Wisconsin Healthcare Insurance laws & HR compliance analysis

Wisconsin Healthcare Insurance: What you need to know

There is no state law requiring employers to offer group healthcare insurance to their employees, but most employers do offer this benefit. However, if any healthcare insurance is offered, Wisconsin's insurance laws require that policies cover certain benefits (mandated benefits), give employees the right to continue group coverage or to convert to individual policies if group coverage is lost, and place limits on certain cost-cutting practices. There is additional information about continuation and conversion requirements.
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States are not permitted to regulate self-insured benefit plans. Wisconsin's mandated benefits, continuation, and conversion provisions do not apply to health plans in which the employer pays all benefits without the proceeds of any insurance policy. An employer's health plan is self-insured if the risk of paying claims is on the employer and not on an insurance company. Self-insured plans may contract with third-party administrators (TPA), including insurance companies, to process benefit claims. The TPA pays the claims and then is reimbursed by the employer. Many self-insured plans also buy “stop-loss” insurance to cover very large claims. The purchase of stop-loss insurance does not result in the loss of self-insured status and the exemption from state regulation.
Wisconsin law requires insurers to disclose the employer's aggregate claims experience for the current and up to the two preceding policy periods to any employer whose policy covers at least 50 employees (Wis. Stat. Sec. 632.797). Disclosure must be made within 30 days of receipt of a request. The information must be provided free of charge one time during any ...

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