LRBs0098/1
TJD:wlj
2017 - 2018 LEGISLATURE
ASSEMBLY SUBSTITUTE AMENDMENT 1,
TO ASSEMBLY BILL 365
June 21, 2017 - Offered by Representatives Petersen and Sanfelippo.
AB365-ASA1,1,8 1An Act to repeal 632.746 (1) (b), 632.746 (2) (c), (d) and (e), 632.746 (3) (a),
2632.746 (3) (d) 2. and 3., 632.746 (5) and 632.76 (2) (ac) 3.; to renumber 632.746
3(3) (d) 1.; to renumber and amend 632.746 (1) (a); to amend 40.51 (8), 40.51
4(8m), 66.0137 (4), 120.13 (2) (g), 185.983 (1) (intro.), 625.12 (1) (a), 625.12 (1) (e),
5625.12 (2), 625.15 (1), 628.34 (3) (a), 632.746 (2) (a), 632.746 (8) (a) (intro.),
6632.76 (2) (a) and (ac) 1. and 2., 632.795 (4) (a) and 632.897 (11) (a); and to
7create
609.847 and 632.728 of the statutes; relating to: coverage of
8individuals with preexisting conditions.
Analysis by the Legislative Reference Bureau
This substitute amendment prohibits a group health benefit plan, including a
self-insured governmental health plan, from imposing a preexisting condition
exclusion. The substitute amendment also prohibits an individual health insurance
policy, known in the substitute amendment as a disability insurance policy, from
reducing or denying a claim or loss incurred or disability commencing under the
policy on the ground that a disease or physical condition existed prior to the effective
date of coverage. The substitute amendment also prohibits a group or individual

health insurance policy or a self-insured governmental health plan from considering
whether an individual, including a dependent, who has continuous coverage and who
would be covered under the plan has a preexisting condition for the purpose of setting
any premiums, deductibles, copayments, or coinsurance under the policy or plan.
The substitute amendment allows the commissioner of insurance to propose a plan
to assist individuals who have preexisting conditions in maintaining or purchasing
coverage. The commissioner's plan must include expanded choices of insurance
coverage, more affordable options for individuals to purchase coverage, and greater
flexibility in portability of coverage. The commissioner shall submit the plan to the
Joint Committee on Finance for review under its passive review process. The plan,
if implemented, would supersede other state insurance statutes to the extent they
are inconsistent.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
AB365-ASA1,1 1Section 1. 40.51 (8) of the statutes is amended to read:
AB365-ASA1,2,62 40.51 (8) Every health care coverage plan offered by the state under sub. (6)
3shall comply with ss. 631.89, 631.90, 631.93 (2), 631.95, 632.72 (2), 632.728, 632.746
4(1) to (8) and (10), 632.747, 632.748, 632.798, 632.83, 632.835, 632.85, 632.853,
5632.855, 632.867, 632.87 (3) to (6), 632.885, 632.89, 632.895 (5m) and (8) to (17), and
6632.896.
AB365-ASA1,2 7Section 2. 40.51 (8m) of the statutes is amended to read:
AB365-ASA1,2,118 40.51 (8m) Every health care coverage plan offered by the group insurance
9board under sub. (7) shall comply with ss. 631.95, 632.728, 632.746 (1) to (8) and (10),
10632.747, 632.748, 632.798, 632.83, 632.835, 632.85, 632.853, 632.855, 632.867,
11632.885, 632.89, and 632.895 (11) to (17).
AB365-ASA1,3 12Section 3. 66.0137 (4) of the statutes is amended to read:
AB365-ASA1,3,413 66.0137 (4) Self-insured health plans. If a city, including a 1st class city, or
14a village provides health care benefits under its home rule power, or if a town
15provides health care benefits, to its officers and employees on a self-insured basis,

1the self-insured plan shall comply with ss. 49.493 (3) (d), 631.89, 631.90, 631.93 (2),
2632.728, 632.746 (1), 632.746 (10) (a) 2. and (b) 2., 632.747 (3), 632.798, 632.85,
3632.853, 632.855, 632.867, 632.87 (4), (5), and (6), 632.885, 632.89, 632.895 (9) to
4(17), 632.896, and 767.513 (4).
