Wis. Admin. Code Office of the Commissioner of Insurance Ins 8.75

Current through May 28, 2024
Section Ins 8.75 - Limitations and restrictions
(1) PREEXISTING CONDITIONS. Section 635.17(1), Stats., applies to a plan subject to this subchapter.

Note: 1995 Wis. Act 289 repealed s. 635.17, Stats. See s. 632.746, Stats.

(2) ANNUAL MAXIMUM. The annual calendar year maximum benefit for a plan is $30,000 per insured individual. Charges for a hospitalization which extends from one calendar year to another shall be subject to the calendar year maximum for the year in which each charge was incurred and only one $100 copayment shall apply to the confinement.
(3) LIMITATION ON COVERAGE FOR MENTAL HEALTH AND SUBSTANCE ABUSE TREATMENT. The annual calendar year benefit payable for treatment of a covered person for nervous and mental disorders and alcoholism and other drug abuse is $1,400. A plan may not apply the cost of outpatient prescription drugs used in the treatment of nervous and mental disorders or alcoholism or other drug abuse toward the annual limit specified in this subsection.

Wis. Admin. Code Office of the Commissioner of Insurance Ins 8.75

Cr. Register, June, 1993, No. 450, eff. 7-1-93.