Wisconsin Statutes & Annotations
Chapter 609 - Defined network plans.
609.03 - Indication of operations.

609.03 Indication of operations.
(1) Certificate of authority. An insurer may apply to the commissioner for a new or amended certificate of authority that limits the insurer to engaging in only the types of insurance business described in sub. (3).
(2) Statement of operations. If an insurer is a cooperative association organized under ss. 185.981 to 185.985, the insurer may apply to the commissioner for a statement of operations that limits the insurer to engaging in only the types of insurance business described in sub. (3).
(3) Restrictions on operations.
(a) An insurer that has a new or amended certificate of authority under sub. (1) or a statement of operations under sub. (2) may engage in only the following types of insurance business:
1. As a health maintenance organization.
2. As a limited service health organization.
3. In other insurance business that is immaterial in relation to, or incidental to, the insurer's business under subd. 1. or 2.
(b) The commissioner may, by rule, define “immaterial" or “incidental", or both, for purposes of par. (a) 3. as a percentage of premiums, except the percentage may not exceed 10 percent of the total premiums written by the insurer.
(4) Removing restrictions. An amendment to a certificate of authority or statement of operations that removes the limitation imposed under this section is not effective unless the insurer, on the effective date of the amendment, complies with the capital, surplus and other requirements applicable to the insurer under chs. 600 to 645.
History: 1989 a. 23.

Structure Wisconsin Statutes & Annotations

Wisconsin Statutes & Annotations

Chapter 609 - Defined network plans.

609.001 - Joint ventures; legislative findings.

609.01 - Definitions.

609.03 - Indication of operations.

609.05 - Primary provider and referrals.

609.10 - Standard plan and point-of-service option plan required.

609.17 - Reports of disciplinary action.

609.20 - Rules for preferred provider and defined network plans.

609.205 - Public health emergency for COVID-19.

609.22 - Access standards.

609.24 - Continuity of care.

609.30 - Provider disclosures.

609.32 - Quality assurance.

609.34 - Clinical decision-making; medical director.

609.35 - Applicability of requirements to preferred provider plans.

609.36 - Data systems and confidentiality.

609.38 - Oversight.

609.60 - Optometric coverage.

609.65 - Coverage for court-ordered services for the mentally ill.

609.655 - Coverage of certain services provided to dependent students.

609.70 - Chiropractic coverage.

609.71 - Disclosure of payments.

609.715 - Coverage of alcoholism and other diseases.

609.717 - Mental health services provided by a recovery charter school.

609.75 - Adopted children coverage.

609.755 - Coverage of dependents.

609.76 - Coverage of student on medical leave.

609.77 - Coverage of breast reconstruction.

609.78 - Coverage of treatment for the correction of temporomandibular disorders.

609.79 - Coverage of hospital and ambulatory surgery center charges and anesthetics for dental care.

609.80 - Coverage of mammograms.

609.805 - Coverage of contraceptives.

609.81 - Coverage related to HIV infection.

609.82 - Coverage without prior authorization for emergency medical condition treatment.

609.83 - Coverage of drugs and devices.

609.837 - Copayment equality for oral and injected chemotherapy.

609.84 - Experimental treatment.

609.846 - Discrimination based on COVID-19 prohibited.

609.85 - Coverage of lead screening.

609.86 - Coverage of hearing aids, cochlear implants, and related treatment for infants and children.

609.87 - Coverage of treatment for autism spectrum disorders.

609.875 - Coverage of colorectal cancer screening.

609.88 - Coverage of immunizations.

609.885 - Coverage of COVID-19 testing.

609.89 - Written reason for coverage denial.

609.90 - Restrictions related to domestic abuse.

609.91 - Restrictions on recovering health care costs.

609.92 - Hospitals, individual practice associations and providers of physician services.

609.925 - Election to be subject to restrictions.

609.93 - Scope of election by an individual practice association or clinic.

609.935 - Notices of election and termination.

609.94 - Summary of restrictions.

609.95 - Minimum covered liabilities.

609.96 - Initial capital and surplus requirements.

609.97 - Compulsory and security surplus.

609.98 - Special deposit.