Section 635.12, Wis. Stat., requires every small employer insurer to annually publish the small employer insurer's current new business premium rates in the manner and according to categories required by rule under s. 635.05 (7), Wis. Stat. Small employer insurers who complete form OCI 26-500 as required by s. Ins 8.52 (4), Wis. Adm. Code, and who return it to the Office of the Commissioner of Insurance on or before December 1, each year, will be in compliance with the requirements of s. 635.12, Wis. Stat., and need not publish the rates themselves. The commissioner will publish the information gathered from all small employer insurers on OCI's website and in pamphlet form, to assist small employers in comparing the rates.
On form OCI 26-500, identify the plan type and form number that your company markets to small employers that features a $500 annual deductible and a co-insurance rate of 80%/20% (or the nearest amount available). List the monthly new business premium rates that will be in effect the following January 1 for both individual and family coverage. For defined network plans, provide the premium rates for a plan that is actuarially equivalent to the amounts above and list all co-payments that apply.
If premium rates vary by group size or geographical criteria, list the individual and family monthly new business premium rates for each group size or geographical criteria. Use additional pages if necessary, and attach to form OCI 26-500.
Remember to include the name of the person who completed form OCI 26-500 and to whom future forms should be sent.
Any questions concerning this bulletin or how to complete form OCI 26-500 may be directed to Jamie Sanftleben, Health & Life Section at email@example.com.
Return the completed form OCI 26-500 as soon as possible but no later than December 1, 2002, to Betsey Rewey, Office of the Commissioner of Insurance, P.O. Box 7873, Madison, Wisconsin 53707-7873. You may fax the completed form to her at (608) 266-9935, or also complete the form on-line and e-mail it to her at firstname.lastname@example.org. A Word version or pdf version of the form can be found on OCI's website at oci.wi.gov, under Company - Special Reporting Forms.