Ins 3.29(10)(10)Effective date. This rule shall become effective September 1, 1974.
Ins 3.29 HistoryHistory: Cr. Register, June, 1974, No. 222, eff. 9-1-74; emerg. am. (1) and (2), eff. 6-22-76; am. (1) and (2), Register, September, 1976, No. 249, eff. 10-1-76; am. (2), Register, March, 1979, No. 279, eff. 4-1-79; am. (3) (a) and (i), r. (3) (j), renum. (7) to be (7) (a) and am., cr. (7) (b), Register, June, 1982, No. 318, eff. 7-1-82; r. (9) under s. 13.93 (2m) (b) 16., Stats., Register, December, 1984, No. 348; corrections in (1), (3) (a) and (4) (d) made under s. 13.93 (2m) (b) 5. and 7., Stats., Register, April, 1992, No. 436; CR 08-112: am. (3) (a) and (7) (b) Register June 2009 No. 642, eff. 7-1-09; CR 19-036: am. (3) (a), (7) (b) Register December 2019 No. 768, eff. 1-1-20.
Ins 3.30Ins 3.30Change of beneficiary and related provisions in accident and sickness insurance policies.
Ins 3.30(1)(1)Purpose. The purpose of this rule is to establish guidelines for wording change of beneficiary provisions and related provisions in accident and sickness insurance policies.
Ins 3.30(2)(2)Scope. This rule shall apply to policy forms subject to s. Ins 6.75 (1) (c) or (2) (c) and s. 600.03 (4), (22) and (23), Stats.
Ins 3.30(3)(3)Guidelines. A change of beneficiary provisions and any related provision:
Ins 3.30(3)(a)(a) Shall comply with s. 632.71, Stats., except as provided in ss. 631.81 and 632.77 (4), Stats., where applicable, and
Ins 3.30(3)(b)(b) May include requirements or limitations which would be consistent with an orderly method of handling beneficiary designations and changes such as:
Ins 3.30(3)(b)1.1. A requirement that a beneficiary designation or change be recorded by the insurer;
Ins 3.30(3)(b)2.2. A provision that a claim payment made before a change in beneficiary designation is recorded is not subject to such change;
Ins 3.30(3)(b)3.3. A requirement that a beneficiary designation or change be written as opposed to oral; or
Ins 3.30(3)(b)4.4. A requirement that a beneficiary designation or change be given to a particular agent, representative or office.
Ins 3.30 HistoryHistory: Cr. Register, May, 1974, No. 221, eff. 6-1-74; emerg. am. (2) and (3) (a), eff. 6-22-76; am. (2) and (3) (a), Register, September, 1976, No. 249, eff. 10-1-76; am. (2) and (3) (a), Register, March, 1979, No. 279, eff. 4-1-79; correction in (2) made under s. 13.93 (2m) (b) 7., Stats., Register, April, 1992, No. 436.
Ins 3.31Ins 3.31Eligibility for and solicitation, underwriting and claims practices in group, blanket and group type accident and sickness insurance.
Ins 3.31(1)(1)Purpose. The purpose of this rule is to promote the fair and equitable treatment of Wisconsin residents in the solicitation, underwriting and administration of accident and sickness insurance and coverage issued by a plan subject to s. 185.981, Stats., or ch. 613, Stats. Sections of Statutes interpreted or implemented by this rule include but are not limited to ss. 601.04 (3), 601.01 (2), 611.20, 618.12 (1) and 632.76, Stats.
Ins 3.31(2)(2)Scope. This rule applies to the solicitation, underwriting and administration of insurance issued by an insurer under s. 600.03 (4) or (23), Stats., except credit accident and sickness insurance under s. Ins 6.75 (1) (c) 1. or (2) (c) 1., and coverage issued on a group basis or group type basis as defined in s. Ins 6.51 (3) by a plan subject to s. 185.981, Stats., or ch. 613, Stats. For the purposes of this rule, references to insurer, certificate, insurance agent or representative, enrollment form and enrollee also apply to organizations or associations operating non-profit plans, contracts, summaries of coverage, persons within the scope of the rule, individual applications and applicants, respectively.
