Chapter Ins 6

Ins 6.05(4)(a)5. 5. If a form contains variable material or language, a written description identifying the range of the variable material or language.

Ins 6.05(4)(a)6. 6. A second copy of each form, if the insurer requires an OCI stamped copy for its records.

Ins 6.05(4)(a)7. 7. A copy of the previously approved form clearly marked “for reference only” if the current form is to supercede the previously approved form.

Ins 6.05(4)(a)8. 8. If the submission of forms is filed by a third-party on behalf of an insurer, a letter from the insurer, authorizing the third-party to file forms on its behalf.

Ins 6.05(4)(a)9. 9. A self-addressed return envelope of sufficient size to return one copy of the materials in subds. 1. and 6., to the insurer.

Ins 6.05(4)(b) (b) Each electronic submission of forms shall include all of the following:

Ins 6.05(4)(b)1. 1. All of the data elements on the transmittal document.

Ins 6.05(4)(b)2. 2. A properly completed certificate of compliance and readability in substantially identical format as in Appendix A.

Ins 6.05(4)(b)3. 3. A filing letter that contains all of the following information:

Ins 6.05(4)(b)3.a. a. In the case of a form that alters or replaces a previously filed form, a description of the changes.

Ins 6.05(4)(b)3.b. b. The form number and approval or filing date of any form superseded by the new form.

Ins 6.05(4)(b)4. 4. One copy of each form in final electronic format exactly as it will be offered for issuance or delivery in the state of Wisconsin, except for hypothetical data and other appropriate variable material.

Ins 6.05(4)(b)5. 5. If a form contains variable material or language, a written description identifying the range of the variable material or language.

Ins 6.05(4)(b)6. 6. A copy of the previously approved or filed form clearly marked “for reference only” if the current form is to supersede the previously approved or filed form.

Ins 6.05(4)(b)7. 7. If the submission of forms is filed by a third-party on behalf of an insurer, a letter from the insurer authorizing the third-party to file forms on its behalf.

Ins 6.05(4)(c) (c) A submission filed by a rate service organization will be considered as filed on behalf of all affiliated insurers.

Ins 6.05(5) (5) Insurer records. Each insurer shall maintain a file of all forms approved or filed under s. 631.20, Stats., for use in Wisconsin until all exposure on the risks insured against has terminated. The file is subject to examination and the commissioner may request that any portion of the file be available for review within ten days of a written request.

Ins 6.05(6) (6) Incomplete filing. The commissioner shall reject without further review any filing which does not include all of the items in sub. (4) (a) and (b).

Ins 6.05(7) (7) Penalty. Insurers violating the provision of this rule by using unapproved or unfiled forms shall be subject to the penalties in s. 601.64, Stats. Each form issued to an individual policyholder shall constitute a separate violation.

Ins 6.05 History History: Cr. Register, July, 1958, No. 31, eff. 8-1-58; am. (3), Register, May, 1975, No. 233, eff. 6-1-75; emerg. am. (1), eff. 6-22-76; am. (1), Register, September, 1976, No. 249, eff. 10-1-76; r. and recr. Register, November, 1977, No. 263, eff. 12-1-77; r. and recr. (4), Register, January, 1980, No. 289, eff. 2-1-80; am. (4) (a), (b) (intro.) and 7., Register, February, 1982, No. 314, eff. 3-1-82; cr. (4) (c) and (d), Register, July, 1982, No. 319, eff. 8-1-82; r. and recr. December, 1987, No. 384, eff. 1-1-88; r. (5), renum. (6) to (8) to be (5) to (7), Register, July, 1989, No. 403, eff. 8-1-89; CR 10-076: am. (3) (b), (4) (a) (intro.), 1. to 5., 8., 9., (5), (6), (7), renum. (3) (d), (e), (f) to be (3) (f), (d), (e) and am., renum. (4) (b) to be (4) (c), cr. (4) (b) Register January 2011 No. 661, eff. 2-1-11.

