Your State Government's Oversight of Health Insurance in Wisconsin
The State Government in Wisconsin is responsible for developing and overseeing health insurance regulations applicable to the state. In meeting this requirement, the State Government will generally work to balance consumer rights with an economic environment that supports strong financial and economic growth. In the arena of health insurance, the State Government serves three major constituents: resident consumers, insurance providers, and independent licensed brokers.
The State Government's most prevalent element of control for assuring a legitimate health insurance market is based on the licensing and management of health insurance companies and independent brokers. For controlling insurance providers, the State Government develops minimum requirements for health insurance products and requires periodic financial statement audits, to assure that tax requirements are being complied with. For health insurance brokers, the Government establishes professional licensing qualifications, manages license testing and license issuance for brokers, establishes and administers continuing education criteria, and is responsible to collect license fees for brokers. The State Government is charged with investigating insurance-related fraud, particularly as it relates to consumers or when it threatens the state business environment.
For state health insurance consumers, the State Government provides public information guidelines to help residents succeed in finding their best insurance choices. The State Government can help consumers file appeals with their health insurance company when a dispute occurs relating to the policy coverage or terms. Finally, the Government of the state is charged with administering the State's Medicare program where Federally funded health insurance is offered to lower income individuals and families, uninsured children, qualified seniors, or self-employed persons.