AB16, s. 5 10Section 5. 120.13 (2) (g) of the statutes is amended to read:
AB16,3,1411 120.13 (2) (g) Every self-insured plan under par. (b) shall comply with ss.
1249.493 (3) (d), 631.89, 631.90, 631.93 (2), 632.746 (10) (a) 2. and (b) 2., 632.747 (3),
13632.85, 632.853, 632.855, 632.87 (4) and, (5), and (6), 632.895 (9) to (15) (16), 632.896,
14and 767.25 (4m) (d) 767.513 (4).
AB16, s. 6 15Section 6. 185.981 (4t) of the statutes is amended to read:
AB16,3,1916 185.981 (4t) A sickness care plan operated by a cooperative association is
17subject to ss. 252.14, 631.17, 631.89, 631.95, 632.72 (2), 632.745 to 632.749, 632.85,
18632.853, 632.855, 632.87 (2m), (3), (4), and (5), and (6), 632.895 (10) to (15) (16), and
19632.897 (10) and chs. 149 and 155.
AB16, s. 7 20Section 7. 185.983 (1) (intro.) of the statutes is amended to read:
AB16,4,221 185.983 (1) (intro.) Every such voluntary nonprofit sickness care plan shall be
22exempt from chs. 600 to 646, with the exception of ss. 601.04, 601.13, 601.31, 601.41,
23601.42, 601.43, 601.44, 601.45, 611.67, 619.04, 628.34 (10), 631.17, 631.89, 631.93,
24631.95, 632.72 (2), 632.745 to 632.749, 632.775, 632.79, 632.795, 632.85, 632.853,
25632.855, 632.87 (2m), (3), (4), and (5), and (6), 632.895 (5) and (9) to (15) (16), 632.896,

1and 632.897 (10) and chs. 609, 630, 635, 645, and 646, but the sponsoring association
AB16, s. 8 3Section 8. 609.86 of the statutes is created to read:
AB16,4,6 4609.86 Coverage of hearing aids, cochlear implants, and related
5treatment for infants and children.
Defined network plans are subject to s.
6632.895 (16).
AB16, s. 9 7Section 9. 632.895 (16) of the statutes is created to read:
AB16,4,98 632.895 (16) Hearing aids, cochlear implants, and related treatment for
9infants and children.
(a) In this subsection:
AB16,4,1110 1. "Cochlear implant" includes any implantable instrument or device that is
11designed to enhance hearing.
AB16,4,1512 2. "Hearing aid" means any externally wearable instrument or device designed
13for or offered for the purpose of aiding or compensating for impaired human hearing
14and any parts, attachments, or accessories of such an instrument or device, except
15batteries and cords.
AB16,4,1616 3. "Physician" has the meaning given in s. 448.01 (5).
AB16,4,1817 4. "Self-insured health plan" means a self-insured health plan of the state or
18a county, city, village, town, or school district.
AB16,4,2019 5. "Treatment" means services, diagnoses, procedures, surgery, and therapy
20provided by a health care professional.
AB16,5,221 (b) 1. Subject to par. (c) and except as provided in par. (d), every disability
22insurance policy and every self-insured health plan shall provide coverage of the cost
23of hearing aids and cochlear implants that are prescribed by a physician, or by an
24audiologist licensed under subch. II of ch. 459, in accordance with accepted
25professional medical or audiological standards, for a child covered under the policy

1or plan who is under 18 years of age and who is certified as deaf or hearing impaired
2by a physician or by an audiologist licensed under subch. II of ch. 459.
AB16,5,53 2. The coverage required under this subsection shall include coverage of
4treatment related to the hearing aids and cochlear implants, including procedures
5for the implantation of cochlear devices.
AB16,5,86 3. Coverage of the cost of hearing aids and related treatment under this
7subsection is not required to exceed the cost of one hearing aid and related treatment
8per ear per child more often than once every 3 years.
AB16,5,129 4. The coverage required under this subsection may be subject to any
10cost-sharing provisions, limitations, or exclusions, other than a preexisting
11condition exclusion, that apply generally under the disability insurance policy or
12self-insured health plan.
AB16,5,1613 (c) 1. Notwithstanding par. (b) 4. and subject to subd. 2., an individual disability
14insurance policy may impose a preexisting condition exclusion that does not exceed
15one year with respect to the coverage required under this subsection for cochlear
16implants and related treatment.
AB16,5,2217 2. An individual disability insurance policy that imposes a preexisting
18condition exclusion as authorized under subd. 1. shall nevertheless cover the cost of
19cochlear implants and related treatment for a child during the preexisting condition
20exclusion period if time is of the essence for the child to receive cochlear implants and
21related treatment as a result of the occurrence during that period of any of the
22following conditions:
AB16,5,2323 a. Vestibular aqueduct syndrome.
AB16,5,2424 b. Viral infection.
AB16,5,2525 c. Ototoxicity.
1d. Autoimmune inner ear disease.
AB16,6,32 e. Any other condition with respect to which a failure to intervene would likely
3negatively impact the child's outcome.
AB16,6,94 3. If an insurer denies coverage under an individual disability insurance policy
5to a child or the child's family and the child would be eligible as specified in par. (b)
61. for coverage of hearing aids and cochlear implants and related treatment, the
7insurer shall advise the child's family of the availability of coverage for hearing aids
8and cochlear implants and related treatment under the BadgerCare Plus program
9under s. 49.471 under the benefits described in s. 49.46 (2) (a) and (b).
AB16,6,1010 (d) This subsection does not apply to any of the following:
AB16,6,1111 1. A disability insurance policy that covers only certain specified diseases.
AB16,6,1412 2. A health care plan offered by a limited service health organization, as defined
13in s. 609.01 (3), or by a preferred provider plan, as defined in s. 609.01 (4), that is not
14a defined network plan, as defined in s. 609.01 (1b).
AB16,6,1515 3. A long-term care insurance policy.
AB16,6,1616 4. A medicare replacement policy or a medicare supplement policy.
AB16, s. 10 17Section 10. Initial applicability.
AB16,6,1818 (1) This act first applies to all of the following:
AB16,6,2119 (a) Except as provided in paragraphs (b) and (c ), disability insurance policies
20that are issued or renewed, and governmental self-insured health plans that are
21established, extended, modified, or renewed, on the effective date of this paragraph.
AB16,6,2422 (b) Disability insurance policies covering employees who are affected by a
23collective bargaining agreement containing provisions inconsistent with this act
24that are issued or renewed on the earlier of the following:
AB16,6,25 251. The day on which the collective bargaining agreement expires.
12. The day on which the collective bargaining agreement is extended, modified,
2or renewed.
AB16,7,63 (c) Governmental self-insured health plans covering employees who are
4affected by a collective bargaining agreement containing provisions inconsistent
5with this act that are established, extended, modified, or renewed on the earlier of
6the following:
AB16,7,7 71. The day on which the collective bargaining agreement expires.
AB16,7,9 82. The day on which the collective bargaining agreement is extended, modified,
9or renewed.
AB16, s. 11 10Section 11. Effective date.
AB16,7,1211 (1) This act takes effect on the first day of the 7th month beginning after
AB16,7,1313 (End)