635.02 – Definitions.
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.
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.
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.
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.
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.
633.09 – Accounts.
633.09 Accounts. (1) Moneys held in fiduciary capacity. An administrator shall hold in a fiduciary capacity all moneys that the administrator collects or receives on behalf of other persons. Within 2 business days after collection or receipt of such moneys, the administrator either shall pay the moneys to the persons entitled to them or shall […]
633.10 – Payment of claims.
633.10 Payment of claims. An administrator shall pay claims from funds paid to the claims paying account under s. 633.09 (4) (b) 5. on drafts or checks authorized in advance by the principal. History: 1991 a. 39.
633.11 – Claim adjustment compensation.
633.11 Claim adjustment compensation. If an administrator adjusts or settles claims under an employee benefit plan, the commission, fees or charges that the principal pays the administrator may not be based on the employee benefit plan’s loss experience. This section does not prohibit compensation based on the number or amount of premiums or charges collected, […]
633.12 – Notification required.
633.12 Notification required. (1) An administrator shall prepare sufficient copies of a written notice approved in advance by the principal for distribution to all insured employees of the principal and either shall distribute the copies to the insured employees or shall provide the copies to the principal for distribution to the insured employees. The written […]
633.13 – License required.
633.13 License required. (1) General. Except as provided in sub. (2), a person may not perform, offer to perform or advertise any service as an administrator or a pharmacy benefit manager unless the person has obtained a license under s. 633.14. A pharmacy benefit manager that also performs services as an administrator need only obtain […]