AB365-ASA1,4 5Section 4. 120.13 (2) (g) of the statutes is amended to read:
AB365-ASA1,3,96 120.13 (2) (g) Every self-insured plan under par. (b) shall comply with ss.
749.493 (3) (d), 631.89, 631.90, 631.93 (2), 632.728, 632.746 (1), 632.746 (10) (a) 2. and
8(b) 2., 632.747 (3), 632.798, 632.85, 632.853, 632.855, 632.867, 632.87 (4), (5), and (6),
9632.885, 632.89, 632.895 (9) to (17), 632.896, and 767.513 (4).
AB365-ASA1,5 10Section 5. 185.983 (1) (intro.) of the statutes is amended to read:
AB365-ASA1,3,1811 185.983 (1) (intro.) Every voluntary nonprofit health care plan operated by a
12cooperative association organized under s. 185.981 shall be exempt from chs. 600 to
13646, with the exception of ss. 601.04, 601.13, 601.31, 601.41, 601.42, 601.43, 601.44,
14601.45, 611.26, 611.67, 619.04, 623.11, 623.12, 628.34 (10), 631.17, 631.89, 631.93,
15631.95, 632.72 (2), 632.728, 632.745 to 632.749, 632.775, 632.79, 632.795, 632.798,
16632.85, 632.853, 632.855, 632.867, 632.87 (2), (2m), (3), (4), (5), and (6), 632.885,
17632.89, 632.895 (5) and (8) to (17), 632.896, and 632.897 (10) and chs. 609, 620, 630,
18635, 645, and 646, but the sponsoring association shall:
AB365-ASA1,6 19Section 6. 609.847 of the statutes is created to read:
AB365-ASA1,3,22 20609.847 Preexisting condition discrimination prohibited. Limited
21service health organizations, preferred provider plans, and defined network plans
22are subject to s. 632.728.
AB365-ASA1,7 23Section 7. 625.12 (1) (a) of the statutes is amended to read:
AB365-ASA1,3,2524 625.12 (1) (a) Past and prospective loss and expense experience within and
25outside of this state, except as provided in s. 632.728.
AB365-ASA1,8
1Section 8. 625.12 (1) (e) of the statutes is amended to read:
AB365-ASA1,4,32 625.12 (1) (e) Subject to s. ss. 632.365 and 632.728, all other relevant factors,
3including the judgment of technical personnel.
AB365-ASA1,9 4Section 9. 625.12 (2) of the statutes is amended to read:
AB365-ASA1,4,135 625.12 (2) Classification. Risks Except as provided in s. 632.728, risks may
6be classified in any reasonable way for the establishment of rates and minimum
7premiums, except that no classifications may be based on race, color, creed or
8national origin, and classifications in automobile insurance may not be based on
9physical condition or developmental disability as defined in s. 51.01 (5). Subject to
10s. ss. 632.365 and 632.728, rates thus produced may be modified for individual risks
11in accordance with rating plans or schedules that establish reasonable standards for
12measuring probable variations in hazards, expenses, or both. Rates may also be
13modified for individual risks under s. 625.13 (2).
AB365-ASA1,10 14Section 10. 625.15 (1) of the statutes is amended to read:
AB365-ASA1,4,2215 625.15 (1) Rate making. An Except as provided in s. 632.728, an insurer may
16itself establish rates and supplementary rate information for one or more market
17segments based on the factors in s. 625.12 and, if the rates are for motor vehicle
18liability insurance, subject to s. 632.365, or the insurer may use rates and
19supplementary rate information prepared by a rate service organization, with
20average expense factors determined by the rate service organization or with such
21modification for its own expense and loss experience as the credibility of that
22experience allows.
AB365-ASA1,11 23Section 11. 628.34 (3) (a) of the statutes is amended to read:
AB365-ASA1,5,524 628.34 (3) (a) No insurer may unfairly discriminate among policyholders by
25charging different premiums or by offering different terms of coverage except on the

1basis of classifications related to the nature and the degree of the risk covered or the
2expenses involved, subject to ss. 632.365, 632.728, 632.746 and 632.748. Rates are
3not unfairly discriminatory if they are averaged broadly among persons insured
4under a group, blanket or franchise policy, and terms are not unfairly discriminatory
5merely because they are more favorable than in a similar individual policy.
