Ins 17.30 Ins 17.30 Peer review council assessments.

Ins 17.30(1) (1) Purpose. This section implements ss. 655.27 (3) (am) and 655.275 (6), Stats., relating to the assessment of fees sufficient to cover the costs, including the costs of administration, of the patients compensation fund peer review council appointed under s. 655.275 (2), Stats.

Ins 17.30(2) (2) Assessments.

Ins 17.30(2)(a) (a) The following fees shall be assessed annually beginning with fiscal year 1986-87:

Ins 17.30(2)(a)1. 1. Against the fund, one-half of the actual cost of operating the council for each fiscal year, less one-half of the amounts, if any, collected under subd. 3.

Ins 17.30(2)(a)2. 2. Against the plan, one-half of the actual cost of operating the council for each fiscal year, less one-half of the amounts, if any, collected under subd. 3.

Ins 17.30(2)(a)3. 3. Against a private medical malpractice insurer, the actual cost incurred by the council for its review of any claim paid by the private insurer, if the private insurer requests a recommendation on premium adjustments with respect to that claim under s. 655.275 (5) (a) 3., Stats.

Ins 17.30(2)(b) (b) Amounts collected under par. (a) 3. shall be applied to reduce, in equal amounts, the assessments under par. (a) 1. and 2. for the same fiscal year.

Ins 17.30(3) (3) Payment. Each assessment under sub. (2) shall be paid within 30 days after the billing date.

Ins 17.30 History History: Cr. Register, June, 1987, No. 378, eff. 7-1-87; am. (2) (a) 1. and 2., Register, June, 1990, No. 414, eff. 7-1-90.

Ins 17.35 Ins 17.35 Primary coverage; requirements; permissible exclusions; deductibles.

Ins 17.35(1) (1) Purpose. This section implements ss. 631.20 and 655.24, Stats., relating to the approval of policy forms for health care liability insurance subject to s. 655.23, Stats.

Ins 17.35(2) (2) Required coverage. To qualify for approval under s. 631.20, Stats., a policy shall at a minimum provide all of the following:

Ins 17.35(2)(a) (a) Coverage for providing or failing to provide health care services to a patient.

Ins 17.35(2)(b) (b) Coverage for peer review, accreditation and similar professional activities in conjunction with and incidental to the provision of health care services, when conducted in good faith by an insured.

Ins 17.35(2)(c) (c) Coverage for utilization review, quality assurance and similar professional activities in conjunction with and incidental to the provision of health care services, when conducted in good faith by an insured.

Ins 17.35(2)(d) (d) Indemnity limits of not less than the amounts specified in s. 655.23 (4), Stats.

Ins 17.35(2)(e) (e) Coverage for supplemental payments in addition to the indemnity limits, including attorney fees, litigation expenses, costs and interest.

Ins 17.35(2)(f) (f) That the insurer will provide a defense of the insured and the fund until there has been a determination that coverage does not exist under the policy or unless otherwise agreed to by the insurer and the fund.

Ins 17.35(2)(g) (g) If the policy is a claims-made policy:

Ins 17.35(2)(g)1. 1. A guarantee that the insured can purchase an unlimited extended reporting endorsement upon cancellation or nonrenewal of the policy.

Ins 17.35(2)(g)2. 2. If the policy is a group policy, a provision that any health care provider, as defined under s. 655.001 (8), Stats., whose participation in the group terminates has the right to purchase an individual unlimited extended reporting endorsement.

Ins 17.35(2)(g)3. 3. A prominent notice that the insured has the obligation under s. 655.23 (3) (a), Stats., to purchase the extended reporting endorsement unless other insurance is available to ensure continuing coverage for the liability of all insureds under the policy for the term the claims-made policy was in effect.

Ins 17.35(2)(g)4. 4. A prominent notice that the insurer will notify the commissioner if the insured does not purchase the extended reporting endorsement and that the insured, if a natural person, may be subject to administrative action by his or her licensing board.

Ins 17.35(2b) (2b) Aggregate limits; unlimited extended reporting endorsements.

Ins 17.35(2b)(a) (a) This subsection interprets and implements s. 655.23 (4), Stats.

Ins 17.35(2b)(b) (b) Highest aggregate limit applies.

Ins 17.35(2b)(b)1. 1. ‘Claims-made coverage.’ The aggregate limit applicable to all claims reported during a reporting year of a claims-made policy shall be the highest limit specified in s. 655.23 (4) (b), Stats., that applies during the reporting year.

Ins 17.35(2b)(b)2. 2. ‘Occurrence coverage.’ The limit applicable to all occurrences during an occurrence year of an occurrence policy shall be the highest limit specified in s. 655.23 (4), Stats., that applies during the occurrence year.