Date:February 1, 2011
To:All Insurers Authorized to Write Group or Individual Health Insurance
From:Theodore K. Nickel, Commissioner of Insurance
Subject:New Individual Uniform Application for Health Insurance and Revised Small Employer Uniform Employee Application

INDIVIDUAL UNIFORM APPLICATION FOR HEALTH INSURANCE

BEGINNING JULY 1, 2011, INSURERS AND THEIR AGENTS ARE REQUIRED TO USE THE NEW INDIVIDUAL UNIFORM APPLICATION FORM FOR ALL INDIVIDUAL MAJOR MEDICAL HEALTH INSURANCE POLICY APPLICATIONS.

Section Ins 3.33, Wis. Adm. Code, is effective January 1, 2011, and first applies to policies issued on or after July 1, 2011. The OCI expects insurers to notify their agents of the new uniform application requirement.

Section 601.41 (10), Wis. Stat., requires insurers to use the individual uniform application form developed by the OCI for all individual major medical health insurance policy applications. An individual major medical health insurance policy means a comprehensive health care plan offered by an insurer that provides individual or family coverage, including coverage provided by an association plan under a group policy that is underwritten on an individual basis. A major medical health insurance policy excludes limited-scope dental and vision policies, specified disease policies, short-term medical policies, long-term care and Medigap policies, hospital indemnity policies, and other limited-benefit insurance products.

In addition to providing the format for the application form [OCI 26-503 (c. 06/2010)], the rule sets forth requirements for the implementation and utilization of the uniform application form. The contents of the individual uniform application form must not vary from the text or format in the rule including bold character, line spacing, the use of boxes around text, and must be in a type size of at least 10 points.

If an insurer allows applicants to select from available deductible, copayment, coinsurance levels, provider networks, and/or payment options during the application process, the information must be collected in a separate form, filed with the OCI. Authorizations, releases and other required notices will also need to be provided to applicants in a separate form from the individual uniform application form.

Insurers that allow applicants to complete an application for an individual major medical health insurance policy electronically or verbally over the telephone may change the order of questions but may not alter the content of any question from the individual uniform application form. Applicants must answer each question and insurers may not automatically populate answers to the questions on the individual uniform application. A printed copy of an application that is completed electronically or verbally over the telephone must be in the same format as appears in the rule.

A copy of the rule may be obtained from the OCI Internet Web site at http://oci.wi.gov/rules/0333fn10.pdf (opens in new window) or by contacting Inger Williams at (608) 264-8110. A copy of the individual uniform application form [OCI 26-503 (c. 06/2010)] can be found at http://oci.wi.gov/ociforms/26-503.pdf (opens in new window).


SMALL EMPLOYER UNIFORM EMPLOYEE APPLICATION

BEGINNING FEBRUARY 1, 2011, INSURERS AND THEIR AGENTS ARE REQUIRED TO USE THE REVISED SMALL EMPLOYER UNIFORM EMPLOYEE APPLICATION FORM FOR SMALL EMPLOYER GROUP HEALTH INSURANCE APPLICATIONS.

Revisions have been made to s. Ins 8.49 Appendix 1, Wis. Adm. Code, the Small Employer Uniform Employee Application for Group Health Insurance, effective February 1, 2011. The OCI expects insurers to notify their agents of the need to use the revised uniform employee application form.

In accordance with an amendment to the Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA), language has been added to the waiver section of the application that informs an employee how to obtain information on electing health insurance coverage through a special election period due to a qualifying event including Medicaid premium assistance. Information also has been updated regarding the treatment of genetic information in the medical information section of the application to comply with the Genetic Information Nondiscrimination Act of 2008 (GINA). Additionally, modifications were made to delete references to a dependent needing to be a full-time student or financially dependent upon the parents since both state and federal law mandate inclusion of adult children as dependents regardless of the adult child's residency or financial dependency.

Insurers and their agents are required to begin using the revised small employer uniform employee application for group health insurance beginning February 1, 2011.

A copy of the rule may be obtained from the OCI Internet Web site at http://oci.wi.gov/rules/0849fn10.pdf (opens in new window) or by contacting Inger Williams at (608) 264-8110. A copy of the small employer uniform employee application form [OCI 26-501 (R 6/2010)] can be found at http://oci.wi.gov/ociforms/26-501.pdf (opens in new window).

Questions concerning the new and revised uniform application forms can be e-mailed to:

Mike Honeck, Chief
Health and Life Section
mike.honeck@wisconsin.gov