The commissioner shall calculate a reinsurance payment with respect to each eligible health carrier's incurred claims costs for an enrolled individual's covered benefits in the applicable benefit year. If the claims costs for an enrolled individual do not exceed the attachment point set under sub. (2)
, the commissioner may not make a reinsurance payment with respect to that enrollee. If the claims costs for an enrolled individual exceed the attachment point, subject to par. (b)
, the commissioner shall make a reinsurance payment that is calculated as the product of the coinsurance rate and whichever of the following is less:
The commissioner shall ensure that any reinsurance payment made to an eligible health carrier does not exceed the total amount paid by the eligible health carrier for any claim. For purposes of this paragraph, the total amount paid of a claim is the amount paid by the eligible health carrier based upon the allowed amount less any deductible, coinsurance, or copayment paid by another person as of the time the data are submitted or made accessible under sub. (5) (c)
An eligible health carrier may request reinsurance payments from the commissioner when the eligible health carrier meets the requirements of this subsection and sub. (4)
An eligible health carrier shall make any requests for a reinsurance payment in accordance with any requirements established by the commissioner.
Each eligible health carrier shall provide the commissioner with access to the data within the dedicated data environment established by the eligible health carrier under the federal risk adjustment program under 42 USC 18063
. Each eligible health carrier shall submit to the commissioner attesting to compliance with the dedicated data environments, data requirements, establishment and usage of masked enrollee identification numbers, and data submission deadlines.
Each eligible health carrier shall provide the access under par. (c)
for each applicable benefit year by April 30 of the calendar year following the end of the applicable benefit year.
Each eligible health carrier shall maintain for at least 6 years documents and records, by paper, electronic, or other media, sufficient to substantiate a request for a reinsurance payment made under this section. An eligible health carrier shall make the documents and records available to the commissioner, upon request, for purposes of verification, investigation, audit, or other review of a reinsurance payment request.
The commissioner may have an eligible health carrier audited to assess the health carrier's compliance with the requirements of this section. The eligible health carrier shall ensure that its contractors, subcontractors, or agents cooperate with any audit under this paragraph. Within 30 days of receiving notice that an audit results in a proposed finding of material weakness or significant deficiency with respect to compliance with any requirement of this section, the eligible health carrier may provide a response to the proposed finding. Within 60 days of the issuance of a final audit report that includes a finding of material weakness or significant deficiency, the eligible health carrier shall do all of the following:
Provide a written corrective action plan to the commissioner for approval.
Implement the corrective action plan under subd. 1.
as approved by the commissioner.
Provide the commissioner with written documentation of the corrective action after implementation.
The commissioner may recover from an eligible health carrier any overpayment of reinsurance payments as determined under the audit under par. (f)
A health carrier is not eligible to receive a reinsurance payment unless the health carrier agrees not to bring a lawsuit against the commissioner or a state agency or employee over any delay in reinsurance payments or any reduction in reinsurance payments in accordance with sub. (3) (c)
Access to information.
Information submitted by an eligible health carrier or obtained by the commissioner for purposes of the healthcare stability plan shall be used only for purposes of this subchapter and is proprietary and confidential under s. 601.465
History: 2017 a. 138
Accounting, reports, and audits. 601.85(1)(1)
The commissioner shall keep an accounting for each benefit year of all of the following:
Funds appropriated for reinsurance payments and administrative and operational expenses.
Requests for reinsurance payments received from eligible health carriers.
Reinsurance payments made to eligible health carriers.
Administrative and operational expenses incurred for the healthcare stability plan.
By November 1 of the calendar year following the applicable benefit year or by 60 days following the final disbursement of reinsurance payments for the applicable benefit year, whichever is later, the commissioner shall make available to the public a report summarizing the healthcare stability plan's operations for each benefit year by posting the summary on the office's Internet site.
The healthcare stability plan is subject to audit by the legislative audit bureau. The commissioner shall ensure that its contractors, subcontractors, or agents cooperate with any audit of the healthcare stability plan performed by the legislative audit bureau.
History: 2017 a. 138
FIRE DEPARTMENT DUES
Payment of dues. 601.93(1g)(1g)
In this section, “fire insurance" includes insurance against loss of or damage to:
Notes, acceptances or any other valuable papers or documents, resulting from any cause, except while in the mail or in the custody or possession of and being transported by any carrier for hire; and
Personal property of individuals when written under an all-risk type of policy commonly known as the “personal property floater", whenever these risks are written in conjunction with insurance against burglary or theft.
Any insurer doing a fire insurance business in this state shall pay fire department dues equal to 2 percent of the amount of all premiums which, during the preceding calendar year, have been received by, or have been agreed to be paid to, the company for insurance against loss by fire, including insurance on property exempt from taxation.
Every insurer doing a fire insurance business in this state shall, before March 1 in each year, file with the commissioner a statement, showing the amount of premiums upon fire insurance due for the preceding calendar year. Return premiums may be deducted in determining the premium on which the fire department dues are computed. Payments of quarterly installments of the total estimated payment for the then current calendar year under this subsection are due on or before April 15, June 15, September 15 and December 15. On March 1 the insurer shall pay any additional amounts due for the preceding calendar year. Overpayments will be credited on the amount due April 15. The commissioner shall, prior to May 1 each year, report to the department of safety and professional services the amount of dues paid under this subsection and to be paid under s. 101.573 (1)
An insurer that fails to make quarterly payments under s. 601.93 (2)
of at least 25 percent of either the total fire dues paid for the previous calendar year or 80 percent of the actual fire dues for the current calendar year is liable, in addition to the amount due, for interest of 1.5 percent of the amount due and unpaid for each month or part of a month that the amount due, together with any interest, remains unpaid.
An insurer that fails to pay an amount due, or file a statement required, under s. 601.93 (2)
, unless the insurer shows that the failure is due to reasonable cause and not due to willful neglect, is liable for the greater of the following amounts:
Five percent of the amount due for each month or fraction of a month during which the failure continues, but not more than 25 percent of the amount due.
History: 1987 a. 166