Individual insurance policy rules changing in Wisconsin

New procedures will allow for independent review of denials because of preexisting conditions and review of cancellations or rescissions.

By Emily Berry — Posted Nov. 6, 2009

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Wisconsin insurers will have to change the way they underwrite individual insurance following regulatory changes aimed at protecting people from unfair denials and policy rescissions.

According to the most recent data collected by the insurance department, 141,569 people in Wisconsin were enrolled in individual insurance plans in 2007, compared with more than 1.5 million in group plans that year.

Though the individual market was small two years ago, compared with the group insurance market, the administration is expecting to see more people driven to individual coverage by the loss of employer-sponsored coverage during the recession, insurance department spokesman Jim Guidry said.

Wisconsin Gov. Jim Doyle inserted the changes to the individual insurance regulations into the state budget enacted June 29 with the support of Insurance Commissioner Sean Dilweg, Guidry said.

The new regulations:

  • Require insurers to report how many individual policies they write and the number they rescind each year.
  • Limit the "look-back period" over which an insurer can look for preexisting medical conditions to 12 months.
  • Require the insurance department to develop a standard application for individual insurance.
  • Establish an independent review board responsible for examining claims denials and policy rescissions.

The insurance department is developing the uniform application and review process, and both are expected to be done by the end of the year, Guidry said.

Phil Dougherty, senior executive officer for the Wisconsin Assn. of Health Plans, said member insurers didn't object to the intent of the legislation, and he is part of the working group developing the rules for independent review of insurer decisions.

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