Ins 6.51(7) (7) Liability of prior insurer. The prior insurer shall be liable only to the extent of its extensions of coverage. Its liability shall be the same whether the group policyholder secures replacement coverage from another insurer, self-insures or declines to provide the group with insurance.

Ins 6.51(7m) (7m) Liability of succeeding insurer. The succeeding insurer shall be liable as provided in this paragraph where its group policy replaces another providing similar coverage:

Ins 6.51(7m)(a) (a) Regular coverage. Regular coverage shall be provided under the succeeding insurer’s group policy to:

Ins 6.51(7m)(a)1. 1. Each employee who is eligible for coverage in accordance with the succeeding insurer’s group policy provisions regarding classes eligible and actively at work requirements.

Ins 6.51(7m)(a)2. 2. Each dependent who is eligible for coverage in accordance with the succeeding insurer’s group policy provisions regarding classes eligible and non-hospital confinement requirements.

Ins 6.51(7m)(a)3. 3. A dependent of a disabled employee if the dependent is eligible for coverage in accordance with the succeeding insurer’s group policy provisions regarding classes eligible and non-hospital confinement requirements and if the disabled employee is covered under the succeeding insurer’s group policy, and

Ins 6.51(7m)(a)4. 4. Each terminated insured who has elected to continue coverage under s. 632.897 (3), Stats.

Ins 6.51(7m)(b) (b) Temporary coverage. Each employee or dependent not covered under the succeeding insurer’s group policy in accordance with par. (a) shall be provided with temporary coverage by the succeeding insurer, for losses occurring or beginning under the replacement policy, subject to:

Ins 6.51(7m)(b)1. 1. Temporary coverage need be provided only if the individual was validly covered under the prior group policy on the date of its termination and meets the requirements necessary to be a member of an eligible class under the succeeding insurer’s group policy, other than requirements for working full time, part time or a stated number of hours.

Ins 6.51(7m)(b)2. 2. The coverage to be provided by the succeeding insurer shall be the coverage of the prior group policy reduced by any benefits payable under such policy. The benefits of the succeeding insurer’s group policy shall be determined after the benefits of the prior group policy have been determined.

Ins 6.51(7m)(b)3. 3. Temporary coverage shall be provided by the succeeding insurer until the first of:

Ins 6.51(7m)(b)3.a. a. The date the individual becomes eligible under the coverage and under the circumstances described in par. (a).

Ins 6.51(7m)(b)3.b. b. For each type of coverage, the date the individual’s coverage would terminate in accordance with the succeeding insurer’s group policy provisions regarding individual termination of coverage, such as at termination of employment or when ceasing to be an eligible dependent.

Ins 6.51(7m)(b)3.c. c. For an individual who is totally disabled on the effective date of the succeeding group policy, under a type of coverage for which sub. (6) requires an extension of coverage, the end of any period of extended coverage required of the prior insurer or, if the prior insurer’s group policy was not subject to sub. (6), would have been required of the prior insurer had its group policy been so subject.

Ins 6.51(7m)(c) (c) Pre-existing conditions. If the succeeding insurer’s group policy contains a pre-existing condition limitation, the coverage for these conditions of persons becoming covered by the succeeding group policy under par. (a) or (b), during the period the limitation applies under that group policy, shall be the lesser of:

Ins 6.51(7m)(c)1. 1. The coverage of the succeeding group policy determined without application of the limitation and

Ins 6.51(7m)(c)2. 2. The coverage of the prior group policy determined after application of any such limitation contained in the policy.

Ins 6.51(7m)(d) (d) Deductibles and waiting periods. The succeeding insurer, in applying any deductibles or waiting periods contained in its group policy, including pre-existing condition waiting periods, shall give credit for the satisfaction or partial satisfaction of the same or similar provisions under the prior group policy, to the extent that the prior and succeeding group policies provide similar coverage. Deductible provision credit shall be given for the same or overlapping benefit periods for expenses incurred and applied against the deductible provisions of the prior group policy during the 90 days preceding the effective date of the succeeding group policy, but only to the extent that these expenses are recognized under the succeeding group policy and are subject to a similar deductible provision.

