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CHAPTER 633
EMPLOYEE BENEFIT PLAN ADMINISTRATORS, PRINCIPALS,
and Pharmacy benefit managers
633.01   Definitions.
633.04   Written agreement required.
633.05   Payment to administrator.
633.06   Examination and inspection of books and records.
633.07   Approval of advertising.
633.08   Underwriting responsibilities.
633.09   Accounts.
633.10   Payment of claims.
633.11   Claim adjustment compensation.
633.12   Notification required.
633.13   License required.
633.14   Issuance of license.
633.15   License; renewal, suspension, limitation, revocation, penalty.
633.16   Regulation.
633.17   Rule-making authority.
Effective date note NOTE: Ch. 633 (title) is shown as amended eff. 1-1-22 by 2021 Wis. Act 9. Prior to 1-1-22 it reads:
Effective date text EMPLOYEE BENEFIT PLAN ADMINISTRATORS AND PRINCIPALS
Ch. 633 Cross-reference Cross-reference: See definitions in ss. 600.03 and 628.02.
Ch. 633 Cross-reference Cross-reference: See also s. Ins 8.20, Wis. adm. code.
633.01 633.01 Definitions. In this chapter:
633.01(1) (1)“Administrator" means a person who directly or indirectly solicits or collects premiums or charges or otherwise effects coverage or adjusts or settles claims for an employee benefit plan, but does not include the following persons if they perform these acts under the circumstances specified for each:
Effective date note NOTE: Sub. (1) (intro.) is shown as amended eff. 1-1-22 by 2021 Wis. Act 9. Prior to 1-1-22 it reads:
Effective date text (1) “Administrator" means a person who directly or indirectly solicits or collects premiums or charges or otherwise effects coverage or adjusts or settles claims for a plan, but does not include the following persons if they perform these acts under the circumstances specified for each:
633.01(1)(a) (a) An employer on behalf of its employees or the employees of a subsidiary or affiliated employer.
633.01(1)(b) (b) A union on behalf of its members.
633.01(1)(c) (c) A creditor on behalf of its debtor, if to obtain payment, reimbursement or other method of satisfaction from an employee benefit plan for any part of a debt owed to the creditor by the debtor.
Effective date note NOTE: Par. (c) is shown as amended eff. 1-1-22 by 2021 Wis. Act 9. Prior to 1-1-22 it reads:
Effective date text (c) A creditor on behalf of its debtor, if to obtain payment, reimbursement or other method of satisfaction from a plan for any part of a debt owed to the creditor by the debtor.
633.01(1)(d) (d) A financial institution that is subject to supervision or regulation in performing these acts by federal or other state authorities.
633.01(1)(e) (e) A company that issues credit cards and provides advances for, or collects premiums or charges from, its credit card holders, if the company does not adjust or settle claims.
633.01(1)(f) (f) An attorney who adjusts or settles claims in the normal course of practice or employment as an attorney, if the attorney does not collect charges or premiums.
633.01(1)(g) (g) An agent licensed in this state whose activities are limited to the sale of insurance.
633.01(1)(h) (h) An insurer authorized to do an insurance business in this state if the insurer performs these acts in the normal course of its insurance business.
633.01(2) (2)“Employee" means any of the following or a family member or dependent of any of the following:
633.01(2)(a) (a) An active or retired wage or salary earner whose services are or were used by an employer.
633.01(2)(b) (b) A member of a union, trust or association.
633.01(2)(c) (c) A college or university student.
633.01(2)(d) (d) A person receiving continued group coverage under s. 632.897.
633.01(2g) (2g)“Employee benefit plan" means an insured or wholly or partially self-insured employee benefit plan which by means of direct payment, reimbursement or other arrangement provides to one or more employees who are residents of this state benefits or services that include, but are not limited to, benefits for medical, surgical or hospital care, benefits in the event of sickness, accident, disability or death, or benefits in the event of unemployment or retirement.
Effective date note NOTE: Sub. (2g) is shown as renumbered from sub. (4) and amended eff. 1-1-22 by 2021 Wis. Act 9.
633.01(2r) (2r)“Enrollee” has the meaning given in s. 632.861 (1) (b).
Effective date note NOTE: Sub. (2r) is created eff. 1-1-22 by 2021 Wis. Act 9.
633.01(3) (3)“Insured employee" means an employee who is a resident of this state and who is covered under an employee benefit plan.
Effective date note NOTE: Sub. (3) is shown as amended eff. 1-1-22 by 2021 Wis. Act 9. Prior to 1-1-22 it reads:
Effective date text (3) “Insured" means an employee who is a resident of this state and who is covered under a plan.
633.01(4) (4)“Plan" means an insured or wholly or partially self-insured employee benefit plan which by means of direct payment, reimbursement or other arrangement provides to one or more employees who are residents of this state benefits or services that include, but are not limited to, benefits for medical, surgical or hospital care, benefits in the event of sickness, accident, disability or death, or benefits in the event of unemployment or retirement.
Effective date note NOTE: Sub. (4) is renumbered to sub. (2g) and amended eff. 1-1-22 by 2021 Wis. Act 9.
633.01(4g) (4g)“Pharmacy benefit manager” has the meaning given in s. 632.865 (1) (c).
Effective date note NOTE: Sub. (4g) is created eff. 1-1-22 by 2021 Wis. Act 9.
633.01(4r) (4r)“Prescription drug benefit” has the meaning given in s. 632.865 (1) (e).
Effective date note NOTE: Sub. (4r) is created eff. 1-1-22 by 2021 Wis. Act 9.
633.01(5) (5)“Principal" means a person, including an insurer, that uses the services of an administrator to provide an employee benefit plan.
Effective date note NOTE: Sub. (5) is shown as amended eff. 1-1-22 by 2021 Wis. Act 9. Prior to 1-1-22 it reads:
Effective date text (5) “Principal" means a person, including an insurer, that uses the services of an administrator to provide a plan.
633.01(6) (6)“Self-insured health plan" has the meaning given in s. 632.85 (1) (c).
Effective date note NOTE: Sub. (6) is created eff. 1-1-22 by 2021 Wis. Act 9.
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2019-20 Wisconsin Statutes updated through 2021 Wis. Act 79 and through all Supreme Court and Controlled Substances Board Orders filed before and in effect on September 17, 2021. Published and certified under s. 35.18. Changes effective after September 17, 2021, are designated by NOTES. (Published 9-17-21)