AB365-ASA1,12 6Section 12. 632.728 of the statutes is created to read:
AB365-ASA1,5,8 7632.728 Coverage of individuals with preexisting conditions. (1) In this
8section:
AB365-ASA1,5,129 (a) “Continuous coverage” means creditable coverage, as defined in 632.745 (4),
10in the 12-month period before the date of enrollment in coverage and during which
11there is no period longer than 63 continuous days during which the applicant for
12coverage did not have creditable coverage.
AB365-ASA1,5,1313 (b) “Disability insurance policy” has the meaning given in s. 632.895 (1) (a).
AB365-ASA1,5,1414 (c) “Self-insured health plan” has the meaning given in s. 632.85 (1) (c).
AB365-ASA1,5,21 15(2) (a) For the purpose of setting rates or premiums for coverage under a group
16or individual disability insurance policy or a self-insured health plan and for the
17purpose of setting any deductibles, copayments, or coinsurance under a group or
18individual disability insurance policy or a self-insured health plan, the policy or plan
19may not consider whether an individual, including a dependent, who has continuous
20coverage and who would be covered under the policy or plan has a preexisting
21condition.
AB365-ASA1,6,1122 (b) The commissioner may propose a plan to assist individuals who have not
23maintained continuous coverage and who have preexisting conditions in purchasing
24coverage. The commissioner's plan under this paragraph shall include expanded
25choices of insurance coverage, more affordable options for individuals to purchase

1coverage, and greater flexibility in portability of coverage. The commissioner shall
2submit the plan under this paragraph to the joint committee on finance for review.
3If, within 14 days after the date of the commissioner's submission, the
4cochairpersons of the committee do not notify the commissioner that the committee
5has scheduled a meeting to review the plan, the commissioner may take actions
6necessary to implement the plan. If the cochairpersons notify the commissioner that
7the committee has scheduled a meeting to review the plan, the commissioner may
8take actions necessary to implement the plan only upon the approval of the
9committee. A plan implemented under this paragraph supersedes ss. 632.746 and
10632.76 and any other section in chs. 600 to 655 to the extent that the plan is
11inconsistent with that section.
AB365-ASA1,6,14 12(3) Nothing in this subchapter shall be construed as permitting health
13insurance issuers to limit access to health insurance coverage for individuals with
14preexisting conditions.
AB365-ASA1,13 15Section 13. 632.746 (1) (a) of the statutes is renumbered 632.746 (1) and
16amended to read:
AB365-ASA1,6,2317 632.746 (1) Subject to subs. (2) and (3), an An insurer that offers a group health
18benefit plan may, with respect to a participant or beneficiary under the plan, not
19impose a preexisting condition exclusion only if the exclusion relates to a condition,
20whether physical or mental, regardless of the cause of the condition, for which
21medical advice, diagnosis, care or treatment was recommended or received within
22the 6-month period ending on the participant's or beneficiary's enrollment date
23under the plan
on a participant or beneficiary under the plan.
AB365-ASA1,14 24Section 14. 632.746 (1) (b) of the statutes is repealed.
AB365-ASA1,15 25Section 15. 632.746 (2) (a) of the statutes is amended to read:
AB365-ASA1,7,3
1632.746 (2) (a) An insurer offering a group health benefit plan may not treat
2genetic information as a preexisting condition under sub. (1) without a diagnosis of
3a condition related to the information
.
AB365-ASA1,16 4Section 16. 632.746 (2) (c), (d) and (e) of the statutes are repealed.
AB365-ASA1,17 5Section 17. 632.746 (3) (a) of the statutes is repealed.
AB365-ASA1,18 6Section 18. 632.746 (3) (d) 1. of the statutes is renumbered 632.746 (3) (d).
AB365-ASA1,19 7Section 19. 632.746 (3) (d) 2. and 3. of the statutes are repealed.
AB365-ASA1,20 8Section 20. 632.746 (5) of the statutes is repealed.
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