Many policies promise to increase benefits after a patient has been in the hospital for 90 consecutive days. However, since the average stay in a hospital for a cancer patient is 13 days, large dollar amounts for extended benefits have very little value for most patients.
Many cancer insurance policies have fixed dollar limits. For example, a policy might pay only up to $1,500 for surgery costs or $1,000 for radiation therapy, or it may have fixed payments such as $50 or $100 for each day in the hospital. Others limit total benefits to a fixed amount such as $5,000 or $10,000.
No policy will cover cancer diagnosed before you applied for the policy. Some policies will deny coverage if you are later found to have had cancer at the time of purchase, even if you did not know it.
Most cancer insurance does not cover cancer-related illnesses. Cancer or its treatment may lead to other physical problems, such as infection, diabetes or pneumonia.
Many policies contain time limits. Some policies require waiting periods of 30 days or even several months before you are covered. Others stop paying benefits after a fixed period of two or three years.:
FOR ADDITIONAL HELP . . .
If you are considering a cancer policy, the company or agent should answer your questions. You do not need to make a decision to purchase the policy the same day you talk to the agent. Be sure to ask how long you have to make your decision. If you do not get the information you want, call or write
Office of the Commissioner of Insurance
121 East Wilson Street
P.O. Box 7873
Madison, WI 53707-7873
(608) 266-0103
If you have a complaint against an insurance company or agent, write the Office of the Commissioner of Insurance at the address above, or call the Complaints Hotline, 800-236-8517.
Ins 3.49
Ins 3.49 Wisconsin automobile insurance plan. Ins 3.49(1)(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 applicants among insurers and outlines access and grievance procedures for such a plan.
Ins 3.49(2)(a)
(a) “Committee" means the governing committee of the Wisconsin Automobile Insurance Plan which is the group of companies administering the Plan.
Ins 3.49(2)(b)
(b) “Plan" means the Wisconsin Automobile Insurance Plan, an unincorporated facility established by s.
204.51, 1967 Stats., and continued under s.
619.01 (6), Stats.
Ins 3.49(3)
(3)
Filing and access. The committee shall submit revisions to its rules, rates and forms for the Plan to the commissioner. Prior approval by the commissioner of the documents is required before they may become effective. The documents shall provide:
Ins 3.49(3)(a)
(a) Reasonable rules governing the equitable distribution of risks by direct insurance, reinsurance or otherwise and their assignment to insurers;
Ins 3.49(3)(b)
(b) Rates and rate modifications applicable to such risks which shall not be excessive, inadequate or unfairly discriminatory;
Ins 3.49(3)(c)
(c) The limits of liability which the insurer shall be required to assume;
Ins 3.49(3)(d)1.1. A method by which an applicant to the Plan denied insurance or an insured under the Plan whose insurance is terminated may request the committee to review the denial or termination and by which an insurer subscribing to the Plan may request the committee to review actions or decisions of the Plan which adversely affect the insurer. The method shall specify that requests for review must be made in writing to the Plan and that the decision of the committee in regard to the review may be appealed by the applicant, insured or insurer to the commissioner of insurance as provided for in ch.
Ins 5. A request for review does stay the termination of coverage.
Ins 3.49(3)(d)2.
2. The committee's decision under subd.
1. shall be in writing and shall include notice of the right to a hearing under ch.
Ins 5 if the person files a petition for a hearing with the commissioner of insurance not later than 30 days after the notice is mailed. The notice shall describe the requirements of s.
Ins 5.11 (1).
Ins 3.49 Note
Note:
A petition under subd. 2. shall be filed as provided in s.
Ins 5.17.
Ins 3.49(3)(d)3.
3. The office of the commissioner of insurance shall hold a hearing within 30 days after receipt of a complete petition under subd.
2., unless the petitioner waives the right to a hearing within 30 days. At the hearing, the petitioner has the burden of proving by a preponderance of the evidence that the committee's decision is erroneous under the policy terms or the plan's rules.
Ins 3.49(3)(d)4.
4. Filing a petition under subd.
2. does not stay the action of the plan with respect to termination of coverage. The plan shall comply with the final decision and order in the contested case proceeding.
Ins 3.49(3)(e)
(e) The commissioner shall maintain files of the Plan's approved rules, rates, and forms and such documents must be made available for public inspection at the office of the commissioner of insurance.
Ins 3.49 History
History: Cr.
Register, November, 1984, No. 347, eff. 12-1-84; renum. (3) (d) to be (3) (d) 1. and am., cr. (3) (d) 2. to 4.,
Register, March, 1996, No. 483, eff. 4-1-96.
Ins 3.51
Ins 3.51
Reports by individual practice associations. Ins 3.51(1)(1)
Definitions. For the purpose of this section only:
Ins 3.51(1)(a)
(a) “Accountant" means an independent certified public accountant who is duly registered to practice and in good standing under the laws of this state or a state with similar licensing requirements.
