LRB-3459/1
PJK:jld:jf
2013 - 2014 LEGISLATURE
March 24, 2014 - Introduced by Senator Risser. Referred to Committee on
Insurance and Housing.
SB691,1,3
1An Act to create 628.41 of the statutes;
relating to: requiring an insurer to
2continue group coverage on the basis of an agent's or representative's
3representations.
Analysis by the Legislative Reference Bureau
Under current law, an insurer or an insurance agent may not make or cause to
be made any communication relating to an insurance contract that contains false or
misleading information. If an insurance agent distributes cards or documents,
exhibits a sign, or publishes an advertisement relating to an insurance contract that
contains false or misleading information, there is a rebuttable presumption that the
insurer also committed the violation. Current law also provides that an insurer is
bound by any act of its agent while the agent's contract remains in force.
This bill requires an insurer that provides coverage under a group health care
policy or plan to allow an insured to continue coverage under the group health care
policy or plan as part of the group for the next term if an agent or other representative
of the insurer has represented in writing to the insured that he or she is eligible to
continue coverage under the group health care policy or plan as part of the group for
the next policy or plan term. The bill prohibits the insurer from charging the insured
a higher premium for the coverage than the premium that is charged other insureds
under the group health care policy or plan. The bill also prohibits an insurance policy
from including a provision that is contrary to the requirements under the bill.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
SB691,1
1Section
1. 628.41 of the statutes is created to read:
SB691,2,11
2628.41 Insurer bound by agent's representations. (1) (a) If an insurer's
3agent or other representative, acting within the scope of the agent's or
4representative's apparent authority, represents in writing to an insured under a
5group health care policy or plan issued by the insurer that the insured is eligible to
6continue coverage for the next policy or plan term as part of the group under the
7group health care policy or plan and the insured relies on that representation, the
8insurer is bound to allow the insured to continue coverage under that group health
9care policy or plan as part of the group for the next policy or plan term, regardless
10of whether the insured is eligible to continue coverage under the policy or plan as part
11of the group and regardless of any provision in the policy or plan to the contrary.
SB691,2,1412
(b) The insurer may not charge an insured whose group coverage is continued
13under par. (a) a premium that is higher than the premium charged to other insureds
14who are part of the group covered under the group health care policy or plan.
SB691,2,16
15(2) A policy may not include a provision that is contrary to the requirements
16under sub. (1).
SB691,2
17Section
2.
Initial applicability.
SB691,2,2018
(1) Except as provided in subsection (2), this act first applies to a representation
19made by an insurance agent or other insurer representative on the effective date of
20this subsection.
SB691,3,4
1(2) If an insurance policy that is in effect on the effective date of this subsection
2contains a provision that is inconsistent with this act, this act first applies to a
3representation first made with respect to that insurance policy on the date on which
4it is renewed.