Ins 6.51(7m)(e) (e) Determination of prior insurer’s coverage. Where a determination of the prior insurer’s coverage is required by the succeeding insurer, the prior insurer, at the succeeding insurer’s request, shall furnish a statement of the coverage available and a copy of pertinent group policy provisions to permit the succeeding insurer to verify the coverage statement or make its own coverage determination. Coverage of the prior group policy shall be determined in accordance with the definitions, conditions and covered expense provisions of that group policy rather than those of the succeeding group policy. The coverage determination shall be made as if coverage had not been replaced by the succeeding insurer.

Ins 6.51(8) (8) More favorable provisions permitted. This section sets out minimum requirements. It does not prohibit a group policyholder and an insurer from agreeing to policy provisions which are more favorable to insured persons.

Ins 6.51(9) (9) Effective date. As provided in s. 227.22, Stats., this section shall take effect on the first day of the month following its publication.

Ins 6.51 History History: Cr. Register, October, 1972, No. 202, eff. 11-1-72; emerg. am. (1) and (2), eff. 6-22-76; am. (1) and (2), Register, September, 1976, No. 249, eff. 10-1-76; am. (1), (2) and (7) (c), Register, March, 1979, No. 279, eff. 4-1-79; r. and recr., Register, March 1982, No. 315, eff. 4-1-82; am. (2), Register, April, 1988, No. 388, eff. 5-1-88; corrections in (7) made under s. 13.93 (2m) (b) 1. and 7., Stats., Register, June, 1997, No. 498; corrections in (3) (a) and (9) made under s. 13.93 (2m) (b) 7., Stats., Register, February, 2000, No. 530; corrections in (7m) (b) (intro.), 3. a. and (c) (intro.) made under s. 13.93 (2m) (b) 7., Stats., Register October 2006 No. 610.

Ins 6.52 Ins 6.52 Biographical data relating to company officers and directors.

Ins 6.52(1) (1) Purpose. This rule is intended to implement and interpret ss. 611.13 (2), 611.54 (1) (a), 611.57, 618.11 (4) and 618.21 (1) (b), Stats., for the purpose of setting standards for the reporting of biographical data relating to company officers, directors, promoters and incorporators, or other persons similarly situated.

Ins 6.52(2) (2) Scope. This rule shall apply to all persons proposing to form an insurer under the laws of this state and to all nondomestic insurers applying for admission to this state and to all insurers authorized to do business in this state except as follows:

Ins 6.52(2)(b) (b) Domestic fraternal benefit societies.

Ins 6.52(2)(c) (c) Nonprofit service plans, cooperative sickness care plans organized or operating under ss. 185.981 to 185.985, Stats., voluntary benefit plans organized or operating under s. 185.991, 1977 Stats., and motor club service companies organized or operating under ss. 616.71 to 616.74 and 616.76 to 616.82, Stats., and donor annuity societies.

Ins 6.52(3) (3) Report of organization of a domestic insurer or admission of a nondomestic insurer. Biographical information in form and substance substantially in accordance with Form A, shown at the end of this rule, shall be furnished to the commissioner of insurance by all promoters, incorporators, directors, trustees and principal officers or proposed directors and principal officers, as the case may be, of an insurer being organized or of an insurer applying for admission. Financial and character reports of any such persons may be ordered by the commissioner and the cost or expense of such reports shall be paid by the incorporators as an organization expense or by the insurer applying for admission.

Ins 6.52(4) (4) Definition. The term “officer” as used in this rule shall include the president, one or more vice presidents, secretary, treasurer, chief actuary, general counsel, comptroller and any person, however described, who enjoys in fact the executive authority of any such officers.