Wisconsin Administrative Code
Office of the Commissioner of Insurance
Chapter Ins 8 - Employee Welfare Funds; Employee Benefit Plan Administrators; Small Employer Health Insurance
Subchapter IV - Basic Health Benefit Plan For Small Employers
Section Ins 8.80 - Rating
Universal Citation: WI Admin Code ยง Ins 8.80
Current through August 26, 2024
(1) In establishing the new business premium rate for the plan, a small employer insurer shall take into account the experience of all of its small employer health benefit plans. The differences between the plan's new business premium rate and the insurer's new business premium rates for all other small employer health benefit plans shall be based solely on the differences in the plan designs and not on the actual or anticipated experience of those insured under the basic health benefit plan.
(2)
(a)
1.
Except as provided in par. (b), the plan shall apply a higher rate to smokers
than to nonsmokers. The rate applied to smokers shall be no higher than
permitted under s.
111.35(3),
Stats. The small employer insurer shall provide the small employer with enough
copies of the statements required under s.
111.35(3) (a) 2. and (b) 2., Stats., for distribution
to all plan participants.
2. For
the purpose of complying with s.
635.05, Stats.,
and s.
Ins 8.52, smoking status shall be treated as a case
characteristic.
(b)
Paragraph (a) does not apply to a health maintenance organization federally
qualified under title 13 of the public health service act.
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