Ins 3.49(3)(d)1.1. A method by which an applicant to the Plan denied insurance or an insured under the Plan whose insurance is terminated may request the committee to review the denial or termination and by which an insurer subscribing to the Plan may request the committee to review actions or decisions of the Plan which adversely affect the insurer. The method shall specify that requests for review must be made in writing to the Plan and that the decision of the committee in regard to the review may be appealed by the applicant, insured or insurer to the commissioner of insurance as provided for in ch. Ins 5. A request for review does stay the termination of coverage.

Ins 3.49(3)(d)2.2. The committee’s decision under subd. 1. shall be in writing and shall include notice of the right to a hearing under ch. Ins 5 if the person files a petition for a hearing with the commissioner of insurance not later than 30 days after the notice is mailed. The notice shall describe the requirements of s. Ins 5.11 (1).

Ins 3.49(3)(d)3.3. The office of the commissioner of insurance shall hold a hearing within 30 days after receipt of a complete petition under subd. 2., unless the petitioner waives the right to a hearing within 30 days. At the hearing, the petitioner has the burden of proving by a preponderance of the evidence that the committee’s decision is erroneous under the policy terms or the plan’s rules.

Ins 3.49(3)(d)4.4. Filing a petition under subd. 2. does not stay the action of the plan with respect to termination of coverage. The plan shall comply with the final decision and order in the contested case proceeding.

Ins 3.49(3)(e)(e) The commissioner shall maintain files of the Plan’s approved rules, rates, and forms and such documents must be made available for public inspection at the office of the commissioner of insurance.

Ins 3.51(1)(1) Definitions. For the purpose of this section only:

Ins 3.51(1)(a)(a) “Accountant” means an independent certified public accountant who is duly registered to practice and in good standing under the laws of this state or a state with similar licensing requirements.

Ins 3.51(1)(b)(b) “Individual practice association” means an individual practice association as defined under s. 600.03 (23g), Stats., which contracts with a health maintenance organization insurer or a limited service health organization to provide health care services which are principally physician services.

Ins 3.51(1)(c)(c) “Work papers” are the records kept by the accountant of the procedures followed, the tests performed, the information obtained, and conclusions reached pertinent to the examination of the financial statements of the independent practice association. Work papers include, but are not limited to, work programs, analysis, memorandum, letters of confirmation and representation, management letters, abstracts of company documents and schedules or commentaries prepared or obtained by the accountant in the course of the examination of the financial statements of the independent practice association and which support the accountant’s opinion.

Ins 3.51(2)(2) Filing of annual audited financial reports. Unless otherwise ordered by the commissioner, an individual practice association shall file an annual audited financial report with the commissioner within 180 days after the end of each individual practice association’s fiscal year. This section applies to individual practice associations for fiscal years terminating on or after March 31, 1991. The annual audited financial report shall report the assets, liabilities and net worth; the results of operations; and the changes in net worth for the fiscal year then ended on the accrual basis in conformity with generally accepted accounting practices. The annual audited financial report shall not be presented on the cash basis or the income tax basis or any other basis that does not fully account for all the independent practice association’s liabilities incurred as of the end of the fiscal year. The annual audited financial report shall include all of the following:

Ins 3.51(3)(3) Scope of audit and report of independent certified public accountant. Financial statements filed under sub. (2) shall be audited by an independent certified public accountant. The audit shall be conducted in accordance with generally accepted auditing standards. The commissioner may from time to time require that additional auditing procedures be observed by the accountant in the audit of the financial statements of the independent practice association under this rule.

Ins 3.51(4)(4) Availability and maintenance of cpa work papers.

Ins 3.51(4)(a)(a) An independent practice association required to file an audited financial report under this rule shall, if requested by the office, require the accountant to make available to the office all the work papers prepared in the conduct of the audit. The independent practice association shall require that the accountant retain the audit work papers for a period of not less than 5 years after the period reported.

Ins 3.51(4)(b)(b) The office may photocopy pertinent audit work papers. These copies are part of the office’s work papers. Audit work papers are confidential unless the commissioner determines disclosure is necessary to carry out the functions of the office.

Ins 3.51(5)(5) Contracts. A health maintenance organization insurer contracting with an independent practice association shall include provisions in the contract which are necessary to enable the individual practice association to comply with this section including, but not limited to: