LRB-1110/1
TJD:kjf
2019 - 2020 LEGISLATURE
January 23, 2019 - Introduced by Senators Jacque, L. Taylor, Darling, Marklein,
Olsen and Wanggaard, cosponsored by Representatives Petersen,
Rohrkaste, Magnafici, Oldenburg, August, Ballweg, Born, Brandtjen,
Brooks, Dittrich, Duchow, Edming, Felzkowski, Gundrum, Horlacher,
Jagler, James, Katsma, Kerkman, Kitchens, Krug, Kuglitsch, Kulp, Kurtz,
Loudenbeck, Macco, Murphy, Mursau, Novak, Ott, Petryk, Plumer,
Pronschinske, Quinn, Ramthun, Rodriguez, Sanfelippo, Schraa,
Skowronski, Snyder, Spiros, Stafsholt, Steffen, Steineke, Summerfield,
Swearingen, Tauchen, Thiesfeldt, Tittl, Tranel, Tusler, VanderMeer,
Vorpagel, Vos, Wittke and Zimmerman. Referred to Committee on Health and
Human Services.
SB2,1,3 1An Act to amend 40.51 (8), 40.51 (8m), 66.0137 (4), 120.13 (2) (g) and 185.983
2(1) (intro.); and to create 609.847 and 632.728 of the statutes; relating to:
3coverage of individuals with preexisting conditions.
Analysis by the Legislative Reference Bureau
Currently, the federal Patient Protection and Affordable Care Act generally
allows premium rates to be based only on individual or family coverage, rating area,
age, and tobacco use; requires group and individual health insurance policies to
accept every employer and individual that applies for coverage, known as
guaranteed issue, and renew health insurance coverage at the option of the sponsor
or individual; and prohibits health insurance policies from imposing preexisting
condition exclusions. If those requirements and prohibitions of the Affordable Care
Act are no longer enforceable or no longer preempt state law, all of the following apply
under this bill: every individual health benefit plan must accept every individual in
this state who applies for coverage and every group health benefit plan must accept
every employer in this state that applies for coverage, regardless of whether any
individual or employee has a preexisting condition; a health benefit plan may restrict
enrollment in coverage to open or special enrollment periods; the commissioner of
insurance must ensure a statewide open enrollment period allowing individuals,
including individuals who do not have coverage, to enroll in coverage; health benefit
plans must provide special enrollment periods for certain qualifying events
described in federal law; a health benefit plan offered on the individual or small
employer market or a self-insured health plan may not vary premium rates for a

specific policy or plan except on the basis of whether the policy or plan covers an
individual or a family, area in the state, age, and tobacco use; a group health benefit
plan, including a self-insured governmental health plan, may not impose a
preexisting condition exclusion; and an individual health benefit plan may not
reduce or deny 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. Certain grandfathered and transitional health insurance policies that are
exempt from some requirements of the Affordable Care Act, including the premium
rate requirements, are exempt from the premium rate requirements under the bill.
This proposal may contain a health insurance mandate requiring a social and
financial impact report under s. 601.423, stats.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
SB2,1 1Section 1. 40.51 (8) of the statutes is amended to read:
SB2,2,62 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.
SB2,2 7Section 2. 40.51 (8m) of the statutes is amended to read:
SB2,2,118 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).
SB2,3 12Section 3. 66.0137 (4) of the statutes is amended to read:
SB2,3,313 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,
16the self-insured plan shall comply with ss. 49.493 (3) (d), 631.89, 631.90, 631.93 (2),

1632.728, 632.746 (10) (a) 2. and (b) 2., 632.747 (3), 632.798, 632.85, 632.853, 632.855,
2632.867, 632.87 (4) to (6), 632.885, 632.89, 632.895 (9) to (17), 632.896, and 767.513
3(4).
SB2,4 4Section 4. 120.13 (2) (g) of the statutes is amended to read:
SB2,3,85 120.13 (2) (g) Every self-insured plan under par. (b) shall comply with ss.
649.493 (3) (d), 631.89, 631.90, 631.93 (2), 632.728, 632.746 (10) (a) 2. and (b) 2.,
7632.747 (3), 632.798, 632.85, 632.853, 632.855, 632.867, 632.87 (4) to (6), 632.885,
8632.89, 632.895 (9) to (17), 632.896, and 767.513 (4).
SB2,5 9Section 5. 185.983 (1) (intro.) of the statutes is amended to read:
SB2,3,1710 185.983 (1) (intro.) Every voluntary nonprofit health care plan operated by a
11cooperative association organized under s. 185.981 shall be exempt from chs. 600 to
12646, with the exception of ss. 601.04, 601.13, 601.31, 601.41, 601.42, 601.43, 601.44,
13601.45, 611.26, 611.67, 619.04, 623.11, 623.12, 628.34 (10), 631.17, 631.89, 631.93,
14631.95, 632.72 (2), 632.728, 632.745 to 632.749, 632.775, 632.79, 632.795, 632.798,
15632.85, 632.853, 632.855, 632.867, 632.87 (2) to (6), 632.885, 632.89, 632.895 (5) and
16(8) to (17), 632.896, and 632.897 (10) and chs. 609, 620, 630, 635, 645, and 646, but
17the sponsoring association shall:
SB2,6 18Section 6. 609.847 of the statutes is created to read:
SB2,3,21 19609.847 Preexisting condition discrimination prohibited. Limited
20service health organizations, preferred provider plans, and defined network plans
21are subject to s. 632.728.
SB2,7 22Section 7. 632.728 of the statutes is created to read:
SB2,3,24 23632.728 Coverage of individuals with preexisting conditions; rating.
24(1) Definitions. In this section:
SB2,3,2525 (a) “Health benefit plan” has the meaning given in s. 632.745 (11).
SB2,4,1
1(b) “Self-insured health plan” has the meaning given in s. 632.85 (1) (c).
SB2,4,22 (c) “Small employer” has the meaning given in s. 635.02 (7).
SB2,4,8 3(2) Access to coverage. Every individual health benefit plan shall accept
4every individual in this state who applies for coverage and every group health benefit
5plan shall accept every employer in this state that applies for coverage, regardless
6of whether any individual or employee has a preexisting condition. A health benefit
7plan may restrict enrollment in coverage described in this subsection to open or
8special enrollment periods under sub. (4).
SB2,4,11 9(3) Premium rate variation. (a) A health benefit plan offered on the individual
10or small employer market or a self-insured health plan may vary premium rates for
11a specific policy or plan based only on the following considerations:
SB2,4,1212 1. Whether the policy or plan covers an individual or a family.
SB2,4,1313 2. Rating area in the state, as established by the commissioner.
SB2,4,1614 3. Age, except that the rate may not vary by more than 3 to 1 for adults over
15the age groups and the age bands shall be consistent with recommendations of the
16National Association of Insurance Commissioners.
SB2,4,1717 4. Tobacco use, except that the rate may not vary by more than 1.5 to 1.
SB2,4,2018 (b) A health benefit plan that is considered a grandfathered health plan under
1942 USC 18011 or has transitional status granted by the federal department of health
20and human services and the commissioner is not required to comply with par. (a).
SB2,4,24 21(4) Enrollment periods. (a) The commissioner shall ensure that every
22individual health benefit plan has open enrollment during a statewide open
23enrollment period to allow individuals, including individuals who do not have
24coverage, to enroll in coverage.
SB2,5,2
1(b) Every health benefit plan shall provide special enrollment periods for
2qualifying events under 26 USC 9801 (f) and 29 USC 1163.
SB2,5,5 3(5) Preexisting condition exclusion. (a) A group health benefit plan or a
4self-insured health plan may not impose a preexisting condition exclusion for any
5time on a participant or beneficiary under the policy or plan.
SB2,5,116 (b) No claim or loss incurred or disability under an individual health benefit
7plan may be reduced or denied on the ground that a disease or physical condition
8existed prior to the effective date of coverage. An individual health benefit plan may
9not define a preexisting condition more restrictively than a condition, whether
10physical or mental, regardless of the cause of the condition, for which medical advice,
11diagnosis, care, or treatment was recommended or received.
SB2,5,19 12(6) Applicability. This section applies only if provisions of the federal Patient
13Protection and Affordable Care Act, P.L. 111-148, as amended, under 42 USC
14300gg-1
to 300gg-4 are no longer enforceable or no longer preempt state law relating
15to individual or group health insurance policies. If this section applies, this section
16supersedes any conflicting provision of ss. 625.12 (1) or (2), 625.15 (1), 628.34 (3),
17632.746, 632.76, 632.795 (4) (a), 632.896 (4), or 632.897 (11) (a) or any other
18conflicting provision in chs. 600 to 655 to the extent this section conflicts with that
19provision.
SB2,5,2020 (End)
Loading...
Loading...