Wisconsin Administrative Code
Office of the Commissioner of Insurance
Chapter Ins 8 - Employee Welfare Funds; Employee Benefit Plan Administrators; Small Employer Health Insurance
Subchapter III - Small Employer Health Insurance
Section Ins 8.52 - Regulation of rates and rate changes
Universal Citation: WI Admin Code § Ins 8.52
Current through February 24, 2025
(1) IDENTIFICATION OF THE SET OF MIDPOINT RATES.
(a) Each small
employer insurer shall identify a set of rates applicable to all combinations
of case characteristics and benefit design characteristics that serves as the
set of midpoint rates for policies issued to small employers. These rates shall
be represented by any combination of rates and rating factors that satisfy the
following:
1. All differences among rates in
the set shall be in accordance with the insurer's rate manual or rating
procedures and shall be based on the actuarially determined values of the
differences in case characteristics and benefit design
characteristics.
2. The differences
among the rates may not reflect any differences due to such factors as the
claim experience, health status and duration of coverage of an individual
policy or a collection of policies grouped according to anything other than
case characteristics or benefit design.
(b) The set of midpoint rates identified in
par. (a) shall apply during a specified period which shall not be less than one
calendar month.
(2) RATE VARIANCE RESTRICTION.
(a) For a new
policy issued on or after March 15, 1992, the following table lists the maximum
percent a rate may vary from the midpoint rate applicable to policies with the
same case characteristics and benefit design characteristics according to the
effective date of any rate applied to that policy:
Effective Date of Rate |
Maximum Variance from Midpoint Rate |
1. March 15, 1992-August 14, 1994 |
35% |
2. August 15, 1994 and after |
30% |
(b)
For a policy issued before March 15, 1992, an insurer shall comply with the
rate variance restriction specified in par. (a) 2 no later than August 15, 1994
(3) PREMIUM RATE CHANGES; DOCUMENTATION AND RESTRICTIONS.
(a)
For the purpose of complying with s.
635.02(2),
Stats., and this subsection, "class of business" means a group of policies with
the same or similar benefit design whose rates are based wholly or partly on
their aggregate loss experience.
(b) For a policy renewed on or after March
15, 1993, an insurer shall maintain sufficient documentation so that each of
the following distinct components can be identified:
1. The percentage change in the new business
premium rate measured from the rating period in which the small employer was
last rated to the current rating period or, in the case of a class of business
for which the insurer is not issuing new policies, the corresponding change in
the base premium rate.
2. The
percentage change due to adjustments in case characteristics, determined in
accordance with the insurer's rate manual or rating procedures.
3. The percentage change due to adjustments
in benefit design, determined in accordance with the insurer's rate manual or
rating procedures.
4. The
percentage change due to such rating factors as claim experience, health status
and duration of coverage, determined in accordance with the insurer's rate
manual or rating procedures.
(c) Each renewal rate, regardless of whether
the rate represents an increase, shall be limited to the previous rate adjusted
by the combination of the 4 components specified in par. (b) with the following
restrictions on the experience component specified in par. (b) 4.:
1. For a policy issued on or after March 15,
1992, the experience component shall be limited to 15% per year, adjusted
proportionately for rating periods of less than one year.
2. For a policy issued before March 15, 1992,
subd. 1. applies, except if the premium rate exceeds the midpoint rate by more
than the percentage specified in sub. (2) (a) for the applicable period for
policies with the same case characteristics and benefit design characteristics,
the experience component may not exceed 0%.
(d) For a rate change made before the end of
the policy term due to the addition of a new entrant, late enrollee,
underwritten individual or a new dependent of an insured employee, par. (c)
applies, except that:
1. The new business
rate change component specified in par. (b) 1. may not be applied at that
time.
2. The experience component
specified in par. (b) 4. may not exceed 15% per year, adjusted proportionately
to the time remaining in the policy term.
3. The experience component specified in par.
(b) 4., when combined with the experience component of the last scheduled rate
renewal and any other subsequent rate changes during the current policy term,
shall not exceed the limit specified in par. (c) 1. or 2., whichever
applies.
(4) ANNUAL PUBLICATION OF RATES.
(a) On or before
December 1, every small employer insurer shall annually file with the
commissioner the small employer insurer's lowest available monthly new business
premium rates which will be in effect the following January 1. The filing shall
be made on a form provided by the commissioner and shall require all of the
following information as may apply to the type of plan offered:
1. For an indemnity plan, the rates shall be
based on the insurer's plan that is closest to a plan that features a $500.00
annual deductible and 80%/20% coinsurance.
2. For a defined network plan, the rates
shall be based on a plan which is actuarially equivalent to the features
described in subd. 1.
3. For all
plans, the rates shall be specified for family and single plans, by group size
and by the geographical criteria that are used by the insurer.
4. The commissioner may require additional
information be provided in the form as appropriate to implement this
subsection.
Note: OCI 26-500, the form described in this subsection may be obtained without charge by contacting the Office of the Commissioner of Insurance PO Box 7873, Madison WI. 53707-7873. The form is also available on the OCI website at oci.wi.gov
(b) Small employer insurers who file rates
with the commissioner as described in this subsection will be in compliance
with the requirements of s.
635.12,
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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