If the moneys credited to s. 20.145 (1) (g) 1.
under other sections of the statutes prove inadequate for the office's supervision of insurance industry program, the commissioner may increase any or all of the fees imposed by s. 601.31
, or may in any year levy a special assessment on all domestic insurers, or both, for the general operation of that program.
Any special assessment shall be in addition to all other taxes, fees, dues and charges and shall not exceed for any such company a maximum of 25 cents per $1,000 of gross premiums received by it during the preceding calendar year on direct insurance in this state, less returned premiums and cancellations.
Any assessment made by the commissioner which is less than the maximum shall be prorated among said companies in the same proportion as if it were a maximum assessment. Any such assessment shall be paid to the commissioner on or before July 31 of each year.
The commissioner may omit the levy of any assessment which would be smaller than the cost of processing and collecting it.
Exemption from taxation.
Municipal insurance mutuals organized under s. 611.11 (4)
are not subject to any taxes or fees except those imposed by ss. 601.31
History: 1977 c. 346
POWERS AND DUTIES OF COMMISSIONER
General duties and powers. 601.41(2)
The commissioner shall have all powers specifically granted to the commissioner, or reasonably implied in order to enable the commissioner to perform the duties imposed by sub. (1)
The commissioner may, without the consent of the attorney general as required under s. 227.21 (2)
, adopt standards of the National Association of Insurance Commissioners by incorporating by reference in rules promulgated by the commissioner any materials published, adopted, or approved by the National Association of Insurance Commissioners, without reproducing the standards in full. The standards referred to in this paragraph do not include any model act or model regulation proposed or adopted by the National Association of Insurance Commissioners. Any materials of the National Association of Insurance Commissioners that are incorporated by reference in rules promulgated by the commissioner shall be obtainable from, and are only required to be kept on file at, the office, which shall be stated in any rule containing such an incorporation by reference. Nothing in this paragraph prohibits the commissioner from adopting standards of the National Association of Insurance Commissioners through incorporation by reference in rules in the manner provided under s. 227.21 (2)
The commissioner shall issue such prohibitory, mandatory, and other orders as are necessary to secure compliance with the law. An order requiring remedial measures or restitution may include any of the following:
Remedial measures or restitution to enforce s. 611.72
or ch. 617
, including seizure or sequestering of voting securities of an insurer owned directly or indirectly by a person who has acquired or who is proposing to acquire voting securities in violation of s. 611.72
or ch. 617
On request of any person who would be affected by an order under par. (a)
, the commissioner may issue a declaratory order to clarify the person's rights or duties.
(5) Informal hearings and public meetings.
The commissioner may at any time hold informal hearings and public meetings, whether or not called hearings, for the purposes of investigation, the ascertainment of public sentiment, or informing the public. No effective rule or order may result from the hearing unless the requirements of ch. 227
(6) Regulation of risk retention groups and risk purchasing groups. 601.41(6)(a)(a)
The commissioner may by rule regulate the condition and conduct of risk retention groups and risk purchasing groups doing business in this state. The commissioner may by order prohibit a risk retention group or risk purchasing group from doing business in this state.
The regulation of risk retention groups and risk purchasing groups under ss. 601.72
is in addition to any other provisions of chs. 600
which apply to risk retention groups or risk purchasing groups and does not authorize a risk retention group or risk purchasing group to do an insurance business except as permitted under chs. 600
(7) Information and technical assistance to employees and former employees who lose health care coverage.
The commissioner shall provide to employees and former employees who lose health care coverage under a group health insurance plan or self-insured health plan information and technical assistance regarding all of the following:
Any rights that the individuals may have under state or federal laws affecting health benefit plans, including laws that relate to portability or continuation coverage or conversion coverage under s. 632.897
The availability of individual health benefit plans in the area in which the individual resides.
(8) Uniform employee application form. 601.41(8)(b)
In consultation with the appropriate advisory council or committee designated by the commissioner, the commissioner shall by rule develop a uniform employee application form that a small employer insurer must use when a small employer applies for coverage under a group health benefit plan offered by the small employer insurer. The commissioner shall revise the form at least every 2 years.
If the federal government has not developed by July 1, 2003, a uniform claim processing form that must be used by all health care providers for submitting claims to insurers and by all insurers for processing claims submitted by health care providers, the commissioner shall develop, by December 31, 2003, a uniform claim processing form for that purpose.