Ins 3.51(1)(b)
(b) “Individual practice association" means an individual practice association as defined under s.
600.03 (23g), Stats., which contracts with a health maintenance organization insurer or a limited service health organization to provide health care services which are principally physician services.
Ins 3.51(1)(c)
(c) “Work papers" are the records kept by the accountant of the procedures followed, the tests performed, the information obtained, and conclusions reached pertinent to the examination of the financial statements of the independent practice association. Work papers include, but are not limited to, work programs, analysis, memorandum, letters of confirmation and representation, management letters, abstracts of company documents and schedules or commentaries prepared or obtained by the accountant in the course of the examination of the financial statements of the independent practice association and which support the accountant's opinion.
Ins 3.51(2)
(2)
Filing of annual audited financial reports. Unless otherwise ordered by the commissioner, an individual practice association shall file an annual audited financial report with the commissioner within 180 days after the end of each individual practice association's fiscal year. This section applies to individual practice associations for fiscal years terminating on or after March 31, 1991. The annual audited financial report shall report the assets, liabilities and net worth; the results of operations; and the changes in net worth for the fiscal year then ended on the accrual basis in conformity with generally accepted accounting practices. The annual audited financial report shall not be presented on the cash basis or the income tax basis or any other basis that does not fully account for all the independent practice association's liabilities incurred as of the end of the fiscal year. The annual audited financial report shall include all of the following:
Ins 3.51(2)(f)
(f) Notes to the financial statements. These notes shall include those needed for fair presentation and disclosure.
Ins 3.51(2)(g)
(g) Supplemental data and information which the commissioner may from time to time require to be disclosed.
Ins 3.51(3)
(3)
Scope of audit and report of independent certified public accountant. Financial statements filed under sub.
(2) shall be audited by an independent certified public accountant. The audit shall be conducted in accordance with generally accepted auditing standards. The commissioner may from time to time require that additional auditing procedures be observed by the accountant in the audit of the financial statements of the independent practice association under this rule.
Ins 3.51(4)
(4)
Availability and maintenance of cpa work papers. Ins 3.51(4)(a)
(a) An independent practice association required to file an audited financial report under this rule shall, if requested by the office, require the accountant to make available to the office all the work papers prepared in the conduct of the audit. The independent practice association shall require that the accountant retain the audit work papers for a period of not less than 5 years after the period reported.
Ins 3.51(4)(b)
(b) The office may photocopy pertinent audit work papers. These copies are part of the office's work papers. Audit work papers are confidential unless the commissioner determines disclosure is necessary to carry out the functions of the office.
Ins 3.51(5)
(5)
Contracts. A health maintenance organization insurer contracting with an independent practice association shall include provisions in the contract which are necessary to enable the individual practice association to comply with this section including, but not limited to:
Ins 3.51(5)(b)
(b) Provisions providing for maintenance of necessary records and systems and segregation of records, accounts and assets; and
Ins 3.51(5)(c)
(c) Other provisions necessary to ensure that the individual practice association operates as an entity distinct from the insurer.
Ins 3.51 History
History: Cr.
Register, August, 1990, No. 416, eff. 9-1-90.
Ins 3.53(1)(1)
Findings. The tests listed in sub.
(4) (e) have been specified by the state epidemiologist in part B (4) of a report entitled “Validated positive, medically significant and sufficiently reliable tests to detect the presence of human immunodeficiency virus (HIV), antigen or nonantigenic products of HIV or an antibody to HIV," dated January 24, 1997. The commissioner of insurance, therefore, finds that these tests are sufficiently reliable for use in underwriting individual life, accident and health insurance policies.
Ins 3.53(2)
(2)
Purposes. The purposes of this section are:
Ins 3.53(2)(b)
(b) To establish procedures for insurers to use in obtaining informed consent for HIV testing and informing individuals of the results of a positive HIV test.
Ins 3.53(2)(d)
(d) To restrict the use of certain information on HIV testing in underwriting group life, accident and health insurance policies.
Ins 3.53(3)(b)
(b) “AIDS service organization" means a state designated organization in this state that provides AIDS prevention and education services to the general public and offers direct care and support services to persons with HIV and AIDS at no cost.
Ins 3.53(3)(e)
(e) “Medical information bureau, inc." means the nonprofit Delaware incorporated trade association, the members of which are life insurance companies, that operates an information exchange on behalf of its members.
Ins 3.53(3)(g)
(g) “Wisconsin AIDSline" means the state designated statewide AIDS information and medical referral service.
Ins 3.53(4)(a)
(a) For use in underwriting an individual life, accident or health insurance policy, an insurer may require that the person to be insured be tested, at the insurer's expense, for the presence of HIV, antigen or nonantigenic products of HIV or an antibody to HIV.
