Ins 17.50(4)(4) Initial filing. A provider that intends to establish a self-insured plan shall file with the office a proposal which shall include all of the following: Ins 17.50(4)(a)(a) If the provider is not a natural person, the history and organization of the provider. Ins 17.50(4)(b)(b) If the provider is not a natural person, a resolution adopted by the provider’s governing body approving the establishment and operation of a self-insured plan. Ins 17.50(4)(c)(c) A description of the proposed method of establishing and operating the self-insured plan. Ins 17.50(4)(d)(d) An actuarial estimate of the liabilities that will be incurred by the self-insured plan in the first year of operation, an actuarial review of the cost of the first year’s funding and a description of how the self-insured plan will be funded. Ins 17.50(4)(e)(e) If prior acts coverage is required under sub. (6) (f) 1., an actuarial estimate of the liabilities of the provider and any natural person covered under sub. (3) (b) for prior acts, an actuarial review of the cost of funding the coverage and a description of how the coverage will be funded. Ins 17.50(4)(f)(f) An actuarial feasibility study which includes a 5-year projection of expected results. Ins 17.50(4)(g)(g) The identity of the bank that will act as trustee for the self-insured plan and a proposed trust agreement between the provider and the bank. Ins 17.50(4)(h)(h) Any proposed investment policy that will be applicable to the investment of the trust’s assets. Ins 17.50(4)(i)(i) A description of the provider’s existing or proposed risk management program. Ins 17.50(4)(j)(j) The estimated number and the professions of natural persons that the self-insured plan will cover under sub. (3) (b). Ins 17.50(4)(k)(k) A description of the proposed contractual arrangements with administrators, claims adjusters and other persons that will be involved in the operation of the self-insured plan. Ins 17.50(4)(L)(L) The provider’s most recent audited annual financial statement prepared under generally accepted accounting principles that includes, if applicable, all affiliated health care providers covered under the self-insured plan on a consolidated basis. Ins 17.50(4)(m)(m) A proposed draft of a letter of credit, if the provider intends to use one as part of the initial funding, except for affiliated health care providers who are prohibited from using a letter of credit for initial funding. Ins 17.50(5)(a)(a) After reviewing a proposal submitted under sub. (4), the office may approve the proposal if all of the following conditions are met: Ins 17.50(5)(a)4.4. The proposal ensures the provider’s continuing ability to meet the financial responsibility requirements of s. 655.23, Stats. Ins 17.50(5)(a)5.5. The provider is sound, reliable and entitled to public confidence and may reasonably be expected to perform its obligations continuously in the future. Ins 17.50(5)(b)(b) If any of the conditions specified under par. (a) is not met, the office may request the provider to submit additional information in writing or may assist the provider in revising the proposal. Ins 17.50(5)(c)(c) A self-insured plan may not begin operation without the written approval of the office which specifies the earliest date operation may begin. Ins 17.50(6)(6) Funding requirements for providers: prohibitions. Ins 17.50(6)(a)(a) The minimum initial funding required for a self-insured plan is $2,000,000. Ins 17.50(6)(b)(b) Before a self-insured plan begins operation, the provider shall establish a trust with a Wisconsin-chartered or federally-chartered bank with trust powers which is located in this state. Ins 17.50(6)(c)(c) For self-insured plans except a self-insured plan for affiliated health care providers, the provider shall provide all of the following: Ins 17.50(6)(c)1.1. If the actuarial estimate under sub. (4) (d) is less than $2,000,000, the provider shall, before the self-insured plan begins operation, deposit in the trust cash equal to the first year’s estimated liabilities plus a letter of credit equal to the difference between the cash funding and $2,000,000 except as provided under sub. (4) (m).