631.20(1)

(1) Filing.

631.20(2)(b)

(b) That it provides benefits or contains other provisions that endanger the solidity of the insurer;

631.20(2)(a)4.

4. Is misleading, deceptive or obscure because of such physical aspects as format, typography, style, color, material or organization;

631.20(1)(c)5.

5. A form filed under ch. 149.

631.20(1)(c)7.

7. A form that includes an appraisal or arbitration provision not specifically authorized by rule. The entire form, including the appraisal or arbitration provision, is subject to para. (a).

631.20(1)(c)8.

8. A form that contains a clause subject to § 631.21, but only as to the clause.

631.20(2)(d)

(d) That it violates a statute or a rule promulgated by the commissioner, or is otherwise contrary to law.

631.20(2)(f)4.

4. It is inconsistent with the purpose of providing health care coverage to those unable to obtain coverage in the private market.

631.20(6)

(6) Form that violates statute or rule.

631.20(1)(a)

(a) No form subject to § 631.01 (1), except as exempted under para. (c), sub. (1g), or § 631.01 (2) to (5) or by rule under para. (b), may be used unless it has been filed with and approved by the commissioner and unless the insurer certifies that the form complies with chs. 600 to 655 and rules promulgated under chs. 600 to 655. It is deemed approved if it is not disapproved within 30 days after filing, or within a 30-day extension of that period ordered by the commissioner prior to the expiration of the first 30 days.

631.20(1)(b)

(b) Subject to § 655.24 (1), the commissioner may by rule exempt certain classes of policy forms from prior filing and approval.

631.20(1)(c)

(c) Subject to sub. (1m), a form first used and not already filed under para. (a) on or after August 1, 2008, is exempt from para. (a) except for any of the following:

631.20(1)(c)1.

1. A form subject to § 655.24 (1).

631.20(1)(c)2.

2. A form for a worker’s compensation policy.

631.20(1)(c)3.

3. A form for a Medicare replacement policy or a Medicare supplement policy.

631.20(1)(c)4.

4. A form for a long-term care insurance policy, including a form for a nursing home or home health care policy.

631.20(1)(c)10.

10. A warranty contract form.

631.20(1m)

(1m) Use of certain forms.

631.20(1)(c)6.

6. A form issued by an insurer ordered by the commissioner under § 601.41 (4) to file forms under para. (a). The commissioner may require an insurer to file forms under para. (a) to secure compliance with the law, including if the commissioner determines that the insurer violated sub. (1m).

631.20(1)(c)9.

9. A form subject to § 618.41 (6m).

631.20(1)(c)11.

11. A form required to be filed under para. (a) by a rule promulgated by the commissioner.

631.20(1g)

(1g) Exempt if approved by commission. A form for a product, as defined in § 601.58 (2)(k), that is approved by or self-certified to, and not disapproved by, the Interstate Insurance Product Regulation Commission is exempt from subs. (1) (a) and (1m) (a), unless otherwise provided by a rule promulgated by the commissioner under § 601.58.

631.20(2)(c)

(c) That in the case of the policy, though not of riders and endorsements, it fails to provide the exact name of the insurer and the full address of its home office; or

631.20(2)(e)

(e) That its use would violate § 631.22.

631.20(2)(f)

(f) In the case of a policy form under ch. 149, that any of the following applies:

631.20(2)(f)1.

1. The benefit design is not comparable to a typical comprehensive individual health insurance policy offered in the private sector market in this state.

631.20(1m)(a)

(a) Except as exempted under sub. (1g) or § 631.01 (2) to (5) or by a rule promulgated by the commissioner, an insurer may not, on or after August 1, 2008, use a form that is exempt from sub. (a) under sub. (c) unless the insurer does all of the following:

631.20(1m)(a)1.

1. Files the form with the commissioner 30 days before its use.

631.20(1m)(a)2.

2. Files the form in the manner and format, and with the attachments, prescribed by the commissioner.

631.20(1m)(a)3.

3. Certifies as required under par. (b) that the form complies with chs. 600 to 655 and rules promulgated under chs. 600 to 655. The commissioner may require an insurer to include specific compliance certifications.

631.20(1m)(b)

(b) An insurer shall provide the certification under par. (a) 3. in the form prescribed by the commissioner. The certification shall be executed by a person who is an officer of the insurer and who is responsible for the form that is the subject of the filing. No insurer may file, and no insurer’s officer may execute, a false certification.

631.20(2)

(2) Grounds for disapproval. The commissioner may disapprove a form under sub. (a) or (3) upon a finding:

631.20(2)(a)

(a) That it is inequitable, unfairly discriminatory, misleading, deceptive, obscure or encourages misrepresentation, including cases where the form:

631.20(2)(a)1.

1. Is misleading because its benefits are too restricted to achieve the purposes for which the policy is sold;

631.20(2)(a)2.

2. Contains provisions whose natural consequence is to obscure or lessen competition;

631.20(2)(a)3.

3. Is unnecessarily verbose or complex in language; or

631.20(2)(f)2.

2. The benefit levels are not generally reflective of and commensurate with comprehensive health insurance coverage offered in the private individual market in the state.

631.20(2)(f)3.

3. The copayments, deductibles, and coinsurance are not actuarially equivalent to comprehensive individual plans and would create undue financial hardship.

631.20(3)

(3) Subsequent disapproval. Whenever the commissioner finds, after a hearing, that a form approved or deemed to be approved under sub. (a), a form filed under sub. (1m), or a form subject to subsequent disapproval under § 601.58 (14) should be disapproved under sub. (2), the commissioner may order that on or before a date not less than 30 nor more than 90 days after the order the use of the form shall be discontinued or appropriate changes shall be made.

631.20(4)

(4) Contents of order of disapproval. The commissioner’s disapproval must be in writing and constitutes an order. It must state the reasons for disapproval sufficiently explicitly that the insurer is provided reasonable guidance in reformulating its proposals.

631.20(5)

(5) Explicit approval of certain clauses. General approval of a form under this section, or failure to disapprove, does not constitute approval of clauses specified in § 631.21.

631.20(6)(a)

(a) The penalties under § 601.64 (3) to (5) may not be imposed against an insurer for any of the following:

631.20(6)(a)1.

1. Using a form that does not comply with a statute or rule, including a rule or uniform standard adopted by the Interstate Insurance Product Regulation Commission, if the statute or rule was in effect on the date the form was approved or deemed to be approved under sub. (a) or § 601.58.

631.20(6)(a)2.

2. The use of a form solely based on a finding of the commissioner that the content of the form is misleading under § 628.34 (1).

631.20(6)(b)

(b) An insurer’s use of a form that does not comply with a statute or rule, including a rule or uniform standard adopted by the Interstate Insurance Product Regulation Commission, that takes effect after the date the form was approved or deemed to be approved under sub. (a) or § 601.58 is a violation of the statute or rule, and the penalties under § 601.64 may be imposed against the insurer using the form.

631.20(6)(c)

(c) Except as provided in par. (a) 2., an insurer’s use of a form filed under sub. (1m) that violates chs. 600 to 655 or rules promulgated under chs. 600 to 655 is a violation of the statute or rule, regardless of whether the form has been subsequently disapproved under sub. (3). The insurer is subject to the penalties and remedial orders provided under chs. 600 to 655, including ss. 601.41 (4) and 601.64.