Ins 3.53(4)(b)
(b) An insurer that requires a test under par.
(a) shall, prior to testing, obtain a signed consent form, in substantially the format specified in Appendix A, either from the person to be tested or from one of the following if the specified condition exists:
Ins 3.53(4)(b)1.
1. The person's parent or guardian, if the person is under 14 years of age.
Ins 3.53(4)(b)2.
2. The person's guardian, if the person is adjudged incompetent under ch.
54, Stats.
Ins 3.53(4)(c)
(c) The insurer shall provide a copy of the consent form to the person who signed it and shall maintain a copy of each consent form for at least one year.
Ins 3.53(4)(d)
(d) The insurer shall provide with the consent form a copy of the document, “Resources for persons with a positive HIV test/The implications of testing positive for HIV." Each insurer shall either obtain copies of the document from the office of the commissioner of insurance or reproduce the document itself. If the document is revised, the insurer shall begin using the revised version no later than 30 days after receiving notice of the revision from the office of the commissioner of insurance.
Ins 3.53 Note
Note:
The document referred to in this paragraph is form number OCI 17-001. It may be obtained from the Office of the Commissioner of Insurance, P.O. Box 7873, Madison, Wisconsin 53707-7873.
Ins 3.53(4)(e)
(e) Tests may be used under par.
(a) only if the tests meet the following criteria:
Ins 3.53(4)(e)1.
1. A single specimen which is repeatedly reactive using any food and drug administration “FDA" licensed enzyme immunoassay “EIA" HIV antibody test and confirmed positive using an FDA licensed HIV antibody confirmatory test.
Ins 3.53(4)(e)2.
2. A single specimen which is repeatedly reactive using any FDA licensed HIV antigen test and an FDA licensed EIA HIV antibody test. A specimen which is repeatedly reactive to an FDA licensed HIV antigen test shall be confirmed through a neutralization assay. A specimen which is repeatedly reactive to an FDA licensed EIA HIV antibody test shall be tested with an FDA licensed HIV antibody confirmatory test.
Ins 3.53(4)(e)3.
3. A single specimen which is tested for the presence of HIV using a molecular amplification method for the detection of HIV nucleic acids consistent with national committee for clinical laboratory standards.
Ins 3.53(4)(e)4.
4. A single specimen which is tested for the presence of HIV using viral culture methods.
Ins 3.53(4)(f)
(f) A test under par.
(e) shall be performed by a laboratory which meets the requirements of the federal health care financing administration under the clinical laboratory improvement amendments act of 1988.
Ins 3.53(4)(g)1.1. An insurer that uses an application asking whether the person to be insured has been tested for the presence of HIV, antigen or nonantigenic products of HIV or an antibody to HIV may ask only whether the person has been tested using one or more of the tests specified in par.
(e).
Ins 3.53(4)(g)2.
2. Notwithstanding subd.
1., the insurer may not require or request the disclosure of any information as to whether the person to be insured has been tested at an anonymous counseling and testing site designated by the state epidemiologist or at a similar facility in another jurisdiction or through the use of an anonymous home test kit, or to reveal the results of such a test.
Ins 3.53(5)
(5)
Positive test result; insurer's obligation. Ins 3.53(5)(a)
(a) If a test under sub.
(4) (e) is positive and, in the normal course of underwriting, affects the issuance or terms of the policy, the insurer shall provide written notice to the person who signed the consent form that the person tested does not meet the insurer's usual underwriting criteria because of a test result. The insurer shall request that the person provide informed consent for disclosure of the test result to a health care provider with whom the person wants to discuss the test result.
Ins 3.53(5)(b)
(b) If informed consent for disclosure is obtained, the insurer shall provide the designated health care provider with the test result. If the person refuses to give informed consent for disclosure, the insurer shall, upon the person's request, provide the person who signed the consent form with the test result. The insurer shall include with the report of the test result all of the following:
Ins 3.53(5)(b)1.
1. A statement that the person should contact a private health care provider, a public health clinic, an AIDS service organization or the Wisconsin AIDSline for additional medical evaluation or referral for such services.
Ins 3.53(6)
(6)
Confidentiality of test results. An insurer that requires a person to be tested under sub.
(4) (a) may disclose the test result only as described in the consent form obtained under sub.
(4) (b) or with written consent for disclosure signed by the person tested or a person specified in sub.
(4) (b) 1. to
3. Ins 3.53(7)
(7)
Group policies; additional prohibition. In underwriting group life, accident or health insurance on an individual basis, in addition to the restrictions specified in s.
631.90 (2), Stats., an insurer may not use or obtain from any source, including the medical information bureau, inc., any of the following:
