A “group insurance policy" is a policy covering a group of persons, and issued to a policyholder on behalf of the group for the benefit of group members who are selected under procedures defined in the policy or agreements collateral thereto, with or without members of their families or dependents.
“Health maintenance organization insurer" means an insurer that satisfies all of the following:
Has a certificate of authority, an amended certificate of authority or a statement of operations issued by the commissioner under s. 609.03
that restricts the insurer to engaging in only the types of insurance business described in s. 609.03 (3)
“Individual practice association" means a person, other than a hospital, clinic or an individual physician or other individual health care provider, that does all of the following:
Contracts with a health maintenance organization, limited service health organization or preferred provider plan, as defined in s. 609.01
, to provide health care services.
Provides health care services primarily through health care providers who are independent contractors or who are obligated to provide the services because of membership in the entity.
“Initial expendable surplus" is the amount of surplus in addition to capital or minimum permanent surplus or both that an insurer obtains in its organizational process in accordance with s. 611.19
and is not required to maintain thereafter.
“Initial surplus" is the sum of minimum permanent surplus and initial expendable surplus.
For an insurer organized or operating under ch. 612
, the inability to pay any loss within 30 days after the due date specified in the first assessment notice issued under s. 612.54 (4)
after the date of the loss, or any other uncontested debt as it becomes due, or the inability to replenish by timely assessment any required surplus.
For any other insurer, that it is unable to pay its debts or meet its obligations as they mature or that its assets do not exceed its liabilities plus the greater of any capital and surplus required by law to be constantly maintained or its authorized and issued capital stock. For purposes of this paragraph “assets" includes one-half of the maximum total assessment liability of the policyholders of the insurer, and “liabilities" includes reserves required by law. For policies issued on the basis of unlimited assessment liability, the maximum total liability, for purposes of determining solvency only, is the amount that could be obtained if there were 100 percent collection of an assessment at the rate of 10 mills.
Risk distributing arrangements providing for compensation of damages or loss through the provision of services or benefits in kind rather than indemnity in money.
Contracts of guaranty or suretyship entered into by the guarantor or surety as a business and not as merely incidental to a business transaction.
Coverage, including stop-loss coverage, of an employer or plan sponsor relating to claims incurred under the employer's or plan sponsor's self-funded employee welfare benefit plan, as defined in 29 USC 1002
See also s. Ins 15.01
, Wis. adm. code.
“Insured" means any person to whom or for whose benefit an insurer makes a promise in an insurance policy. The term includes policyholders, subscribers, members and beneficiaries. This definition applies only to chs. 600
and does not apply to the use of the word in insurance policies.
“Insurer" means any person or association of persons doing an insurance business as a principal, and includes, but is not limited to, fraternals, cooperative associations organized under s. 185.981
, insurers operating under subch. I of ch. 616
, and risk retention groups. “Insurer" also includes any person purporting or intending to do an insurance business as a principal on his or her own account. “Insurer" does not include a person that issues only qualified charitable gift annuities, as defined in s. 632.65 (1)
“Intermediary" means an insurance marketing intermediary as defined in s. 628.02
“Long-term care insurance policy" means a disability insurance policy or certificate advertised, marketed, offered or designed primarily to provide coverage for care that is provided in institutional and community-based settings and that is convalescent or custodial care or care for a chronic condition or terminal illness. The term does not include a medicare supplement policy or medicare replacement policy or a continuing care contract, as defined in s. 647.01 (2)
“Medicare replacement policy" means to the extent permitted under federal law, any of the following:
A disability insurance policy or certificate issued to a resident of this state pursuant to a contract between the federal health care financing administration and a federally qualified health maintenance organization or a federally certified competitive medical plan to provide health care benefits to persons eligible for medicare under 42 USC 1395f
A plan, contract or policy that the commissioner by rule determines is similar to, or supplements or replaces, a program described in par. (a)
“Medicare supplement policy" means a disability insurance policy or certificate advertised, marketed or designed primarily to supplement benefits under medicare for the hospital, medical or surgical expenses of persons eligible for medicare.
“Member" means a person having membership rights in a corporation. Any person may be a member of a corporation unless the law specifically provides otherwise. See also “insured".
