Ins 17.28(3e)(3e) Primary coverage required. Each provider shall ensure that primary coverage for the provider and the provider’s employees other than employees excluded from fund coverage under par. (b), is in effect on the date the provider begins practice or operation and for all periods during which the provider practices or operates in this state. A provider does not have fund coverage for any of the following:

Ins 17.28(3e)(a)(a) Any period during which primary coverage is not in effect.

Ins 17.28(3e)(b)(b) Any employee who is a health care practitioner under the circumstances described in s. 655.005 (2), Stats.

Ins 17.28(3h)(3h) Supervision and direction. For the purposes of clarifying s. 655.005 (2) (a), Stats., health care services that are “under the direction and supervision of a physician or nurse anesthetist” include, but are not limited to the health care services being provided pursuant to and within the scope of the health care practitioner’s professional license and:

Ins 17.28(3h)(a)(a) The health care practitioner is subject to a quality assurance program, peer review process, or other similar program or process that is implemented for and designed to ensure the provision of competent and quality patient care and that program or process also includes participation by a physician or a nurse anesthetist; or

Ins 17.28(3h)(b)(b) The health care services are provided by the health care practitioner within the scope of standing orders, protocols, procedures or clinical practice guidelines established or approved by a physician or nurse anesthetist.

Ins 17.28(3m)(3m) Exemptions; eligibility. A medical or osteopathic physician licensed under ch. 448, Stats., or a nurse anesthetist licensed under ch. 441, Stats., may claim an exemption from ch. 655, Stats., if at least one of the following conditions applies:

Ins 17.28(3m)(a)(a) The provider will not practice more than 240 hours in the fiscal year.

Ins 17.28(3m)(c)(c) During the fiscal year, the provider will derive more than 50% of the income from his or her practice from outside this state or will attend to more than 50% of his or her patients outside this state.

Ins 17.28(3s)(a)(a) A provider that begins or resumes practice or operation during a fiscal year, has claimed an exemption or has failed to comply with sub. (3e) may obtain fund coverage during a fiscal year by giving the fund advance written notice of the date on which fund coverage should begin.

Ins 17.28(3s)(b)(b) The board may authorize retroactive fund coverage for a provider who submits a timely request for retroactive coverage showing that the failure to procure coverage occurred through no fault of the provider and despite the fact that the provider acted reasonably and in good faith. The provider shall furnish the board with an affidavit describing the necessity for the retroactive coverage and stating that the provider has no notice of any pending claim alleging malpractice or knowledge of a threatened claim or of any occurrence that might give rise to such a claim. The authorization shall be in writing, specifying the effective date of fund coverage.

Ins 17.28(4)(a)(a) Definition. In this subsection, “semimonthly period” means the 1st through the 14th day of a month or the 15th day through the end of a month.

Ins 17.28(4)(b)(b) Entry during fiscal year; prorated annual fee. If a provider begins practice or operation or enters the fund under sub. (3s) (b) after the beginning of a fiscal year, the fund shall charge the provider one twenty-fourth of the annual fee for each semimonthly period or part of a semimonthly period from the date fund coverage begins to the next June 30.

Ins 17.28(4)(c)(c) Ceasing practice or operation; refunds. A provider or person acting on the provider’s behalf shall notify the fund in the form specified by the fund if any of the following occurs:

Ins 17.28(4)(cm)(cm) Eligibility for exemption; refund. If a provider claims an exemption after paying all or part of the annual fee, the fund shall issue a refund equal to one twenty-fourth of the provider’s annual fee for each full semi-monthly period from the date the provider becomes eligible for the exemption to the due date of the next payment. The refund for any past exemption period will be limited to the current fiscal year and the immediate prior fiscal year.

Ins 17.28(4)(cs)(cs) Ineligibility for fund coverage; refund.

Ins 17.28(4)(cs)1.1. If a provider who has paid all or part of the annual fee is or becomes ineligible to participate in the fund under s. 655.003 (1) or (3), Stats., or because he or she does not practice in this state, the fund shall issue a full refund of any amount the provider paid for fund coverage for which he or she was not eligible.

Ins 17.28(4)(cs)2.2. If a provider that has paid all or part of the annual fee is ineligible for fund coverage because the provider is not in compliance with sub. (3e), the fund shall issue a full refund of the amount paid for the period of noncompliance, beginning with the date the noncompliance began.

Ins 17.28(4)(d)(d) Change of classification; increased annual fee.

Ins 17.28(4)(d)1.1. If a provider’s change of classification under sub. (6) during a fiscal year results in an increased annual fee, the fund shall adjust the provider’s annual fee to equal the sum of the following:

Ins 17.28(4)(d)1.a.a. One twenty-fourth of the annual fee for the provider’s former classification for each full semimonthly period from the due date of the provider’s first payment during the current fiscal year to the date of the change.

Ins 17.28(4)(d)1.b.b. One twenty-fourth of the annual fee for the provider’s new classification for each full or partial semimonthly period from the date of the change to the next June 30.