Ins 18.10(3) (3) “Health benefit plan” has the meaning provided in s. 632.835 (1) (c), Stats., and includes Medicare supplement and replacement plans as defined in s. 600.03 (28p) and (28r), Stats., and s. Ins 3.39 (3) (v) and (w). Health benefit plan includes Medicare cost and select plans but does not include Medicare Advantage plans.

Ins 18.10(4) (4) “Medical or scientific evidence” means information from any of the following sources:

Ins 18.10(4)(a) (a) Peer-reviewed scientific studies published in or accepted for publication by medical journals that meet nationally recognized requirements for scientific manuscripts and that submit most of their published articles for review by experts who are not part of the editorial staff.

Ins 18.10(4)(b) (b) Peer-reviewed medical literature, including literature relating to therapies reviewed and approved by a qualified institutional review board, biomedical compendia and other medical literature that meet the criteria of the National Institutes of Health’s Library of Medicine for indexing in Index Medicus, Excerpta Medicus (EMBASE), Medline and MEDLARS database Health Services Technology Assessment Research (HSTAR).

Ins 18.10(4)(c) (c) Medical journals recognized by the Secretary of Health and Human Services under 42 USC1320c et. seq. of the federal Social Security Act.

Ins 18.10(4)(d) (d) Any of the following standard reference compendia most current edition in publication at the time of the dispute:

Ins 18.10(4)(d)1. 1. The American Hospital Formulary Service — Drug Information.

Ins 18.10(4)(d)2. 2. The Center for Drug Evaluation and Research History.

Ins 18.10(4)(d)3. 3. The ADA/PDR Guide to Dental Therapeutics, current edition.

Ins 18.10(4)(d)4. 4. The United States Pharmacopeia — National Formulary.

Ins 18.10(4)(e) (e) Findings, studies or research conducted by, or under the auspices of, federal governmental agencies and nationally recognized federal research institutes, including:

Ins 18.10(4)(e)1. 1. The federal Agency for Healthcare Research and Quality.

Ins 18.10(4)(e)2. 2. The National Institutes of Health.

Ins 18.10(4)(e)3. 3. The National Cancer Institute.

Ins 18.10(4)(e)4. 4. The National Academy of Sciences.

Ins 18.10(4)(e)5. 5. The Health Care Financing Administration.

Ins 18.10(4)(e)6. 6. Any national board recognized by the National Institutes of Health for the purpose of evaluating the medical value of health care services.

Ins 18.10(4)(e)7. 7. Any other medical or scientific evidence that is comparable to the sources listed in this paragraph.

Ins 18.10(4e) (4e) “Preexisting condition exclusion denial determination” has the meaning as defined in s. 632.835 (1) (cm), Stats.

Ins 18.10(4m) (4m) “Legal basis” means information from any of the following sources:

Ins 18.10(4m)(a) (a) The most current version of The American Journal of Jurisprudence.

Ins 18.10(4m)(b) (b) United States 7th Judicial Circuit Court decisions.

Ins 18.10(4m)(c) (c) Wisconsin statutory and common law.

Ins 18.10(4m)(d) (d) The terms of the insurance contract applicable for the period of coverage in dispute.

Ins 18.10(5) (5) “Unbiased” means an independent review organization that complies with all of the following:

Ins 18.10(5)(a) (a) Section 632.835 (6), Stats.

Ins 18.10(5)(b) (b) The independent review organization does not provide incentives of any kind, including financial incentives, to providers or consumers as inducements for selection as the independent review organization.

Ins 18.10(5)(c) (c) The independent review organization does not directly or indirectly receive any compensation, in any form, related to a review, other than the compensation permitted under this subchapter and s. 632.835, Stats.

Ins 18.10(5)(d) (d) The independent review organization does not promote, to providers, consumers or insurers any of the following: