Wisconsin Administrative Code
Office of the Commissioner of Insurance
Chapter Ins 6 - General
Section Ins 6.55 - Discrimination based on sex, unfair trade practice
Universal Citation: WI Admin Code ยง Ins 6.55
Current through February 26, 2024
(1) PURPOSE. The purpose of this rule is to eliminate the act of denying benefits or refusing coverage on the basis of sex, to eliminate unfair discrimination in underwriting criteria based on sex, and to eliminate any differences in rates based on sex which cannot be justified by credible supporting information. This rule interprets and implements s. 601.01(3), Stats., and ch. 628, Stats.
(2) DEFINITIONS.
(a) Insurer has the meaning
defined in s.
600.03(27),
Stats., and in addition includes nonprofit service plans or service insurance
corporations.
(b) Contract means
any insurance policy, plan, certificate, subscriber agreement, statement of
coverage, binder, rider or endorsement offered by an insurer subject to
Wisconsin insurance law.
(3) APPLICABILITY AND SCOPE.
(a) This rule shall apply to all contracts
delivered in Wisconsin, or issued for delivery in Wisconsin on or after the
effective date of this rule and to all existing group contracts subject to
Wisconsin insurance law which are amended or renewed on or after the effective
date of this rule.
(b) This rule
shall not affect the right of fraternal benefit societies to determine
eligibility requirements for membership.
(4) AVAILABILITY REQUIREMENTS.
(a) It is an unfair trade practice for an
insurer to:
1. Refuse or cancel coverage or
deny benefits on the basis of the sex of the applicant or insured;
2. Restrict, modify, or reduce the benefits,
term, or coverage on the basis of the sex of the applicant or
insured.
(b) Examples of
unfair trade practices defined by par. (a) and prohibited by this rule are:
1. Denying coverage to females gainfully
employed at home, employed part-time, or employed by relatives when coverage is
offered to males similarly employed;
2. Denying benefits offered by policy riders
to females when the riders are available to males;
3. Denying, under group contracts, dependent
coverage to husbands of female employees, when dependent coverage is available
to wives of male employees;
4.
Denying disability income coverage to employed women when coverage is offered
to men similarly employed;
5.
Treating complications of pregnancy differently from any other illness or
sickness under a contract;
6.
Restricting, reducing, modifying, or excluding benefits payable for treatment
of the genital organs of only one sex;
7. Offering lower maximum monthly benefits to
women than to men who are in the same underwriting, earnings or occupational
classification under a disability income contract;
8. Offering more restrictive benefit periods
and more restrictive definitions of disability to women than to men in the same
underwriting, earnings or occupational classification under a disability income
contract;
9. Establishing different
conditions by sex under which the policyholder may exercise benefit options
contained in the contract.
(5) RATES. When rates are differentiated on the basis of sex, the insurer must:
(a) File
a brief letter of explanation along with a rate filing.
(b) Maintain written substantiation of such
rate differentials in its home office.
(c) Justify in writing to the satisfaction of
the commissioner the rate differential upon request.
(d) Base all such rates on sound actuarial
principles or a valid classification system and actual experience
statistics.
(6) PENALTY. Violation of this rule shall subject the insurer to the penalties set forth in s. 601.64, Stats.
Disclaimer: These regulations may not be the most recent version. Wisconsin may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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