Section 18.105. Annual CPI adjustment for independent review eligibility.

 

(1)   Publication and effective date. The commissioner shall publish to the office of the commissioner of insurance website on or before December 1 of each year the consumer price index for urban consumers as determined by the U.S. Department of Labor and publish the adjusted dollar amount in accordance with s. 632.835 (5) (c) , Stats. The adjusted dollar amount published each December shall be used by insurers offering health benefit plans when complying with s. Ins 18.10 (2) (d) and s. 632.835 (1) (a) 4. , Stats., effective the following January 1.

(2)   Determination of adjusted rates. Insurers offering health benefit plans shall apply the adjusted dollar amount published annually by the commissioner that is required to be met in accordance with s. 632.835 (1) (a) 4. and (b) 4. , Stats., as follows:

(a) For adverse determinations when treatment was received by the insured, the insurer shall use the date treatment was received to determine the proper adjusted dollar amount that is required to be met in accordance with s. 632.835 (1) (a) 4. , Stats.

(b) For adverse determinations when a course of treatment was received by the insured or terminated by the insurer, the insurer shall use later of the following dates to determine the proper adjusted dollar amount that is required to be met in accordance with s. 632.835 (1) (a) 4. , Stats.:

1. The last date treatment was received by the insured; or,

2. The date the insurer mailed written notification to the insured, or the insured's authorized representative, that the course of treatment was terminated or denied.

(c) For experimental treatment determinations the insurer shall use the date the insurer mailed written notification to the insured, or the insured's authorized representative, that for the proposed treatment the insurer has either denied the treatment or denied payment for the treatment, to determine the proper adjusted dollar amount that is required to be met in accordance with s. 632.835 (1) (b) 4. , Stats., and s. Ins 18.10 (2) (d) .

CR 04-079 : cr. Register December 2004 No. 588 , eff. 1-1-05.

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Office website address: http://oci.wi.gov . Microsoft Windows NT 6.1.7601 Service Pack 1