632.82 – Renewability of long-term care insurance policies.
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 or alter the long-term care insurance policy except for nonpayment of premium. The rule may […]
632.825 – Midterm termination of long-term care insurance policy by insured.
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 long-term care insurance policy may prohibit the insured under the policy from canceling the policy before the expiration of the agreed term. (b) If an insured under a long-term care insurance policy […]
632.83 – Internal grievance procedure.
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 (11) (b) 9. that provides only limited-scope dental or vision benefits. […]
632.835 – Independent review of coverage denial determinations.
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 facility, the availability of care, the continued stay or other […]
632.84 – Benefit appeals under certain policies.
632.84 Benefit appeals under certain policies. (1) Definitions. In this section: (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 in a nursing home. (2) Review and appeal. (a) Except as provided in […]
632.795 – Open enrollment upon liquidation.
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 provided by rule or order of the commissioner, an insurer described in sub. (3) […]
632.797 – Disclosure of group health claims experience.
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 multiple-employer trust, with the policyholder’s or the employer’s aggregate group health […]
632.798 – Out-of-pocket costs.
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” includes an enrollee under a self-insured health plan and […]
632.80 – Restrictions on medical payments insurance.
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, provided the loss, damage or expense arises out of a hazard directly related […]
632.81 – Minimum standards for certain disability policies.
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 and long-term care insurance policies. The commissioner may by rule exempt from the minimum standards certain types of coverage, if the commissioner […]