Ins 6.05 Appendix A

CERTIFICATE OF COMPLIANCE AND READABILITY

I __________________________, (name), an officer of____________________(company name), hereby certify that I have authority to bind and obligate the company by filing this (these) form(s). I further certify that, to the best of my information, knowledge and belief:

1. The accompanying form(s) as identified by the attached listing comply(ies) with all applicable provisions of the Wisconsin Statutes and with all applicable administrative rules of the Commissioner of Insurance;

2. The form(s) does (do) not contain any inconsistent, ambiguous, or misleading clauses;

3. The form(s) does (do) not contain specification or conditions that unreasonably or deceptively limit the risk purported to be assumed in the general coverage of the policy form(s);

4. The only variations from a form currently on file with the commissioner of insurance and the only unconventional policy provisions are clearly marked or otherwise indicated pages __________________ of the attached form(s) or in an attachment; and

5. The attached form(s) is (are) in final printed format or typed facsimile and is (are) as will be offered for issuance or delivery in Wisconsin after approval by the Commissioner of Insurance, except for hypothetical data and other appropriate variable material.

6. If this form is a consumer insurance policy, the text of the form(s) meet(s) the minimum reading ease score or, if authorized by the commissioner, the score is lower than the minimum required by s. Ins 6.07 (4) (a) 1., Wis. Adm. Code. Product used to determine the Flesch score:____________________.

I understand that the commissioner of insurance will rely on this certification regarding the forms filed, and should it be determined that the policy form(s) does(do) not comply with the applicable laws, regulations, filing requirements and product standards or that this certification is materially false or incorrect, appropriate corrective and disciplinary action, including retroactive disapproval, as authorized by law, may be taken by the commissioner against the company and the officer completing this certification.

     
(signature)
     
(title)
     
(date)

Individual responsible for this filing:

Name:       Title:_________________________

Address:     ________________

Phone Number:_______________ Date:  

Ins 6.06 Ins 6.06 Minimum documentation in support of rate filings.

Ins 6.06(1) (1) Purpose. The purpose of this section is to establish the minimum supplementary rate information required to be submitted with rate filings to the commissioner. Statutes interpreted or implemented by this section are ss. 601.42 (1g), 625.01, 625.02 (3), and 625.11, Stats.

Ins 6.06(2) (2) Scope. Except as provided in sub. (4), any insurer or rate service organization which is subject to s. 625.13 (1), Stats., and is filing rates for any kind or line of direct insurance in this state shall include, in that filing, the supplementary rate information required by sub. (5) or (6).

Ins 6.06(3) (3) Definitions.

Ins 6.06(3)(a) (a) A “frequency trend factor” means any factor which adjusts the past number of paid or incurred claims to reflect more accurately the number of claims that can be expected to develop during the period the proposed rates will be used.

Ins 6.06(3)(b) (b) A “loss adjustment factor” means any factor used to modify or adjust the actual losses paid or incurred during the period under examination or review.

Ins 6.06(3)(c) (c) A “loss development factor” means any factor used either to adjust the reported amount of incurred losses to include incurred but not reported losses or to correct errors in the estimation of loss reserves for reported claims that have not been paid, or both.

Ins 6.06(3)(d) (d) A “premium adjustment factor” means any factor used to modify or adjust the actual premiums earned during the period under examination or review.

Ins 6.06(3)(e) (e) A “rate level factor” means any factor that adjusts prior earned premiums to the premiums that would have been earned if the present rates had been in effect throughout the period under examination or review.

Ins 6.06(3)(f) (f) A “severity trend factor” means any factor which adjusts the past average claim amount to reflect more accurately the average claim amount that can be expected to develop during the period the proposed rates will be used.

Ins 6.06(4) (4) Exemptions.

Ins 6.06(4)(a) (a) Life and disability insurance as defined in s. Ins 6.75 (1), disability insurance as defined in s. Ins 6.75 (2) (c), title insurance as defined in s. Ins 6.75 (2) (h), mortgage guaranty insurance as defined in s. Ins 6.75 (2) (i), municipal bond insurance as defined in s. Ins 3.08 (3) (e), and worker’s compensation insurance as defined in s. Ins 6.75 (2) (k) are exempt from the provisions of this section.

