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Market Conduct Standards for Defined Network Plans, Preferred Provider Plans and Limited Service Health Organizations | Midpage
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Wisconsin Administrative Code
Ins
Ins 9
III
Market Conduct Standards for Defined Network Plans, Preferred Provider Plans and Limited Service Health Organizations
Office of the Commissioner of Insurance
9.20
Scope.
9.21
Limited exemptions.
9.25
Preferred provider plan same service provisions.
9.26
Preferred provider plan subject to defined network plan regulations.
9.27
Preferred provider plan requirements.
9.30
Group and blanket health insurers compliance.
9.31
Annual certification of access standards.
9.32
Defined network plan requirements.
9.33
Enrollee election of nonparticipating provider reimbursement.
9.35
Continuity of care.
9.36
Gag clauses.
9.37
Notice requirements.
9.38
Policy and certificate language requirements.
9.39
Disenrollment.
9.40
Required quality assurance and remedial action plans.
9.41
Right of the commissioner to request OCI complaints be handled as grievances.
9.42
Compliance program requirements.