632.797 Disclosure of group health claims experience.
(1)
(a) Except as provided in subs. (2) and (3), an insurer shall provide the policyholder of a group or blanket disability insurance policy, or an employer that provides health care coverage to its employees through a multiple-employer trust, with the policyholder's or the employer's aggregate group health claims experience for the current policy period, and for up to 2 policy periods immediately preceding the current policy period if the insurer provided coverage during those periods, upon request from the policyholder or employer.
(b) The insurer shall provide the information under par. (a) no later than 30 days after receiving a request for that information from the policyholder or employer.
(c) The insurer may not charge the policyholder or the employer for providing the information under par. (a) one time in a 12-month period.
(d) Except for charging a fee under par. (c), an insurer may not change the rating methodology between community rating and experience rating or otherwise penalize a policyholder or employer for requesting the information under par. (a).
(2) An insurer is not required to provide the information under sub. (1) unless the policyholder or employer requesting the information provides coverage under the policy for at least 50 individuals, exclusive of individuals who have coverage under the policy as a dependent of another individual.
(3) Notwithstanding sub. (1), an insurer is not required to provide health claims experience under sub. (1) for any period of time that is before 18 months before the date on which the information is requested.
(4) Subsection (1) does not require that an insurer provide the policyholder of a group or blanket disability insurance policy, or an employer that provides health care coverage to its employees through a multiple-employer trust, with the health claims experience of an individual employee or insured.
(5) An insurer is not required under sub. (1) to provide information that identifies an individual or that is confidential under s. 146.82.
(6) An insurer that provides aggregate health claims experience information in compliance with this section is immune from civil liability for its acts or omissions in providing such information.
History: 1993 a. 448; 2011 a. 32.
Structure Wisconsin Statutes & Annotations
Wisconsin Statutes & Annotations
Chapter 632 - Insurance contracts in specific lines.
632.07 - Prohibiting requiring property insurance in excess of replacement value.
632.10 - Definitions applicable to property insurance escrow.
632.102 - Payment of final settlement.
632.103 - Procedure for payment of withheld funds.
632.104 - Funds released to mortgagee.
632.14 - Bonds need not be under seal.
632.17 - Validity of surety bonds.
632.18 - Rustproofing warranties insurance.
632.185 - Vehicle protection product warranty insurance policy.
632.22 - Required provisions of liability insurance policies.
632.23 - Prohibited exclusions in aircraft insurance policies.
632.24 - Direct action against insurer.
632.25 - Limited effect of conditions in employer's liability policies.
632.32 - Provisions of motor vehicle insurance policies.
632.34 - Defense of noncooperation.
632.35 - Prohibited rejection, cancellation and nonrenewal.
632.36 - Accident in the course of business or employment.
632.365 - Use of emission inspection data in setting rates.
632.37 - Motor vehicle glass repair practices; restriction on specifying vendor.
632.375 - Motor vehicle repair practices; restriction on specifying vendor.
632.38 - Nonoriginal manufacturer replacement parts.
632.41 - Prohibited provisions in life insurance.
632.42 - Trustee and deposit agreements in life insurance.
632.43 - Standard nonforfeiture law for life insurance.
632.435 - Standard nonforfeiture law for individual deferred annuities.
632.44 - Required provisions in life insurance.
632.45 - Contracts providing variable benefits.
632.46 - Incontestability and misstated age.
632.47 - Assignment of life insurance rights.
632.475 - Life insurance policy loans.
632.48 - Designation of beneficiary.
632.50 - Estoppel from medical examination.
632.56 - Required group life insurance provisions.
632.57 - Conversion option in group and franchise life insurance.
632.60 - Limitation on credit life insurance.
632.62 - Participating and nonparticipating policies.
632.63 - Unclaimed life insurance and annuities.
632.64 - Certification of disability.
632.65 - Annuities exempt from regulation.
632.66 - Annuity contracts without life contingencies.
632.67 - Effect of power of attorney for health care.
632.695 - Applicability of general transfers at death provisions.
632.697 - Benefits subject to department's right to recover.
632.71 - Estoppel from medical examination, assignability and change of beneficiary.
632.715 - Reports of action against health care provider.
632.72 - Medical benefits or assistance; assignment.
632.725 - Standardization of health care billing and insurance claim forms.
632.726 - Current procedural terminology code changes.
632.729 - Prohibiting discrimination based on COVID-19.
632.73 - Right to return policy.
632.74 - Reinstatement of individual or franchise disability insurance policies.
632.745 - Coverage requirements for group and individual health benefit plans; definitions.
632.746 - Preexisting condition; portability; restrictions; and special enrollment periods.
632.747 - Guaranteed acceptance.
632.748 - Prohibiting discrimination.
632.749 - Contract termination and renewability.
632.7495 - Guaranteed renewability of individual health insurance coverage.
632.7497 - Modifications at renewal.
632.75 - Prohibited provisions for disability insurance.
632.755 - Public assistance and early intervention services.
632.76 - Incontestability for disability insurance.
632.77 - Permitted provisions for disability insurance policies.
632.775 - Effect of power of attorney for health care.
632.78 - Required grace period for disability insurance policies.
632.793 - Notice of loss of primary insurance coverage due to age.
632.795 - Open enrollment upon liquidation.
632.797 - Disclosure of group health claims experience.
632.798 - Out-of-pocket costs.
632.80 - Restrictions on medical payments insurance.
632.81 - Minimum standards for certain disability policies.
632.82 - Renewability of long-term care insurance policies.
632.825 - Midterm termination of long-term care insurance policy by insured.
632.83 - Internal grievance procedure.
632.835 - Independent review of coverage denial determinations.
632.84 - Benefit appeals under certain policies.
632.845 - Prohibiting refusal to cover services because liability policy may cover.
632.85 - Coverage without prior authorization for treatment of an emergency medical condition.
632.853 - Coverage of drugs and devices.
632.855 - Requirements if experimental treatment limited.
632.857 - Explanation required for restriction or termination of coverage.
632.861 - Prescription drug charges.
632.865 - Pharmacy benefit managers.
632.866 - Step therapy protocols.
632.867 - Oral and injected chemotherapy.
632.87 - Restrictions on health care services.
632.873 - Restrictions relating to fees for dental services.
632.875 - Independent evaluations relating to chiropractic treatment.
632.88 - Policy extension for handicapped children.
632.885 - Coverage of dependents.
632.89 - Coverage of mental disorders, alcoholism, and other diseases.
632.896 - Mandatory coverage of adopted children.
632.897 - Hospital and medical coverage for persons insured under individual and group policies.
632.8985 - Prohibiting abortion coverage.
632.899 - Medical savings accounts study.
632.93 - The fraternal contract.
632.95 - Fraud in obtaining membership.
632.96 - Beneficiaries in fraternal contracts.
632.97 - Application of proceeds of credit insurance policy.
632.975 - Portable electronics insurance.