“Minimum capital" is the capital that a stock insurance corporation is required by statute or administrative determination to have and constantly to maintain. See s. 611.19
“Minimum permanent surplus" is the surplus that an insurance corporation is required by statute or administrative determination to have and constantly to maintain in accordance with s. 611.19
“Mutual" means “mutual insurance corporation".
“Nondomestic insurer" means a foreign or alien insurer. Compare “domestic insurer".
“Office" means the office of the commissioner of insurance of this state.
“Policy" means any document other than a group certificate used to prescribe in writing the terms of an insurance contract, including endorsements and riders and service contracts issued by motor clubs.
“Policyholder" means the person who controls the policy by ownership, payment of premiums or otherwise. See also “insured".
“Premium" means any consideration for an insurance policy, and includes assessments, membership fees or other required contributions or consideration, however designated.
“Principal officers" of a corporation mean the officers designated under s. 611.12 (3)
, or corresponding sections of other chapters.
“Proceedings" includes “actions" and “special proceedings" under s. 801.01
“Reciprocal" means any unincorporated association of persons, operating through an attorney in fact and exchanging insurance contracts with one another, which provide insurance coverage to each other thereunder.
“Security surplus" is the amount of assets in excess of liabilities needed by a particular insurer to satisfy s. 623.12
“Service insurance corporation" means any corporation organized or operating under ch. 613
“State" means the same as in s. 990.01 (40)
except that it also includes the Panama Canal Zone.
“Stock corporation" means “stock insurance corporation".
“Subsidiary" of a person means a stock corporation more than one-half the voting shares of which are owned by the person either alone or with its affiliates.
“Surplus" means the excess of assets over the sum of capital and liabilities.
“Town mutual" means a corporation organized or operating under ch. 612
and is synonymous with “town mutual insurance corporation".
“Trustee" is synonymous with “director".
“Unauthorized insurer" means any insurer not holding a valid certificate of authority to do an insurance business in this state, and any insurer holding a valid certificate, with respect to business not authorized by the certificate. “Unauthorized insurer" includes a surplus lines insurer.
“Wholly owned subsidiary" of a person is a subsidiary all of the voting shares of which are owned by the person either alone or with its affiliates, except for the minimum number of shares required by the law of the subsidiary's domicile to be owned by directors or others.
History: 1971 c. 260
; 1973 c. 22
; Sup. Ct. Order, 67 Wis. 2d 585, 776 (1975); 1975 c. 223
; 1977 c. 339
; 1979 c. 89
; 1979 c. 102
, 236 (22)
; 1979 c. 177
; 1981 c. 38
; 1983 a. 120
; 1985 a. 29
; 1987 a. 167
; 1989 a. 23
; 1989 a. 187
; 1993 a. 201
; 1995 a. 225
; 1999 a. 30
; 2001 a. 65
; 2003 a. 261
; 2007 a. 170
; 2009 a. 28
; 2013 a. 271
; 2019 a. 66
See also ss. Ins 3.13
, and 3.23
, Wis. adm. code.
“Insurance" is not defined by sub. (25). Under s. 600.02 (2), statements that a term `includes' or `excludes' something else are not definitions. “Insurance" has a commonly understood meaning of being a contract that shifts the risk of loss in exchange for premiums. Sub. (25) was not unconstitutionally vague as applied to the facts of this case, nor was the use of the term “insurance" in other applicable sections of chs. 600 and 601. National Motorists Association v. Office of the Commissioner of Insurance, 2002 WI App 308
, 259 Wis. 2d 240
, 655 N.W.2d 179
Unless otherwise provided, chs. 600
shall be liberally construed to achieve the purposes stated therein. Unless expressly provided otherwise or clearly appearing from the context the purposes stated shall constitute an aid and guide to interpretation but not an independent source of power.
If a provision of chs. 600
conflicts with another statutory provision, the provision of chs. 600
Orders relaxing restrictions. 600.13(1)(1)
After notice under sub. (2)
and a hearing, the commissioner may issue an order freeing a person from any requirement of chs. 600
otherwise applicable to the person if the commissioner finds that the interests of residents, as defined in s. 647.01 (11)
, insureds, creditors and the public will not be endangered thereby.
Unless the order is issued under specific authorization of another section of chs. 600
, the notice preceding the hearing under sub. (1)
and any such order shall be published as a class 1 notice, under ch. 985
, in the official state newspaper before it is effective.