AB 540

Current law specifies how an insurer that is domiciled in another state (a

foreign insurer) may transact an insurance business in this state. If the insurer

satisfies certain specified requirements, the insurer will be issued a certificate of

authority and may offer insurance policies in this state. Generally, unless a specific

exemption applies, a foreign insurer that provides insurance coverage to a person or

entity in this state is subject to the insurance laws and other requirements of this

state.

This bill provides that a foreign insurer may offer health care plans to groups

and individuals in this state. Both the insurer and the health care plans offered are

exempt from all insurance laws and requirements of this state except for certain

specified ones. To be able to offer these health care plans, a foreign insurer must be

in compliance with all the laws and regulations of the insurer's domiciliary state that

apply to the insurer, must have been issued a certificate of authority by this state to

transact an insurance business in this state, must be in compliance with the laws and

requirements of this state that do apply to the insurer, and must offer coverage in its

domiciliary state under any health care plan that it intends to offer in this state and

that health care plan must be in compliance with the laws and regulations of the

insurer's domiciliary state. If there is a conflict between a law of the insurer's

domiciliary state and a law of this state that applies to the insurer or the health care

plan, the law of this state takes precedence unless the Commissioner of Insurance

(commissioner) exempts the insurer from this state's law.

A foreign insurer offering health care plans under the bill would be subject to

the taxation requirements in this state that apply to insurers in general and would

be required to pay the assessments that health insurers pay to help fund the Health

Insurance Risk-Sharing Plan (HIRSP). Wisconsin statutes and any administrative

rules promulgated under those statutes that specifically apply to the foreign insurer

and health care plans offered by the insurer include: requirements relating to the

disclosure of personal medical information; prohibitions on various unfair marketing

practices; requiring insurers to provide notice of an insured's right to file a complaint

with the Office of the Commissioner of Insurance; prohibitions on certain actions

relating to whether an applicant or insured has obtained a test, and what the results

were, for the presence of human immunodeficiency virus (HIV); preexisting

condition, portability, and contract renewability requirements and discrimination

prohibitions that apply to employer group health care plans under the federal Health

Insurance Portability and Accountability Act of 1996; contract renewability

requirements for individual health insurance policies; and prohibitions on a health

care plan from refusing to cover the services of certain health care professionals if

the health care plan covers the same services when provided by a different type of

health care professional. Every application for, and policy of, a health care plan

offered by a foreign insurer must include plain language disclosing: 1) the