Section 3.15. Blanket accident and sickness insurance.

 

(1)   Purpose. This rule implements and interprets applicable statutes for the purpose of establishing procedures and requirements to expedite the review and approval of blanket accident and sickness policies permitted by s. 600.03 (4) , Stats., and s. Ins 6.75 (1) (c) or (2) (c) .

(3)   Rate filings. Schedules of premium rates shall be filed in accordance with the requirements of ch. 601 , Stats. , and s. 631.20 , Stats. The schedules of premium rates shall bear the insurer's name and shall identify the coverages to which such rates are applicable.

(4)   Eligible risks.

(a) In accordance with the provisions of s. 600.03 (4) , Stats., the following are eligible for blanket accident and health insurance:

1. Volunteer fire departments, 2. National guard units, 3. Newspaper delivery carriers, 4. Dependents of students, 5. Volunteer civil defense organizations, 6. Volunteer auxiliary police organizations, 7. Law enforcement agencies, 8. Cooperatives organized under ch. 185 , Stats. , on a membership basis without capital stock, 9. Registered guests in a motel, hotel, or resort, 10. Members or members and advisors of fraternal organizations including women's auxiliaries of such organizations and fraternal youth organizations, 11. Associations of sports officials, 12. Purchasers of protective athletic equipment, 13. Migrant workers, 14. Participants in racing meets, 15. Patrons or guests of a recreational facility or resort.

(b) A company may submit any other risk or class of risks, subject to approval by the commissioner, which it believes is properly eligible for blanket accident and health insurance.

(5)   Coverage requirements.

(a) Surgical benefit provisions or schedules shall provide that the benefit for any covered surgical procedure not specifically listed in the schedule and not excluded by the provisions of the policy shall be determined by the company on a basis consistent with the benefit provided for a comparable listed procedure.

(b) A policy which contains any provision under which the claimant may elect one benefit in lieu of another shall not limit to a specified period the time within which election may be made.

Cr. Register, March, 1958 , no. 27, eff. 4-1-58; am. (4) (a), cr. (5), Register, November, 1959, No. 47 , eff. 12-1-59; am. (1), (3) and (4) (a), Register, October, 1961, No. 70 , eff. 11-1-61; am. (4) (a), Register, April, 1963, No. 88 , eff. 5-1-63; am. (4) (a), Register, June, 1963, No. 90 , eff. 7-1-63; am. (4) (a), Register, October, 1963, No. 94 , eff. 11-1-63; am. (4) (a), Register, August, 1964, No. 104 , eff. 9-1-64; am. (4) (a), Register, August, 1968, No. 152 , eff. 9-1-68; am. (4) (a), Register, March, 1969, No. 159 , eff. 4-1-69; am. (4) (a), Register, August, 1970, No. 176 , eff. 9-1-70; am. (4) (a), renum. (5) to be (5) (a), and cr. (b), Register, June, 1971, No. 186 , eff. 7-1-71; emerg. am. (1), (3) and (4) (a), eff. 6-22-76; am. (1), (3) and (4) (a), Register, September, 1976, No. 249 , eff. 10-1-76; r. (2), Register, January, 1980, No. 289 , eff. 2-1-80; am. (1), Register, September, 1986, No. 369 , eff. 10-1-86; corrections to (4) made under s. 13.93 (2m) (b) 5. and 7., Stats., Register, April, 1992, No. 436 .