609.91 Restrictions on recovering health care costs.
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609.91 Restrictions on recovering health care costs.
(1)Immunity of enrollees and policyholders. Except as provided in sub.
(1m)or
(1p), an enrollee or policyholder of a health maintenance organization insurer is not liable for health care costs that are incurred on or after January 1, 1990, and that are covered under a policy or certificate issued by the health maintenance organization insurer, if any of the following applies:
(a)The health care is provided by a provider who satisfies any of the following:
1. Is an affiliate of the health maintenance organization insurer.
2. Owns at least 5 percent of the voting securities of the health maintenance organization insurer.
3. Is entitled, alone or with one or more affiliates, to solely select one or more board members of the health maintenance organization insurer, or has an affiliate that is entitled to solely select one or more board members of the health maintenance organization insurer.