Remarks: (See s. Ins 6.42 (10)
I affirm under penalty of perjury that the
foregoing is full, true, and correct.
Date of statement
Statement of changes in beneficial ownership of securities. Ins 6.43(1)(1)
Persons required to file statements.
Statements on Form 4 (shown at the end of this rule) of changes in beneficial ownership of securities are required to be filed by every person who at any time during any calendar month was directly or indirectly the beneficial owner of more than 10% of any class of equity security of a domestic stock insurance company, or by a director or officer of the company which is the issuer of such securities, and who during such month had any change in his or her beneficial ownership of any class of equity security of such company.
Beginning September 1, 1966, statements are required to be filed on or before the 10th day after the end of each month in which any change in beneficial ownership has occurred. Statements are not deemed to have been filed with the commissioner until they have actually been received by him or her.
Statements for each month for the period January 31, 1966, through August 31, 1966, in which any changes in beneficial ownership have occurred shall be filed by September 10, 1966.
(3) Where statements are to be filed.
One signed copy of each statement shall be filed with the commissioner of insurance, P.O. Box 7873, Madison, Wisconsin 53707-7873.
(4) Separate statements for each company.
A separate statement shall be filed with respect to the securities of each company.
(5) Relationship of reporting person to company.
Indicate clearly the relationship of the reporting person to the company; for example, “Director", “Director and Vice President", “Beneficial owner of more than 10% of the company's common stock", etc.
(6) Transactions and holdings to be reported.
Every transaction shall be reported even though purchases and sales during the month are equal or the change involves only the nature of ownership; for example, from direct to indirect ownership. Beneficial ownership at the end of the month of all classes of securities required to be reported shall be shown even though there has been no change during the month in the ownership of securities of one or more classes.
(7) Title of security.
The statement of the title of the security shall be such as clearly to identify the security even though there may be only one class; for example, “Class A Common Stock".
(8) Date of transaction.
The exact date (month, day and year) of each transaction shall be stated opposite the amount involved in the transaction.
(9) Statement of amounts of securities.
In stating the amount of the securities acquired, disposed of, or beneficially owned, give the face amount of debt securities or the number of shares or other units of other securities. In the case of securities owned indirectly, i.e., through a partnership, corporation, trust or other entity, the entire amount of securities involved in the transaction or owned by the partnership, corporation, trust or other entity shall be stated. The person whose ownership is reported may, if he or she so desires, also indicate in a footnote, or other appropriate manner, the extent of his or her interest in the transaction or holdings of the partnership, corporation, trust or other entity.
(10) Nature of ownership.
Nature of ownership", state whether ownership of the securities is “direct" or “indirect". If the ownership is indirect, i.e., through a partnership, corporation, trust or other entity, indicate in a footnote, or other appropriate manner, the name or identity of the medium through which the securities are indirectly owned. The fact that securities are held in the name of a broker or other nominee does not, of itself, constitute indirect ownership. Securities owned indirectly shall be reported on separate lines from those owned directly and from those owned through a different type of indirect ownership.
(11) Character of transaction.
If the transaction was with the issuer of the securities, so state. If it involved the purchase of securities through the exercise of options, so state and give the exercise price per share. If any other purchase or sale was effected otherwise than in the open market, that fact shall be indicated. If the transaction was not a purchase or sale, indicate its character; for example, gift, 5% stock dividend, etc., as the case may be. The foregoing information may be appropriately set forth in the table or under “Remarks" at the end of the table.
(12) Inclusion of additional information.
A statement may include any additional information or explanation deemed relevant by the person filing the statement.
If the statement is filed for a corporation, partnership, trust, etc., the name of the organization shall appear over the signature of the officer or other person authorized to sign the statement. If the statement is filed for an individual, it shall be signed by him or her or specifically on his or her behalf by a person authorized to sign for him or her.
State of Wisconsin
Commissioner of Insurance
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
(Filed pursuant to Wisconsin Administrative Code section Ins 6.43
(Name of insurance company)
(Name of person whose ownership is reported)
(Business address of such person; street, city, state, zip code)
Relationship of such person to company named above. (See s. Ins 6.43 (5)
Statement of Calendar Month of
Changes During Month and Month-End Ownership (See s. Ins 6.43 (6)
) - See PDF for table
Remarks: (See s. Ins 6.43 (11)
I affirm under penalty of perjury that the
foregoing is full, true, and correct.
Date of statement
Kinds of individual intermediary or agent licenses. Ins 6.50(1)(1)
This rule sets forth the kinds of individual intermediary-agents, reinsurance intermediary and managing general agent licenses which may be issued.
(2) Lines of licenses.
The following individual licenses may be issued, each authorizing the solicitation of the line of insurance or the function indicated:
Life insurance — insurance coverage on human lives including benefits of endowment and annuities, and may include benefits in the event of death or dismemberment by accident and benefits for disability income.
Accident and health insurance — insurance coverage for sickness, bodily injury or accidental death and may include benefits for disability income.
Property insurance — insurance coverage for the direct or consequential loss or damage to property of every kind.
Casualty insurance — insurance coverage against legal liability, including that for death, injury or disability or damage to real or personal property.
Personal lines insurance — property and casualty insurance coverage sold to individuals and families for primarily noncommercial purposes.
Variable life and variable annuity products — insurance coverage provided under variable life insurance contracts and variable annuities.
Credit insurance — credit life, credit disability, credit property, credit unemployment, involuntary unemployment, mortgage life, mortgage guaranty, mortgage disability, guaranteed automobile protection (gap) insurance, and any other form of insurance offered in connection with an extension of credit that is limited to partially or wholly extinguishing that credit obligation that the insurance commissioner determines should be designated a form of limited line credit insurance.
Legal expense insurance — insurance that covers only legal expenses incurred by or provided to an individual or business
Miscellaneous Limited Line insurance — insurance for an insurer authorized to do business in Wisconsin which is permitted as a limited line of insurance in a Wisconsin nonresident intermediary's home state and is not described in this section shall have the same scope of authority as granted under the limited license issued by the producer's resident state which shall be briefly described on the license issued.
Ins 6.50 Note
Note: All intermediaries holding the limited line automobile authority on the effective date of this rule and all intermediaries holding the limited line town mutual non-property insurance on May 1, 1991 are grandfathered for these authorities.
Travel insurance — insurance coverage for trip cancellation, trip interruption, baggage, life, sickness and accident, disability and personal effects when limited to a specific trip and sold in connection with transportation provided by a common carrier.
Crop — Insurance providing protection against damage to crops from unfavorable weather conditions, fire or lightning, flood, hail, insect infestation, disease or other yield-reducing conditions or perils provided by the private insurance market, or that is subsidized by the Federal Crop Insurance Corporation, including Multi-Peril Crop Insurance.
Surety — Insurance or bond that covers obligations to pay the debts of, or answer for the default of another, including faithlessness in a position of public or private trust.
Other Licenses issued to individuals are:
Ins 6.50 History
Cr. Register, December, 1967, No. 144
, eff. 1-1-68; r. and recr. (3) (d), Register, November, 1971, No. 191
, eff. 12-1-71: am. (2) (e), Register, February, 1973, No. 206
, eff. 3-1-73; am. (2) (h), Register, September, 1973, No. 213
, eff. 10-1-73: cr. (2) (o), Register, May, 1975, No. 233
, eff. 6-1-75; emerg. am. (1), (2), (3) (a) and (c), eff. 6-22-76; am. (1), (2), (3) (a) and (c), Register, September, 1976, No. 249
, eff. 10-1-76; r. and recr., Register, August, 1977, No. 260
, eff. 9-1-77; r. (2) (f), Register, October, l981, No. 310, eff. 11-1-81; r. (2) (i), Register, July, 1991, No. 427
, eff. 8-1-91; emerg. am. (1) and (2) (intro.), cr. (2) (i) to (k), eff. 3-12-93; emerg. am. (2) (b) and (e), eff. 7-1-93; am. (1) and (2) (intro.), (b) and (e), cr. (2) (i) to (k), Register, July, 1993, No. 451
, eff. 8-1-93; CR 01-074
: r. and recr. (2), Register January 2002 No. 553
, eff. 2-1-02; CR 07-096
: cr. (2) (b) 5. Register March 2008 No. 627
, eff. 4-1-08; CR 09-022
: cr. (2) (a) 6., (b) 6. and 7. Register August 2009 No. 644
, eff. 9-1-09; correction to numbering of (2) (b) 6. and 7. made under s. 13.92 (4) (b) 1.
, Stats., Register August 2009 No. 644
Group life and disability coverage termination and replacement. Ins 6.51(1)(1)
This section is intended to promote the fair and equitable treatment of group policyholders, insurers, employees and dependents, and the general public by setting out procedures to be followed when a group life or disability insurance policy is terminated or replaced, and to interpret ss. 632.79
This section shall apply to all group life and group disability policies covering employees or employees and dependents, issued by insurers providing insurance as defined in s. Ins 6.75 (1) (a)
or (2) (c)
. It shall apply to blanket policies only if they provide 24-hour coverage for both injury and sickness; any blanket policy, covering any type of group, which provides for renewal shall be subject to subs. (4)
; any blanket policy covering students of a college or university, regardless of whether it provides for renewal, shall be subject to subs. (6)
. Subsection (4) (a)
shall apply only to group policies as defined in sub. (3) (c) 2.
do not apply to excess or stop-loss insurance purchased under s. 120.13 (2) (c)
, Stats., by a county or school district that self-insures employee health benefits.
