635.01 Scope. This chapter applies to all group health insurance plans, policies or certificates, written on risks or operations in this state, providing coverage for employees of a small employer, or employees of a small employer and the employer, and to individual health insurance policies, written on risks or operations in this state, providing coverage […]
635.02 Definitions. In this chapter: (1) “Base premium rate” means the lowest premium rate chargeable under a rating system to small employers with similar case characteristics and the same or similar benefit design characteristics in the same class of business. (1m) “Benefit design characteristics” means covered services, cost sharing, utilization management, managed care networks and […]
635.05 Rate regulation. Notwithstanding ch. 625, the commissioner shall promulgate rules: (1) Establishing restrictions on premium rates that a small employer insurer may charge a small employer such that the premium rates charged to small employers with similar case characteristics for the same or similar benefit design characteristics do not vary from the midpoint rate […]
635.10 Uniform employee application. Beginning no later than August 1, 2003, every small employer insurer shall use the uniform employee application form developed by the commissioner by rule under s. 601.41 (8) (b) when a small employer applies for coverage under a group health benefit plan offered by the small employer insurer. History: 2001 a. […]
635.11 Disclosure of rating factors and renewability provisions. (1m) Before the sale of a plan or policy subject to this chapter, a small employer insurer shall disclose to a small employer all of the following: (a) The small employer insurer’s right to increase premium rates and the factors limiting the amount of increase. (b) The […]
635.13 Records. A small employer insurer shall maintain at its principal place of business complete and detailed records relating to its rating methods and practices and its renewal underwriting methods and practices, and shall make the records available to the commissioner upon request. History: 1991 a. 39, 250; 1997 a. 27; 2015 a. 90.
635.15 Temporary suspension of rate regulation. The commissioner may suspend the operation of all or any part of s. 635.05 with respect to one or more small employers for one or more rating periods upon the written request of a small employer insurer and a finding by the commissioner that the suspension is necessary in […]
635.18 Fair marketing standards. (1) Every small employer insurer shall actively market health benefit plan coverage to small employers in the state. (2) (a) Except as provided in par. (b), a small employer insurer or an intermediary may not, directly or indirectly, do any of the following: 1. Discourage a small employer from applying, or […]
635.19 Issuance of coverage in small group market. (1) (a) Except as provided in subs. (2) to (6), a small employer insurer that offers a group health benefit plan in the small group market shall do all of the following: 1. Accept any small employer in the state that applies for such coverage. 2. Accept […]