(10) Uniform application for individual health insurance policies. 601.41(10)(a)(a)
The commissioner shall by rule prescribe uniform questions and the format for applications, which may not exceed 10 pages in length, for individual major medical health insurance policies.
After the effective date of the rules promulgated under par. (a)
, an insurer may use only the prescribed questions and format for individual major medical health insurance policy applications. The commissioner shall publish a notice in the Wisconsin Administrative Register that states the effective date of the rules promulgated under par. (a)
For purposes of this subsection, an individual major medical health insurance policy includes health coverage provided on an individual basis through an association.
“Instruction" means education, training, instruction, or other experience related to an occupation or profession.
“License" means a license, certificate, or permit issued by the commissioner under chs. 601
for an occupation or profession.
In connection with the issuance of a license, the commissioner shall count any relevant instruction that an applicant for a license has obtained in connection with military service, as defined in s. 111.32 (12g)
, toward satisfying any requirements for instruction for that license, if the applicant demonstrates to the satisfaction of the commissioner that the instruction obtained by the applicant is substantially equivalent to the instruction required for the license.
See also Ins
, Wis. adm. code.
Sub. (4) gives the commissioner the authority to issue not only prohibitory and mandatory orders, but also other orders as are necessary to secure compliance with the law. There is no limitation on the nature of the other orders except that they be necessary to secure compliance with the law. Sub. (4) permitted the order of refunds when the commissioner determined that a company violated the law by selling its contracts without a certificate of authority. Homeward Bound Services, Inc. v. Office of the Insurance Commissioner, 2006 WI App 208
, 296 Wis. 2d 481
, 724 N.W. 2d 380
Why process consumer complaints? A case study of the office of the commissioner of insurance of Wisconsin. Whitford, Kimball, 1974 WLR 639.
The duties listed in this section are in addition to other duties imposed under chs. 600
. Failure to list a specified power, duty or function of the commissioner in this section does not affect the validity of the power, duty or function.
(1) Joint survey committee on retirement systems.
The commissioner or an experienced actuary in the office designated by the commissioner shall serve as a member of the joint survey committee on retirement systems under s. 13.50
(2) Group insurance board.
The commissioner shall serve as a member of the group insurance board under s. 15.165 (2)
(3) Wisconsin retirement board.
The commissioner or an experienced actuary in the office designated by the commissioner shall serve as a member of the Wisconsin retirement board under s. 15.165 (3) (b)
(5) Cooperation with department of administration.
The commissioner shall cooperate with the department of administration in placing insurance under s. 16.865 (4)
(7) Determination of variable interest rate adjustments.
The commissioner shall approve indexes for variable interest rate adjustments under s. 138.055 (4) (c)
(8) Long-Term Care Partnership Program.
The commissioner shall provide the certifications required under s. 49.45 (31) (b) 5.
and shall cooperate with the department of health services in approving the training program under s. 49.45 (31) (c)
for agents who sell long-term care insurance policies.
(9) Consumer credit law.
The commissioner shall cooperate with the division of banking in the administration of ch. 424
, shall determine the method for computation of refunds under s. 424.205
, shall approve forms, schedules of premium rates and charges under s. 424.209
and shall issue rules or orders of compliance to insurers under s. 424.602
(10) Petroleum product storage remedial action program rules.
The commissioner shall promulgate the rules required under s. 292.63 (1m)
(11) Amendments to Own Risk and Solvency Assessment Guidance Manual.
The commissioner shall, in his or her discretion, adopt amendments made after April 18, 2014, by the National Association of Insurance Commissioners to the guidance manual, as defined in s. 622.03 (1)
. Any such amendments made by the National Association of Insurance Commissioners become effective in this state if adopted by the commissioner by order after giving 30 days' notice to insurers of the changes proposed by the National Association of Insurance Commissioners. If one or more insurers request a hearing on the proposed changes during the 30-day period, the commissioner shall hold a hearing to determine whether the commissioner will, in his or her discretion, adopt one or more of the changes made by the National Association of Insurance Commissioners.
(13) Membership in the National Conference of Insurance Legislators.
Annually, from the appropriation account under s. 20.145 (1) (g)
, the commissioner shall credit to the appropriation account under s. 20.765 (3) (g)
an amount sufficient for the payment of annual dues by the legislature for membership in the National Conference of Insurance Legislators.
Reports and replies. 601.42(1g)(1g)
The commissioner may require any of the following from any person subject to regulation under chs. 600
Statements, reports, answers to questionnaires and other information, and evidence thereof, in whatever reasonable form the commissioner designates, and at such reasonable intervals as the commissioner chooses, or from time to time.
Full explanation of the programming of any data storage or communication system in use.
That information from any books, records, electronic data processing systems, computers or any other information storage system be made available to the commissioner at any reasonable time and in any reasonable manner.
Statements, reports, answers to questionnaires or other information, or reports, audits or certification from a certified public accountant or an actuary approved by the commissioner, relating to the extent liabilities of a health maintenance organization insurer are or will be liabilities for health care costs for which an enrollee or policyholder of the health maintenance organization is not liable to any person under s. 609.91
(1r) Reports by individual practice associations.
The commissioner may by rule require that an individual practice association submit to the commissioner information reasonably necessary to determine the financial condition of the individual practice association. The information required under this subsection may include, but is not limited to, financial statements of the individual practice association, except the commissioner may not require members of the individual practice association or other health care providers who contract with the individual practice association to submit individual financial statements.
The commissioner may prescribe forms for the reports under subs. (1g)
and specify who shall execute or certify such reports. The forms for the reports required under sub. (1g)
shall be consistent, so far as practicable, with those prescribed by other jurisdictions.
(3) Accounting methods.
The commissioner may prescribe reasonable minimum standards and techniques of accounting and data handling to ensure that timely and reliable information will exist and will be available to the commissioner.
Any officer, manager or general agent of any insurer authorized to do or doing an insurance business in this state, any person controlling or having a contract under which the person has a right to control such an insurer, whether exclusively or otherwise, any person with executive authority over or in charge of any segment of such an insurer's affairs, any individual practice association or officer, director or manager of an individual practice association, any insurance agent or other person licensed under chs. 600
, any provider of services under a continuing care contract, as defined in s. 647.01 (2)
, any independent review organization certified or recertified under s. 632.835 (4)
or any health care provider, as defined in s. 655.001 (8)
, shall reply promptly in writing or in other designated form, to any written inquiry from the commissioner requesting a reply.
The commissioner may require that any communication made to the commissioner under this section be verified.
In the absence of actual malice, no communication to the commissioner required by law or by the commissioner shall subject the person making it to an action for damages for defamation. This paragraph applies to communications received by the commissioner before May 11, 1990, or on or after June 1, 1994.
In the absence of actual malice, no communication to the commissioner or office required by law or by the commissioner shall subject the person making it to an action for damages for the communication. This paragraph applies to communications received by the commissioner or office on or after May 11, 1990, and before June 1, 1994.
The commissioner may employ experts to assist the commissioner in an examination or in the review of any transaction subject to approval under chs. 600
. The person that is the subject of the examination, or that is a party to a transaction under review, including the person acquiring, controlling or attempting to acquire the insurer, shall pay the reasonable costs incurred by the commissioner for the expert and related expenses.
See also s. 623.02
as to standards for accounting rules.
See also ss. Ins 6.61
, and 6.63
, Wis. adm. code.
Social and financial impact reports. 601.423(1)(1)
In this section, “health insurance mandate" means a statute of this state that does any of the following:
Requires an insurance policy, plan, or contract to do any of the following:
Permit a person insured under the policy, plan or contract to obtain treatment or services from a particular type of health care provider, including, but not limited to, requiring a health maintenance organization, preferred provider plan, limited service health organization or other plan to select a particular type of health care provider for participation in the plan.
Provide coverage for the treatment of a particular disease, condition or other health care need.
Provide coverage of a particular type of health care treatment or service, or of equipment, supplies or drugs used in connection with a health care treatment or service.
Provide coverage for particular persons because of their relation to the insured or legal status with respect to the insured, or for any other reason.
Requires a particular benefit design or imposes conditions on cost sharing under an insurance policy, plan, or contract for the treatment of a particular disease, condition, or other health care need, for a particular type of health care treatment or service, or for the provision of equipment, supplies, or drugs used in connection with a health care treatment or service.
Imposes limits or conditions on a contract between an insurer and a health care provider, as defined in s. 146.81 (1)