions on health care services. (1) No insurer may refuse to provide or pay for benefits for health care services provided by a licensed health care professional on the ground that the services were not rendered by a physician as defined in s. 990.01 (28), unless the…
Wis. Stat. § 632.872 Restrictions relating to virtual credit card payments for disability insurance policies
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632.872 Restrictions relating to virtual credit card payments for disability insurance policies. (1) DEFINITIONS. In this section: (a) “Disability insurance policy” has the meaning given in s. 632.895 (1) (a). (b) “Health care provider” has the meaning given in s. 146.81 (1). (c)…
Wis. Stat. § 632.873 Restrictions relating to fees for dental services
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632.873 Restrictions relating to fees for dental services. (1) DEFINITIONS. In this section, unless the context requires otherwise: (a) “Covered service” means, with respect to dental or related services specified in a policy or plan that provides coverage for those services, a s…
Wis. Stat. § 632.875 Independent evaluations relating to chiropractic treatment
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632.875 Independent evaluations relating to chiropractic treatment. (1) In this section: (a) “Chiropractor” means a person licensed to practice chiropractic under ch. 446. (b) “Independent evaluation” means an examination or evaluation by or recommendation of a chiropractor or a …
Wis. Stat. § 632.88 Policy extension for handicapped children
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632.88 Policy extension for handicapped children. (1) TERMINATION OF COVERAGE. Every hospital or medical expense insurance policy or contract that provides that coverage of a dependent child of a person insured under the policy shall terminate upon attainment of a limiting age fo…
Wis. Stat. § 632.885 Coverage of dependents
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632.885 Coverage of dependents. (1) DEFINITIONS. In this section: (af) “Eligible employer-sponsored plan” has the meaning given in 26 USC 5000A (f) (2). (ar) “Grandfathered health plan” has the meaning given under section 1251 of the Patient Protection and Affordable Care Act (P.…