Ins 8.52(3)(b)3. 3. The percentage change due to adjustments in benefit design, determined in accordance with the insurer’s rate manual or rating procedures.

Ins 8.52(3)(b)4. 4. The percentage change due to such rating factors as claim experience, health status and duration of coverage, determined in accordance with the insurer’s rate manual or rating procedures.

Ins 8.52(3)(c) (c) Each renewal rate, regardless of whether the rate represents an increase, shall be limited to the previous rate adjusted by the combination of the 4 components specified in par. (b) with the following restrictions on the experience component specified in par. (b) 4.:

Ins 8.52(3)(c)1. 1. For a policy issued on or after March 15, 1992, the experience component shall be limited to 15% per year, adjusted proportionately for rating periods of less than one year.

Ins 8.52(3)(c)2. 2. For a policy issued before March 15, 1992, subd. 1. applies, except if the premium rate exceeds the midpoint rate by more than the percentage specified in sub. (2) (a) for the applicable period for policies with the same case characteristics and benefit design characteristics, the experience component may not exceed 0%.

Ins 8.52(3)(d) (d) For a rate change made before the end of the policy term due to the addition of a new entrant, late enrollee, underwritten individual or a new dependent of an insured employee, par. (c) applies, except that:

Ins 8.52(3)(d)1. 1. The new business rate change component specified in par. (b) 1. may not be applied at that time.

Ins 8.52(3)(d)2. 2. The experience component specified in par. (b) 4. may not exceed 15% per year, adjusted proportionately to the time remaining in the policy term.

Ins 8.52(3)(d)3. 3. The experience component specified in par. (b) 4., when combined with the experience component of the last scheduled rate renewal and any other subsequent rate changes during the current policy term, shall not exceed the limit specified in par. (c) 1. or 2., whichever applies.

Ins 8.52(4) (4) Annual publication of rates.

Ins 8.52(4)(a) (a) On or before December 1, every small employer insurer shall annually file with the commissioner the small employer insurer’s lowest available monthly new business premium rates which will be in effect the following January 1. The filing shall be made on a form provided by the commissioner and shall require all of the following information as may apply to the type of plan offered:

Ins 8.52(4)(a)1. 1. For an indemnity plan, the rates shall be based on the insurer’s plan that is closest to a plan that features a $500.00 annual deductible and 80%/20% coinsurance.

Ins 8.52(4)(a)2. 2. For a defined network plan, the rates shall be based on a plan which is actuarially equivalent to the features described in subd. 1.

Ins 8.52(4)(a)3. 3. For all plans, the rates shall be specified for family and single plans, by group size and by the geographical criteria that are used by the insurer.

Ins 8.52(4)(a)4. 4. The commissioner may require additional information be provided in the form as appropriate to implement this subsection.

Ins 8.52 Note Note: OCI 26-500, the form described in this subsection may be obtained without charge by contacting the Office of the Commissioner of Insurance PO Box 7873, Madison WI. 53707-7873. The form is also available on the OCI website at oci.wi.gov

Ins 8.52(4)(b) (b) Small employer insurers who file rates with the commissioner as described in this subsection will be in compliance with the requirements of s. 635.12, Stats.

Ins 8.52 History History: Cr. Register, October, 1992, No. 442, eff. 11-1-92; am. (3) (d) (intro.), Register, November, 1993, No. 455, eff. 2-1-94; CR 02-043: cr. (4), Register October 2002 No. 562, eff. 11-1-02.

Ins 8.54 Ins 8.54 Guaranteed renewability; cancellation and renewal restrictions.

Ins 8.54(1) (1) Definition.

Ins 8.54(1)(a) (a) In this section, “medically underwritten policy” means a policy that is issued after the small employer insurer has, for purposes of risk selection, used information about the group’s claim experience or the health history or medical records of one or more persons eligible for coverage.

Ins 8.54(1)(b) (b) Notwithstanding par. (a), a small employer insurer may apply medical underwriting standards to an individual who originally declined and later applies for coverage under a nonmedically underwritten policy without converting that policy to a medically underwritten policy.

Ins 8.54(2) (2) Class of business.

Ins 8.54(2)(a) (a) In this section, each of the following is a separate class of business, regardless of variations in policy forms, marketing methods or duration of coverage among small employers in the class of business:

Ins 8.54(2)(a)1. 1. All small employers with medically underwritten policies.

Ins 8.54(2)(a)2. 2. All small employers with policies that are not medically underwritten.

Ins 8.54(2)(a)3. 3. All small employers whose policies constitute a block of business assumed by the small employer insurer under a specific assumption treaty with an insurer that is not an affiliate.

Ins 8.54(2)(b) (b) No small employer insurer may establish a class of business other than one specified in par. (a).

Ins 8.54(3) (3) Guaranteed renewability. Except as provided in s. 635.07, Stats., a policyholder has the right to renew a policy on the same terms subject to the premium rate restrictions specified in s. Ins 8.52 (3). The subsection does not prohibit a small employer insurer from offering a policyholder renewal with altered benefit design characteristics if the offer is available to all policyholders in the same class of business without regard to claim experience.