Section 3.41. Individual conversion policies.

 

(1)   Reasonably similar coverage. An insurer provides reasonably similar coverage under s. 632.897 (4) , Stats., to a terminated insured as defined in s. 632.897 (1) (f) , Stats., if a person is offered individual coverage under the group policy or individual policy, or is offered his or her choice of the 3 plans described in s. Ins 3.42 , or is offered a high limit comprehensive plan of benefits approved for the purpose of conversion by the commissioner as meeting the standards described in s. Ins 3.43 . Individual conversion policies must include benefits required for individual disability insurance policies by subch. VI of ch. 632 , Stats. This subsection does not apply to a long-term care policy as defined under s. Ins 3.46 (3) (m) .

(2)   Renewability.

(a) Except as provided in par. (b) , individual conversion policies shall be renewable at the option of the insured unless the insured fails to make timely payment of a required premium amount, there is over-insurance as provided by s. 632.897 (4) (d) , Stats., or there was fraud or material misrepresentation in applying for any benefit under the policy.

(b) Conversion policies issued to a former spouse under s. 632.897 (9) (b) , Stats., must include renewal provisions at least as favorable to the insured as did the previous coverage.

(3)   Premium rates.

(a) In determining the rates for the class of risks to be covered under individual conversion policies, the premium and loss experience of policies issued to meet the requirements of s. 632.897 (4) , Stats., may be considered in determining the table of premium rates applicable to the age and class of risks of each person to be covered under the policy and to the type and amount of coverage provided.

(b) Except as provided in par. (c) , conditions pertaining to health shall not be an acceptable basis for classification of risks.

(c) A conversion policy issued to a former spouse under s. 632.897 (9) (b) , Stats., may be rated on the basis of a health condition if a similar rating had been previously applied to the prior individual coverage due to the same condition.

Cr. Register, April, 1981, No. 304 , eff. 5-1-81; am. (1), Register, April, 1991, No. 424 , eff. 6-1-91; EmR0817 : emerg. am. (1), eff. 6-3-08; CR 08-032 : am. (1) Register October 2008 No. 634 , eff. 11-1-08.

Note

CR 08-032 first applies to policies or certificates issued on or after January 1, 2009 or on the first renewal date on or after January 1, 2009, but no later than January 1, 2010 for collectively bargained policies or certificates. Microsoft Windows NT 6.1.7601 Service Pack 1