(a) In accordance with s.
Stats., small employer insurers shall use the small employer uniform employee
application form as the only acceptable form when small employers apply for
coverage from small employer insurers. Small employer insurers shall implement
procedures and policies necessary to use the small employer uniform employee
employer insurers shall treat and accept a copy of the uniform employee
application as an original.
contents of the uniform small employer application shall not vary, except as
permitted in par. (d), from the text or format including bold character, line
spacing, the use of boxes around text and shall use a type size of at least 10
points as delineated in form OCI 26-501.
Small employer insurers and licensed
intermediaries may pre-print the name of the small employer insurer on the
uniform employee application provided that the form contains at least 3
additional spaces to insert the names of insurers to whom the uniform
applications may be sent and the form complies with par. (c).
Note: A copy of the uniform employee application form OCI
26-501 (c. 2/2004), required in par. (a), may be obtained at no cost from the
Office of the Commissioner of Insurance, P.O. Box 7873, Madison WI 53707-7873,
or at the Office's web address: oci.wi.gov.
information contained within each uniform employee application shall be
considered current information by the small employer insurer if the information
is received by the small employer insurer within 45 days of completion of the
earliest signed and completed uniform employee application form. For the period
of time that the information contained within the uniform employee application
is considered current, small employer insurers may not require a small employer
employee to complete a new application form or any document, addendum or
certification representing that the information contained in the completed
uniform employee applications is current.
(b) A small employer insurer may accept and
utilize information provided by a small employer employee subsequent to the
date the employee signed the completed application if the employee is providing
the insurer with additional or modified information.
A small employer insurer may require
small employer employees to complete and submit new uniform employee
applications if either of the following occurs:
1. The authorization signed by the employees
does not include the name of the small employer insurer that the small employer
is requesting provide it with an underwritten premium amount and
2. The completed uniform
employee applications are received by the small employer insurer after 45 days
of completion of the earliest signed and completed uniform employee
Small employer insurers that receive a written request from a small employer to
forward copies of the completed uniform employee applications to a different
small employer insurer listed within the authorization section of the
application shall forward copies of the uniform employee applications within 5
business days from receipt of the request without requiring a fee be paid for
the photocopying or delivery of the copies of completed uniform employee
applications. The small employer insurer shall notify the employer, as soon as
practicable, if the small employer insurer is unable to comply with the request
because the small employer has requested that information be sent to a small
employer insurer not identified within the authorization.
(b) An intermediary shall forward, within 5
business days from receipt of the applications, copies of the uniform employee
applications to all small employer insurers identified within the uniform
employee application authorization to receive the applications, or to an
authorized representative of each small employer insurer. The intermediary may
withhold distribution to a small employer insurer, or the insurer's authorized
representative, at the request of the small employer.
(c) Completed uniform employee applications
shall be maintained by small employer insurers and licensed intermediaries, as
applicable, in accordance with subch. V of ch. Ins 25.
Small employer insurers shall either state the premium to the small employer
within 10 business days from receipt of all pertinent information required for
its underwriting of the small employer's application for group health
insurance, including completed uniform employee applications, or deny the
application in accordance with s.
(b) Small employer insurers
shall make a reasonable effort to promptly obtain information it determines is
necessary to make an underwriting decision including the information described
in par. (a).