Ins 3.31(3)(b)3.c.c. A benefit maximum; or
Ins 3.31(3)(b)3.d.d. Other policy limitation.
Ins 3.31(3)(c)(c) Where the group or group type plan is issued to trustees of a fund, use the plan’s provisions regarding individual eligibility for coverage and individual termination of coverage to deny liability for or to defend against a claim only if the certificate issued pursuant to the plan, under an appropriate caption or captions, includes the applicable requirements regarding an individual’s eligibility for coverage and the conditions under which an individual’s coverage terminates under the plan.
Ins 3.31(4)(4)Blanket insurance. An insurer issuing insurance under s. 600.03 (4), Stats., shall
Ins 3.31(4)(a)(a) Include in an enrollment form used in connection with such insurance no question relating to the medical history or other matter concerning the insurability of the person or persons to be insured and
Ins 3.31(4)(b)(b) Be subject to the following:
Ins 3.31(4)(b)1.1. A claim shall not be reduced or denied on the grounds that the disease or physical condition resulting in the loss or disability had existed prior to the effective date of coverage, under coverage providing such a defense, unless the insurer has evidence that such disease or physical condition had manifested itself prior to such date. Such manifestation may be established by evidence of:
Ins 3.31(4)(b)1.a.a. Medical diagnosis or treatment of such disease or physical condition prior to the effective date, or
Ins 3.31(4)(b)1.b.b. The existence of symptoms of such disease or physical condition prior to the effective date which would cause an ordinarily prudent person to seek diagnosis, care or treatment and for which such diagnosis, care or treatment was not sought prior to such date.
Ins 3.31(4)(b)2.2. Coverage which contains wording which requires the cause of the disease or physical condition, as distinguished from the disease or physical condition itself, to originate after the effective date of coverage shall be administered in accordance with subd. 1. b.
Ins 3.31(4)(b)3.3. An insurer shall not exclude or limit benefits for a particular condition where the claimant’s medical records indicate a reasonable basis for, and the policy language permits, distinguishing between the eligible condition or conditions which necessitated the hospital confinement or medical or surgical treatment for which claim is made, or which resulted in the disability for which the claim is made, and a concurrently non-eligible existing condition or conditions which did not contribute to the need for the confinement or treatment, or contribute to the disability. The exclusion or limitation of benefits includes the use of:
Ins 3.31(4)(b)3.a.a. A pre-existence defense;
Ins 3.31(4)(b)3.b.b. A waiting period, such as for pregnancy, surgery or other stated condition or procedure;
Ins 3.31(4)(b)3.c.c. A benefit maximum; or
Ins 3.31(4)(b)3.d.d. Other policy limitation.
Ins 3.31(5)(5)Effective date. This rule shall apply to all solicitation, underwriting, and claims activities relating to Wisconsin residents after December 1, 1974, except that sub. (3) (a) 4. a. and b. shall apply to coverage issued after said date and sub. (3) (a) 3. d., e. and g. shall apply to such activities after February 1, 1975.
Ins 3.31 HistoryHistory: Cr. Register, November, 1974, No. 227, eff. 12-1-74; emerg. am. (1), (2), (3) (intro.) and (c) and (4), eff. 6-22-76; am. (1), (2), (3) (intro.) and (c) and (4), Register, September, 1976, No. 249, eff. 10-1-76; am. (1) and (2), Register, March, 1979, No. 279, eff. 4-1-79; am. (1), (2), (3) (intro.), (3) (a) 3. d., f. and 4. b., (3) (c) and (4), r. and recr. (3) (a) 3. c., (3) (b) 1. and 3., (4) (b) 1. and 3., Register, April, 1982, No. 316, eff. 5-1-82; correction in (2) and (3) (intro.) made under s. 13.93 (2m) (b) 7., Stats., Register, April, 1992, No. 436; am. (3) (a) 4. a., Register, November, 1993, No. 455, eff. 2-1-94; correction in (3) (a) 4. a. and (4) (intro.) made under s. 13.93 (2m) (b) 7., Stats., Register, July, 1999, No. 523.
Ins 3.32Ins 3.32Title insurance; prohibited practices.
Ins 3.32(1)(1)Purpose. This rule implements and interprets s. 601.01 (3), Stats., and ch. 628, Stats., for the purpose of prohibiting unfair practices in the transaction of the business of title insurance.
Ins 3.32(2)(2)Scope. This section applies to all title insurers and title insurance agents.
Ins 3.32(3)(3)Definitions. In this section:
Ins 3.32(3)(a)(a) “Affiliate” has the meaning provided under s. 600.03 (1), Stats.
Ins 3.32(3)(am)(am) “Agent” has the meaning provided under s. 600.03 (1r), Stats.
Ins 3.32(3)(b)(b) “Affiliate producer” means an affiliate of a producer of title insurance, but only for the 12-month period commencing after June 30, 1987, and after the end of any quarter calendar year in which the affiliate’s gross revenue from operation in this state from title insurance directly or indirectly referred by affiliated producers of title insurance exceeds 40% of the affiliate’s gross revenue from operations in this state for title insurance in the previous quarter calendar year. However, if the previous quarter calendar year commences prior to July 1, 1988, the percentage is 80%; and if it commences prior to July 1, 1989, the percentage is 60%. “Affiliate producer” does not include a person who is affiliated with producers of title insurance who are all attorneys if the affiliate examines the title for each title insurance policy it issues.
Ins 3.32(3)(bm)(bm) “Control” has the meaning provided under s. 600.03 (13), Stats.
Ins 3.32(3)(c)(c) “Producer of title insurance” means any of the following, other than a title insurer, who order or influence, directly or indirectly, the ordering of title insurance and related services:
Ins 3.32(3)(c)1.1. Any owner or prospective owner of real or personal property or any interest therein;
Ins 3.32(3)(c)2.2. Any lender or prospective lender in a transaction involving an obligation secured or to be secured either in whole or in part by real or personal property or any interest therein; and
Ins 3.32(3)(c)3.3. Any agent, representative, attorney or employee of any owner or prospective owner or of any lender or prospective lender.