Chapter Ins 8

Ins 8.78 Note Note: 1997 Wis. Act 27 repealed s. 635.20.

Ins 8.78(1)(b) (b) In par. (c), the number of persons in a group means the number of eligible employees without other qualifying coverage, as defined in s. 635.02 (5m), Stats.

Ins 8.78 Note Note: 1995 Wis. Act 289 repealed s. 635.02 (5m).

Ins 8.78(1)(c) (c) A small employer insurer may impose participation requirements on a plan offered to a small employer, not to exceed the following:

Ins 8.78(1)(c)1. 1. For a group of more than 10 persons: 70% of the group.

Ins 8.78(1)(c)2. 2. For a group of 10 persons: 6 participants.

Ins 8.78(1)(c)3. 3. For a group of 8 or 9 persons: 5 participants.

Ins 8.78(1)(c)4. 4. For a group of 7 persons: 4 participants.

Ins 8.78(1)(c)5. 5. For a group of 5 or 6 persons: 3 participants.

Ins 8.78(1)(c)6. 6. For a group of 2 to 4 persons: 2 participants.

Ins 8.78(2) (2) Probationary period. A small employer may impose a waiting period of not more than 90 days from the date of hire before a new employee is eligible to enroll in the small employer’s plan.

Ins 8.78(3) (3) Enrollment.

Ins 8.78(3)(a) (a) A plan may require that new employees of a small employer and newly eligible dependents enroll in the plan within 30 days after becoming eligible to enroll.

Ins 8.78(3)(b) (b) An eligible employee or dependent whose coverage under another health insurance plan terminates for any reason may enroll in a small employer’s plan without medical underwriting within 30 days after termination of the other coverage.

Ins 8.78(3)(c) (c) Section Ins 8.63 (2) applies to an eligible employee or dependent who does not enroll in a small employer’s plan within the period specified in par. (a) or (b).

Ins 8.78(4) (4) Employer contribution exception.

Ins 8.78(4)(a) (a) A plan may limit coverage to eligible employees, as defined in s. 635.20 (1m), Stats., and their dependents.

Ins 8.78 Note Note: 1997 Wis. Act 27 repealed s. 635.20.

Ins 8.78(4)(b) (b) If a plan permits employees other than those defined as eligible employees in s. 635.20 (1m), Stats., to enroll, the small employer is not required to pay the employer contribution specified under s. 635.254 (1), Stats., for those employees. If the small employer elects not to contribute, the small employer shall withhold the entire amount of the premium from the earnings of each employee permitted to participate, as provided in s. 635.254 (2), Stats.

Ins 8.78 Note Note: 1997 Wis. Act 27 repealed ss. 635.20 and 635.254. See ss. 632.745 (5) and 635.19 (4), Stats.

Ins 8.78 History History: Cr. Register, June, 1993, No. 450, eff. 7-1-93; cr. (3) (c), Register, November, 1993, No. 455, eff. 2-1-94.

Ins 8.79 Ins 8.79 Managed care options. A small employer insurer that offers health benefit plans with one or more managed care options in the small employer market shall offer purchasers of a basic health benefit plan at least one managed care option. If the option offered is a preferred provider plan, as defined under s. 609.01 (4), Stats., the small employer insurer, in order to encourage the use of health care providers that participate in the plan, may increase any copayment specified in s. Ins 8.77 (2) or the percentage of an insured’s coinsurance under s. Ins 8.77 (3) if the insured uses a nonparticipating health care provider.

Ins 8.79 History History: Cr. Register, June, 1993, No. 450, eff. 7-1-93.

Ins 8.80 Ins 8.80 Rating.

Ins 8.80(1) (1) In establishing the new business premium rate for the plan, a small employer insurer shall take into account the experience of all of its small employer health benefit plans. The differences between the plan’s new business premium rate and the insurer’s new business premium rates for all other small employer health benefit plans shall be based solely on the differences in the plan designs and not on the actual or anticipated experience of those insured under the basic health benefit plan.

Ins 8.80(2) (2) 

Ins 8.80(2)(a) (a)

Ins 8.80(2)(a)1. 1. Except as provided in par. (b), the plan shall apply a higher rate to smokers than to nonsmokers. The rate applied to smokers shall be no higher than permitted under s. 111.35 (3), Stats. The small employer insurer shall provide the small employer with enough copies of the statements required under s. 111.35 (3) (a) 2. and (b) 2., Stats., for distribution to all plan participants.

Ins 8.80(2)(a)2. 2. For the purpose of complying with s. 635.05, Stats., and s. Ins 8.52, smoking status shall be treated as a case characteristic.

Ins 8.80(2)(b) (b) Paragraph (a) does not apply to a health maintenance organization federally qualified under title 13 of the public health service act.

Ins 8.80 History History: Cr. Register, June, 1993, No. 450, eff. 7-1-93.

Ins 8.81 Ins 8.81 Form approval and marketing.

Ins 8.81(1) (1) Except as provided in s. 635.26 (2m) to (4), Stats., each small employer insurer shall file its basic health benefit plan policy form with the commissioner of insurance under s. 631.20, Stats., before October 1, 1993.

Ins 8.81 Note Note: 1997 Wis. Act 27 repealed s. 635.26, Stats. See s. 635.19 (2), Stats.

Ins 8.81(2) (2) Except as provided in s. 635.26 (2m) to (4), Stats., no small employer insurer shall market any health benefit plan to small employers on and after December 1, 1993 unless its basic health benefit plan policy form has been filed with and approved by the commissioner of insurance under s. 631.20, Stats.

Ins 8.81 Note Note: 1997 Wis. Act 27 repealed s. 635.26, Stats. See 635.19 (2), Stats.

Ins 8.81 History History: Cr. Register, June, 1993, No. 450, eff. 7-1-93.