Section 600.01. Scope of application.

 

(1)   General.

(a) Chapters 600 to 655 restrict otherwise legitimate business activity and what chs. 600 to 655 do not prohibit is permitted unless contrary to other provisions of the law of this state.

(b) Unless otherwise expressly provided, chs. 600 to 646 do not apply to:

1. Reinsurance.

2. Death and disability benefits provided by an organization the principal purpose of which is not to provide such benefits but to seek charitable, educational, social or religious objectives not related thereto, if the organization does not incur a legal obligation to pay a specified amount.

3. Group or blanket insurance covering risks in this state if:

a. Both the policyholder and the group exist primarily for purposes other than to procure insurance;

am. The relationship or association between the policyholder and the group was not created for purposes of procuring insurance;

b. The policyholder is not a Wisconsin corporation or other resident and does not have its principal office in Wisconsin;

c. No more than 25 percent of the certificate holders or insureds are resident in this state;

cm. Exemption from the operation of chs. 600 to 646 is not determined by rule or order of the commissioner to be contrary to the public interest;

d. On request of the commissioner, the insurer files with the commissioner a copy of the policy and a copy of each form of certificate; and

e. The insurer agrees to pay taxes on the Wisconsin portion of the business on the same basis it would do if authorized to do business in this state, and provides the commissioner with such security as the commissioner deems necessary for the payment of such taxes.

4. Group or blanket insurance covering risks mainly outside this state if:

a. Both the policyholder and the group exist primarily for purposes other than to procure insurance;

am. The relationship or association between the policyholder and the group was not created for purposes of procuring insurance;

b. The policyholder is not a Wisconsin corporation or other resident and does not have its principal office in Wisconsin; and

c. Any Wisconsin residents insured under the policy are covered because their principal place of employment is outside the state.

5. Other business specified in rules promulgated by the commissioner on a finding that the transaction of such business in this state does not require regulation for the protection of the interests of Wisconsin insureds or public or for which it would be impracticable to require compliance with chs. 600 to 646 , when necessary expenses and efforts are compared with the possible benefits.

6. Transactions directly procured through negotiations under s. 618.42 , except as they are subject to taxation under s. 618.43 .

7. Guarantees of the Wisconsin Health and Educational Facilities Authority under s. 231.35 .

8. Guarantees of the Wisconsin Housing and Economic Development Authority under s. 234.68 , 1995 stats., s. 234.69 , 1995 stats., s. 234.765 , 1995 stats., s. 234.82 , 1995 stats., s. 234.87 , 1995 stats., and ss. 234.67 , 234.83 , 234.84 , 234.90 , 234.905 , 234.907 and 234.91 .

9. The publication and clearinghouse activities described in subd. 9. c. , the association undertaking those activities, with respect to those activities, and the association's periodic publication resulting from and furthering those activities if all of the following apply:

a. The publication and clearinghouse activities are undertaken by an association that is organized not for profit for religious and charitable purposes.

b. The publication activities of the association are limited to subscribers who are members of the same church or religious denomination.

c. The publication activities of the association function as an organizational clearinghouse that matches subscribers to the publications of the association who have financial, physical or medical needs and subscribers to the publications of the association who desire to financially assist with those needs and who have a present ability to pay.

d. Although the association, through its publications, may suggest voluntary payment levels between subscribers described in subd. 9. c. , the association and the subscribers do not assume any risk or make any promise of payment by the association or any subscribers.

e. The association provides to each subscriber a written monthly statement that lists the total dollar amount of qualified needs submitted for publication in the previous month and the total dollar amount of qualified needs submitted that were actually published and assigned for payment.

f. On or accompanying all written materials distributed by or on behalf of the association, including applications, guidelines, promotional or informational materials and periodic publications, the association provides the following written disclaimer:

ATTENTION

This publication is not issued by an insurance company, nor is it offered through an insurance company. This publication does not guarantee or promise that your medical bills will be published or assigned to others for payment. Whether anyone chooses to pay your medical bills is entirely voluntary. This publication should never be considered a substitute for an insurance policy. Whether or not you receive any payments for medical expenses, and whether or not this publication continues to operate, you are responsible for the payment of your own medical bills.

g. No payments between subscribers described in subd. 9. c. are made through the association.

10.

a. Except as provided in subd. 10. b. , long-term care services funded by the family care benefit, as defined in s. 46.2805 (4) , that are provided by a care management organization that contracts with the department of health services under s. 46.284 and enrolls only individuals who are eligible under s. 46.286 .

b. The exemption under subd. 10. a. does not apply if the services offered by the care management organization or a nonstock, nonprofit corporation under ch. 181 created under s. 46.284 (4m) or 46.2895 (4) (q) include hospital, physician or other acute health care services other than mental health and alcohol and other drug abuse treatment services.

11. Warrantors, sellers, or administrators of vehicle protection product warranties under s. 100.203 .

12. Service contracts, as defined in s. 616.50 (11) , or providers, service contract sellers, or administrators of service contracts under subch. III of ch. 616 .

(2)   Exceptions.

(a) After a hearing, the commissioner may order an insurer to transfer the Wisconsin portion of the business under sub. (1) (b) 3. or 4. to an authorized insurer if it is written by an unauthorized one, or may subject any insurance under sub. (1) (b) 1. to 6. to chs. 600 to 646 , on a finding that the foregoing conditions are not satisfied or that any circumstances require that the insurer be authorized to do business in this state or that the transactions be subject to chs. 600 to 646 in order to provide adequate protection to Wisconsin insureds and public. Coverage of a resident of this state is the doing of an insurance business in this state and subjects the insurer to the jurisdiction of the commissioner and of the courts of this state.

(b) Group or blanket insurance described in sub. (1) (b) 3. and 4. is not exempt from ss. 632.745 to 632.749 , 632.83 or 632.835 or ch. 633 or 635 .

Cross-reference: See also Ins and chs. Ins 15 and 22 , Wis. adm. code.

Legislative Council Note to (1) (a), 1975: There is a widespread but entirely erroneous notion that the provisions of the insurance code constitute, in general, an enabling act. On the contrary, insurance is an area of free contractual activity except as restricted by the insurance code. It is well to have that point of departure clearly established by the statutes. [Bill 642-S]

Excess-of-policy coverage clause in a reinsurance agreement constituted a liability insurance contract insuring against tortious failure to settle a claim and was not exempt from regulation under sub. (1) (b) 1. Ott v. All-Star Ins. Corp. 99 Wis. 2d 635 , 299 N.W.2d 839 (1981).