Wisconsin Administrative Code (Last Updated: January 10, 2017) |
Agency Ins. Office of the Commissioner of Insurance |
Chapter 18. Health Benefit Plan Grievances And Independent Review Organizations Certification And Review Procedures |
SubChapter II. Grievance Procedures |
Section 18.06. Reporting requirements.
Latest version.
- An insurer offering a health benefit plan shall comply with all of the following requirements:(1) Each record of each complaint and grievance submitted to the insurer shall be kept and retained for a period of at least 3 years. These records shall be maintained at the insurer's home or principal office and shall be available for review during examinations by or on request of the commissioner or office.(2) Submit a grievance experience report required by s. 632.83 (2) (c) , Stats., to the commissioner by March 1 of each year. The report shall provide information on all grievances received during the previous calendar year. The report shall be in a form prescribed by the commissioner and, at a minimum, shall classify grievances into the following categories:(a) Plan administration including plan marketing, policyholder service, billing, underwriting and similar administrative functions.(b) Benefit services including denial of a benefit, denial of experimental treatment, quality of care, refusal to refer insureds or to provide requested services.
Note
A copy of the grievance experience report form OCI26-007, required under par. (2), may be obtained from the Office of the Commissioner of Insurance, P. O. Box 7873, Madison WI 53707-7873.
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