“Employee" means an employee of an employer or a member of a union or association or a student of a college or university.
Means a policy or contract covering employees issued by an insurer to an employer, labor union, association or trust fund or, in the case of a blanket policy, a college or university, or a group type plan, except that;
In sub. (4) (a)
, means only a policy or contract issued by an insurer or a s. 185.981
, Stats., co-operative or a group type plan issued by a ch. 613
, Stats., corporation, providing hospital, surgical or medical expense coverage to or on behalf of an employer.
A “group policy providing medical expense coverage" does not include a policy providing coverage for dental, vision care, hearing care or prescription drug expense coverage only.
“Group policyholder" means an employer, labor union, association, trust fund or other entity responsible for making group policy premium payments to an insurer.
“Group type plan" means an insurance plan using individual policies which meets the following conditions:
Coverage is provided to classes of employees defined in terms of conditions pertaining to employment or membership.
The coverage is not available to the general public and can be obtained and maintained only because of the covered person's connection with the particular organization or group.
Premiums are paid by the group policyholder to the insurer on behalf of covered employees, and
An employer, union, association or trust fund sponsors or authorizes the plan.
“Individual policy" means an individual or family policy or subscriber contract issued by an insurer.
“Insurer" means an insurance company subject to chs. 631
, Stats., or a service insurance corporation subject to ch. 613
“Premium" means a policy premium or a subscriber contract subscription fee.
“Pre-existing condition" means a disease or physical condition including pregnancy which manifested itself prior to the effective date of coverage through medical diagnosis or treatment or the existence of symptoms which would cause an ordinarily prudent person to seek diagnosis or treatment.
“Validly covered" means that the individual involved was covered and met all policy requirements regarding eligibility for coverage, as opposed to an individual who was covered without having met all such requirements.
(4) Effective date of termination for non-payment of premium; Notice of termination; liability of insurer. Ins 6.51(4)(a)(a)
A group policy subject to s. 632.79
, Stats., as defined in sub. (3) (c) 2.
may not be terminated by the insurer unless it has provided the termination notices required by s. 632.79 (2)
, Stats., except as provided in s. 632.79 (5)
, Stats. The insurer shall be liable for valid claims for covered losses as provided in s. 632.79 (3)
Under a group policy other than one subject to s. 632.79
, Stats., the insurer shall be liable for valid claims for covered losses incurred prior to the end of the grace period provided in the policy. This provision does not prevent a group policyholder from giving written notice of termination of the group policy, prior to the termination date, in accordance with the group policy terms, to reduce or eliminate the grace period.
The insurer shall also be liable for valid claims for covered losses beginning prior to the effective date of written notice of termination to the group policyholder if, after the end of the grace period provided in the policy:
It continues to recognize claims subsequently incurred for which recognition is not required by an applicable extension of coverage provision, or
It fails to request that the group policyholder notify covered employees of the termination and, except for life and disability income coverages, describe their rights, if any, upon termination.
The effective date of termination shall not be prior to midnight at the end of the third scheduled work day after the date on which the notice is delivered.
This paragraph shall not apply if a group policy is terminated and immediately replaced by another group policy providing similar coverage.
A notice of termination given by an insurer to a group policyholder in accordance with sub. (4) (a)
A request to notify covered employees of the termination and, except for life and disability income coverages, the rights, if any, available to them under the group policy,
A statement that, unless otherwise provided in the group policy, the insurer will not be liable for claims for losses incurred after the termination date, and
If the group policy involves employee contributions, a statement that, if the group policyholder continues to collect contributions for the coverage beyond the date of termination, the group policyholder may be held solely liable for the benefits with respect to which the contributions have been collected.
At the same time, the insurer shall furnish to the group policyholder for distribution to covered employees a supply of a notice form indicating the termination, its effective date and the rights, if any, available to them upon termination, except that, for life and disability income coverages, the notice need only urge the covered employees to refer to their certificate or individual policy to determine what rights, if any, are available upon termination.
A group policy shall, if a covered employee or dependent is totally disabled at the date of termination of the policy, provide an extension of coverage for the individual, beginning at the date of termination of the group policy and continuing during the period of total disability as provided in this subsection.