Section Ins 8.78 - Participation; enrollment(1) PARTICIPATION. (a) A small employer insurer shall offer a plan to any small employer meeting the definition of eligible employer in s. 635.20(2), Stats., regardless of the number required for participation in other small group health benefit plans offered by the small employer insurer. Note: 1997 Wis. Act 27 repealed s. 635.20.
(b) In par. (c), the number of persons in a group means the number of eligible employees without other qualifying coverage, as defined in s. 635.02(5m), Stats. Note: 1995 Wis. Act 289 repealed s. 635.02(5m).
(c) A small employer insurer may impose participation requirements on a plan offered to a small employer, not to exceed the following:1. For a group of more than 10 persons: 70% of the group.2. For a group of 10 persons: 6 participants.3. For a group of 8 or 9 persons: 5 participants.4. For a group of 7 persons: 4 participants.5. For a group of 5 or 6 persons: 3 participants.6. For a group of 2 to 4 persons: 2 participants.(2) PROBATIONARY PERIOD. A small employer may impose a waiting period of not more than 90 days from the date of hire before a new employee is eligible to enroll in the small employer's plan.(3) ENROLLMENT. (a) A plan may require that new employees of a small employer and newly eligible dependents enroll in the plan within 30 days after becoming eligible to enroll.(b) An eligible employee or dependent whose coverage under another health insurance plan terminates for any reason may enroll in a small employer's plan without medical underwriting within 30 days after termination of the other coverage.(c) Section Ins 8.63(2) applies to an eligible employee or dependent who does not enroll in a small employer's plan within the period specified in par. (a) or (b). (4) EMPLOYER CONTRIBUTION EXCEPTION. (a) A plan may limit coverage to eligible employees, as defined in s. 635.20(1m), Stats., and their dependents. Note: 1997 Wis. Act 27 repealed s. 635.20.
(b) If a plan permits employees other than those defined as eligible employees in s. 635.20(1m), Stats., to enroll, the small employer is not required to pay the employer contribution specified under s. 635.254(1), Stats., for those employees. If the small employer elects not to contribute, the small employer shall withhold the entire amount of the premium from the earnings of each employee permitted to participate, as provided in s. 635.254(2), Stats.Wis. Admin. Code Office of the Commissioner of Insurance Ins 8.78
Cr. Register, June, 1993, No. 450, eff. 7-1-93; cr. (3) (c), Register, November, 1993, No. 455, eff. 2-1-94.1997 Wis. Act 27 repealed ss. 635.20 and 635.254. See ss. 632.745(5) and 635.19(4), Stats.