609.20 Rules for preferred provider and defined network plans. - Wisconsin Statutes

609.20

609.20 Rules for preferred provider and defined network plans.

609.20(1m)

(1m) The commissioner may promulgate rules relating to preferred provider plans and defined network plans for any of the following purposes, as appropriate:

609.20(1m)(a)

(a) To ensure that enrollees are not forced to travel excessive distances to receive health care services.

609.20(1m)(b)

(b) To ensure that the continuity of patient care for enrollees meets the requirements under s. 609.24.

609.20(1m)(c)

(c) To define substantially equivalent coverage of health care expenses for purposes of s. 609.10 (1) (am).

609.20(1m)(d)

(d) To ensure that employees offered a health maintenance organization or a preferred provider plan that provides comprehensive services under s. 609.10 (1) (am) are given adequate notice of the opportunity to enroll, as well as complete and understandable information under s. 609.10 (1) (c) concerning the differences among the health maintenance organization or preferred provider plan, the standard plan and the point-of-service option plan, as defined in s. 609.10 (1) (ac), including differences among providers available and differences resulting from special limitations or requirements imposed by an institutional provider because of its affiliation with a religious organization.

609.20(2m)

(2m) Any rule promulgated under this chapter shall recognize the differences between preferred provider plans and other types of defined network plans, take into account the fact that preferred provider plans provide coverage for the services of nonparticipating providers, and be appropriate to the type of plan to which the rule applies.

609.20 - ANNOT.

History: 1985 a. 29; 1997 a. 237; 1999 a. 9; 2001 a. 16.