Ins 6.06(4)(b) (b) All companies licensed under ch. 612, Stats., are exempt from the provisions of this section.

Ins 6.06(4)(c) (c) The commissioner may, upon written application, exempt an insurer from full or partial compliance with this rule.

Ins 6.06(5) (5) Supplemental rate information. A rate filing and accompanying supplemental rate information shall be appropriately organized for the kind, class or line of business for which the filing is being made. Except as provided in sub. (6), all rate filings shall include the following supplementary rate information:

Ins 6.06(5)(a) (a)

Ins 6.06(5)(a)1. 1. At least 3 separate and consecutive years of both Wisconsin and aggregate of all states’ experience showing:

Ins 6.06(5)(a)1.a. a. Premiums earned;

Ins 6.06(5)(a)1.b. b. Losses paid;

Ins 6.06(5)(a)1.c. c. Separate reserves for reported but unpaid losses; and

Ins 6.06(5)(a)1.d. d. Reserves for losses incurred but not reported.

Ins 6.06(5)(a)2. 2. If any of the information required by subd. 1. is omitted or less than 3 years’ experience is provided, an explanation shall be submitted.

Ins 6.06(5)(b) (b) An explanation of the rate-making procedures including a description of any statistical data and actuarial methods utilized; or a statement of facts and other detailed information which explain judgments used; or a statement as to how the rates of the filing company compare with those of the competition, providing detail where the rates are substantially higher or lower; or any combination.

Ins 6.06(5)(c) (c) Explanation of the permissible or target loss ratio, including an explanation of how any investment income has been taken into account.

Ins 6.06(5)(d) (d) When used, any premium adjustment factors and loss adjustment factors by year and an explanation of methods and judgments underlying each factor. Loss adjustment factors include but are not limited to loss development factors, frequency trend factors, and severity trend factors. Premium adjustment factors include but are not limited to rate level factors.

Ins 6.06(6) (6) Other supplemental rate information. The commissioner may accept supplemental information other than that required by sub. (5) if the insurer or rate service organization can demonstrate to the commissioner that this information fully supports the rate filing and complies with s. 625.11, Stats.

Ins 6.06(7) (7) Use of rate service organization rates. A member of or subscriber to a rate service organization licensed under s. 625.32, Stats., shall file supplementary rate information if its rates deviate from those filed on its behalf by the rate service organization. Such a filing shall be as required by subs. (5) and (6).

Ins 6.06(8) (8) Additional information. The commissioner may require additional rate filing information if the commissioner determines that the original filing does not explain the proposed rate. Such additional information shall be provided within 30 days of the request.

Ins 6.06 History History: Cr. Register, March, 1988, No. 387, eff. 4-1-88; am. (5) (a) 1. intro. and (9), Register, November, 1988, No. 395, eff. 12-1-88; r. (9) and Appendix, Register, January, 1995, No. 469, eff. 2-1-95; correction in (1) made under s. 13.93 (2m) (b) 7., Stats., Register, February, 2000, No. 530.

Ins 6.07 Ins 6.07 Insurance policy language simplification.

Ins 6.07(1) (1) Purpose. The purpose of this rule is to establish minimum standards for legibility, coherence and understandability in consumer insurance policies delivered or issued for delivery in the state of Wisconsin on or after the effective dates stipulated in sub. (8). Sections of statutes interpreted or implemented by this rule are ss. 631.20 (2) (a) and 631.22, Stats.

Ins 6.07(2) (2) Scope. This rule shall apply to “consumer insurance policies”as defined in sub. (3) and not exempted under sub. (5).

Ins 6.07(3) (3) Definitions.

Ins 6.07(3)(a) (a) In this section “consumer insurance policy”means a life, disability, property or casualty insurance policy, or a certificate or a substitute for a certificate for group life, disability, property or casualty insurance coverage, which is issued to a person for personal, family or household purpose and a copy of which is customarily, in the insurance industry, delivered or is required by law, rule or agreement to be delivered to the person obtaining insurance coverage.