Ins 3.31(3)(3)Group and group type insurance. An insurer issuing insurance under s. 600.03 (23), Stats., or group or group type coverage under s. 185.981 or ch. 613, Stats., shall,
Ins 3.31(3)(a)(a) Where the enrollment form contains questions relating to the medical history of the person or persons to be covered, be subject to the following:
Ins 3.31(3)(a)1.1. ‘Enrollment form.’ An enrollment form shall provide to the effect that statements made by the enrollee in the enrollment form regarding the general medical history or general health of the proposed insured person which require an opinion or the exercise of judgment are representations or are to the best of the enrollee’s knowledge and/or belief. Such form need not so provide with respect to statements regarding specifically named diseases, physical conditions, or types of medical consultation or treatment. Such forms shall not require the enrollee to state that he or she has not withheld any information or concealed any facts in completing the enrollment form; however, the enrollee may be required to state that his or her answers are true and complete.
Ins 3.31(3)(a)2.2. ‘Solicitation.’ An insurance agent or representative shall review carefully with the enrollee all questions contained in each enrollment form which he or she prepares and shall set down in each such form all material information disclosed to him or her by the enrollee in response to the questions in such form. This does not require that an insurance agent or representative prepare or assist in the preparation of each enrollment form.
Ins 3.31(3)(a)3.3. ‘Underwriting.’
Ins 3.31(3)(a)3.a.a. An insurer shall make provision for adequate underwriting personnel and procedures so as to process without undue delay each enrollment form for insurance received by it.
Ins 3.31(3)(a)3.b.b. An insurer shall give due consideration to all statements in each enrollment form for insurance submitted to it and shall duly evaluate the proposed insured person before issuing evidence of coverage for such person.
Ins 3.31(3)(a)3.c.c. An insurer which issues evidence of coverage for a person shall not use the statements, information or material set out in subds. 1., 2. and 3. to void the coverage on the basis of misrepresentation in the enrollment form, or deny a claim on the basis of a pre-existing condition defense, unless the insurer has resolved patently conflicting or incomplete statements in the enrollment form for the coverage, duly considered information furnished to it in connection with the processing of such enrollment form, or duly considered the material which it would have obtained through reasonable inquiry following due consideration of such statements or information.
Ins 3.31(3)(a)3.d.d. An insurer shall furnish to the certificate holder or subscriber a notice printed prominently in contrasting color on the first page of the certificate or amendment, or in the form of a sticker or other form to be attached to the first page of the certificate or amendment, or furnish to the group policyholder or other such entity within 10 days after the issuance or amendment of coverage for delivery to the certificate holder or subscriber, a notice in the form of a letter or other form, such notice to contain substantially the following:
IMPORTANT NOTICE CONCERNING STATEMENTS IN THE ENROLLMENT FORM FOR YOUR INSURANCE
Please read the copy of the enrollment form attached to this notice or to your certificate or which has been otherwise previously delivered to you by the insurer or group policyholder. Omissions or misstatements in the enrollment form could cause an otherwise valid claim to be denied. Carefully check the enrollment form and write to the insurer within 10 days if any information shown on the form is not correct and complete or if any requested medical history has not been included. The insurance coverage was issued on the basis that the answers to all questions and any other material information shown on the enrollment form are correct and complete.
Ins 3.31(3)(a)3.e.e. An insurer shall file with the commissioner a description of the procedure it will follow and the form or forms it will use to meet the requirements of subd. 3. d.
Ins 3.31(3)(a)3.f.f. An insurer which, after evidence of coverage for a person has been issued, receives information regarding such person which would reasonably be considered a sufficient basis to void or reform such person’s coverage, shall effect such voiding or reformation, as provided in s. 631.11 (4), Stats., or the insurer shall be held to have waived its rights to such action.