Ins 6.07(3)(b) (b) The term “text” as used in this section shall include all printed or electronic matter except the following:

Ins 6.07(3)(b)1. 1. The name and address of the insurer; the name, number or title of the consumer insurance policy; the table of contents or index; captions and subcaptions; specification pages, schedules or tables; and

Ins 6.07(3)(b)2. 2. Any such form language that is drafted to conform to the requirements of any federal law, regulation or agency interpretation; any form language required by any collectively bargained agreement; any medical terminology; any words which are defined in the form; and any form language required by state law or regulation; provided, however, the insurer identifies the language or terminology excepted by this subdivision and certifies, in writing to the commissioner, that the language or terminology is entitled to be excepted by this subdivision.

Ins 6.07(4) (4) Minimum standards.

Ins 6.07(4)(a) (a) In addition to any other requirements of law, no consumer insurance policy, unless excepted under sub. (5), shall be delivered or issued for delivery in this state on or after the dates such forms must be approved under this section, unless:

Ins 6.07(4)(a)1. 1. The text achieves a minimum score of 50 for those policies labeled as Medicare supplement policies as defined by s. Ins 3.39 and a minimum score of 40 for all other policies included under this rule, on the Flesch reading ease test as described in par. (b), or an equivalent score on any other comparable test as provided in par. (c) or this subsection unless a lower score is authorized under sub. (7);

Ins 6.07(4)(a)2. 2. It is printed, except for specification pages, schedules and tables, in not less than 10 point type, one point leaded;

Ins 6.07(4)(a)3. 3. It is appropriately divided and captioned, presented in a meaningful sequence, and the style, arrangement and overall appearance of the policy enhance its understandability;

Ins 6.07(4)(a)4. 4. It contains a table of contents or an index of the principal sections of the policy if the policy contains more than 3,000 words or if the policy has more than 3 pages;

Ins 6.07(4)(a)5. 5. It contains a single section listing exclusions or the exclusions are listed within the form and given at least equal prominence including same type size;

Ins 6.07(4)(a)6. 6. It defines words and expressions which are not commonly understood, or whose commonly understood meaning is not intended;

Ins 6.07(4)(a)7. 7. Cross-referencing between sections of the policy is maintained at a minimum.

Ins 6.07(4)(b) (b) For the purpose of this section, a Flesch reading ease test score shall be measured by the following method:

Ins 6.07(4)(b)1. 1. For consumer insurance policies containing 10,000 words or less of text, the entire form shall be analyzed. For such forms containing more than 10,000 words, the readability of two 200-word samples per page may be analyzed instead of the entire form. The samples shall be separated by at least 20 printed lines.

Ins 6.07(4)(b)2. 2. The number of words and sentences in the text shall be counted and the total number of words divided by the total number of sentences. The figure obtained shall be multiplied by a factor of 1.015.

Ins 6.07(4)(b)3. 3. The total number of syllables shall be counted and divided by the total number of words. The figure obtained shall be multiplied by a factor of 84.6.

Ins 6.07(4)(b)4. 4. The sum of the figures computed under subds. 2. and 3. subtracted from 206.835 equals the Flesch reading ease score for the consumer insurance policy.

Ins 6.07(4)(b)5. 5. For purposes of subds. 2., 3., and 4., the following procedures shall be used:

Ins 6.07(4)(b)5.a. a. A contraction, hyphenated word, or numbers and letters, when separated by spaces, shall be counted as one word;

Ins 6.07(4)(b)5.b. b. A unit of words ending with a period, semicolon, or colon, but excluding headings and captions, shall be counted as a sentence; and

Ins 6.07(4)(b)5.c. c. A syllable means a unit of spoken language consisting of one or more letters of a word as divided by an accepted dictionary. Where the dictionary shows 2 or more equally acceptable pronunciations of a word, the pronunciation containing fewer syllables may be used.

Ins 6.07(4)(b)6. 6. The title or name of a state or federal government organization or regulatory entity that is required to be used within the policy form may be excluded from the Flesch readability score.

Ins 6.07(4)(c) (c) Any other reading test may be approved by the commissioner for use as an alternative to the Flesch reading ease test if it is comparable in result to the Flesch reading ease test.

Ins 6.07(5) (5) Exemptions. This section does not apply to: