1997 Wisconsin Act 27

601.415 (12) Health insurance risk-sharing plan. The commissioner shall perform the duties specified to be performed by the commissioner in ss. 149.13 and 149.144. The commissioner, or his or her designee, shall serve as a member of the board under s. 149.15.

27,4798 Section 4798 . 601.429 of the statutes is repealed.

27,4801 Section 4801 . 601.64 (1) of the statutes is amended to read:

601.64 (1) Injunctions and restraining orders. The commissioner may commence an action in circuit court in the name of the state to restrain by temporary or permanent injunction or by temporary restraining order any violation of chs. 600 to 655, s. 149.13 or 149.144, any rule promulgated under chs. 600 to 655 or any order issued under s. 601.41 (4). Except as provided in s. 641.20, the commissioner need not show irreparable harm or lack of an adequate remedy at law in an action commenced under this subsection.

27,4802 Section 4802 . 601.64 (3) (a) of the statutes is amended to read:

601.64 (3) (a) Restitutionary forfeiture. Whoever violates an effective order issued under s. 601.41 (4) or , any insurance statute or rule or s. 149.13 or 149.144 shall forfeit to the state twice the amount of any profit gained from the violation, in addition to any other forfeiture or penalty imposed.

27,4803 Section 4803 . 601.64 (3) (c) of the statutes is amended to read:

601.64 (3) (c) Forfeiture for violation of statute or rule. Whoever violates an insurance statute or rule or s. 149.13 or 149.144, intentionally aids a person in violating an insurance statute or rule or s. 149.13 or 149.144 or knowingly permits a person over whom he or she has authority to violate an insurance statute or rule or s. 149.13 or 149.144 shall forfeit to the state not more than $1,000 for each violation. If the statute or rule imposes a duty to make a report to the commissioner, each week of delay in complying with the duty is a new violation.

27,4804 Section 4804 . 601.64 (4) of the statutes is amended to read:

601.64 (4) Criminal penalty. Whoever intentionally violates or intentionally permits any person over whom he or she has authority to violate or intentionally aids any person in violating any insurance statute or rule of this state, s. 149.13 or 149.144 or any effective order issued under s. 601.41 (4) may, unless a specific penalty is provided elsewhere in the statutes, be fined not more than $10,000 if a corporation or if a natural person be fined not more than $5,000 or imprisoned for not to exceed 3 years or both. Intent has the meaning expressed under s. 939.23.

27,4804b Section 4804b. 609.77 of the statutes is created to read:

609.77 Coverage of breast reconstruction. Health maintenance organizations, limited service health organizations and preferred provider plans are subject to s. 632.895 (13).

27,4804c Section 4804c. 609.78 of the statutes is created to read:

609.78 Coverage of treatment for the correction of temporomandibular disorders. Health maintenance organizations, limited service health organizations and preferred provider plans are subject to s. 632.895 (11).

27,4804e Section 4804e. 609.79 of the statutes is created to read:

609.79 Coverage of hospital and ambulatory surgery center charges and anesthetics for dental care. Health maintenance organizations, limited service health organizations and preferred provider plans are subject to s. 632.895 (12).

27,4808 Section 4808. 613.03 (3) of the statutes is amended to read:

613.03 (3) Applicability of insurance laws. Except as otherwise specifically provided, service insurance corporations organized or operating under this chapter are subject to subch. II of ch. 619 and ss. 610.01, 610.11, 610.21, 610.23 and 610.24 and chs. 600, 601, 609, 617, 620, 623, 625, 627, 628, 631, 632, 635 and 645 and to no other insurance laws.

27,4809 Section 4809 . 613.03 (4) of the statutes is created to read:

613.03 (4) Mandatory health insurance risk-sharing plan. Service insurance corporations organized or operating under this chapter are subject to ch. 149.

27,4810 Section 4810 . 614.05 (1) of the statutes is amended to read:

614.05 (1) Chapters 611 and 619. No section of ch. 611 or subch. I of ch. 619 applies to fraternals unless it is specifically made applicable by this chapter.

27,4811 Section 4811 . Subchapter I of chapter 619 [precedes 619.001] of the statutes is renumbered chapter 619 [precedes 619.001].

27,4812 Section 4812 . Subchapter I (title) of chapter 619 [precedes 619.01] of the statutes is repealed.

27,4813 Section 4813 . Subchapter II (title) of chapter 619 [precedes 619.10] of the statutes is repealed.

27,4814 Section 4814 . 619.10 (intro.) of the statutes is renumbered 149.10 (intro.) and amended to read:

149.10 Definitions. (intro.) In this subchapter chapter:

27,4815 Section 4815 . 619.10 (1) of the statutes is repealed.

27,4816 Section 4816 . 619.10 (1m) of the statutes is repealed.

27,4817 Section 4817 . 619.10 (2) of the statutes is renumbered 149.10 (2) and amended to read:

149.10 (2) “Board" means the board of governors established under s. 619.15 149.15.

27,4817b Section 4817b. 619.10 (2c) of the statutes is created to read:

619.10 (2c) “Church plan" has the meaning given in section 3 (33) of the federal Employee Retirement Income Security Act of 1974.

27,4817bm Section 4817bm. 619.10 (2c) of the statutes, as created by 1997 Wisconsin Act .... (this act), is renumbered 149.10 (2c).

27,4817c Section 4817c. 619.10 (2j) of the statutes is created to read:

619.10 (2j) (a) Except as provided in par. (b), “creditable coverage" means coverage under any of the following:

1. A group health plan.

2. Health insurance.

3. Part A or part B of title XVIII of the federal Social Security Act.

4. Title XIX of the federal Social Security Act, except for coverage consisting solely of benefits under section 1928 of that act.

5. Chapter 55 of title 10 of the United States Code.

6. A medical care program of the federal Indian health service or of an American Indian tribal organization.

7. A state health benefits risk pool.

8. A health plan offered under chapter 89 of title 5 of the United States Code.

9. A public health plan.

10. A health coverage plan under section 5 (e) of the federal Peace Corps Act, 22 USC 2504 (e).

(b) “Creditable coverage" does not include coverage consisting solely of coverage of excepted benefits, as defined in section 2791 (c) of P.L. 104-191.

27,4817cm Section 4817cm. 619.10 (2j) of the statutes, as created by 1997 Wisconsin Act .... (this act), is renumbered 149.10 (2j).

27,4817m Section 4817m. 619.10 (2t) of the statutes is created to read:

619.10 (2t) “Eligible individual" means an individual for whom all of the following apply:

(a) The aggregate of the individual's periods of creditable coverage is 18 months or more.

(b) The individual's most recent period of creditable coverage was under a group health plan, governmental plan, federal governmental plan or church plan, or under any health insurance offered in connection with any of those plans.

(c) The individual does not have creditable coverage and is not eligible for coverage under a group health plan, part A or part B of title XVIII of the federal Social Security Act or a state plan under title XIX of the federal Social Security Act or any successor program.

(d) The individual's most recent period of creditable coverage was not terminated for any reason related to fraud or intentional misrepresentation of material fact or a failure to pay premiums.

(e) If the individual was offered the option of continuation coverage under a federal continuation provision or similar state program, the individual elected the continuation coverage.

(f) The individual has exhausted any continuation coverage under par. (e).

27,4817mm Section 4817mm. 619.10 (2t) of the statutes, as created by 1997 Wisconsin Act .... (this act), is renumbered 149.10 (2t).

27,4818 Section 4818 . 619.10 (3) of the statutes is renumbered 149.10 (3) and amended to read:

149.10 (3) “Eligible person" means a resident of this state who qualifies under s. 619.12 149.12 whether or not the person is legally responsible for the payment of medical expenses incurred on the person's behalf.

27,4818c Section 4818c. 619.10 (3c) of the statutes is created to read:

619.10 (3c) “Federal continuation provision" means any of the following:

(a) Section 4980B of the Internal Revenue Code of 1986, except for section 4980B (f) (1) of that code insofar as it relates to pediatric vaccines.

(b) Part 6 of subtitle B of title I of the federal Employee Retirement Income Security Act of 1974, except for section 609 of that act.

(c) Title XXII of P.L. 104-191.

27,4818cm Section 4818cm. 619.10 (3c) of the statutes, as created by 1997 Wisconsin Act .... (this act), is renumbered 149.10 (3c).

27,4818d Section 4818d. 619.10 (3d) of the statutes is created to read:

619.10 (3d) “Federal governmental plan" means a benefit program established or maintained for its employes by the government of the United States or by any agency or instrumentality of the government of the United States.

27,4818dm Section 4818dm. 619.10 (3d) of the statutes, as created by 1997 Wisconsin Act .... (this act), is renumbered 149.10 (3d).

27,4818g Section 4818g. 619.10 (3g) of the statutes is created to read:

619.10 (3g) “Governmental plan" has the meaning given under section 3 (32) of the federal Employee Retirement Income Security Act of 1974.

27,4818gm Section 4818gm. 619.10 (3g) of the statutes, as created by 1997 Wisconsin Act .... (this act), is renumbered 149.10 (3g).

27,4818j Section 4818j. 619.10 (3j) of the statutes is created to read:

619.10 (3j) “Group health plan" means any of the following:

(a) An employe welfare plan, as defined in section 3 (1) of the federal Employee Retirement Security Act of 1974, to the extent that the employe welfare plan provides medical care, including items and services paid for as medical care, to employes or to their dependents, as defined under the terms of the employe welfare plan, directly or through insurance, reimbursement or otherwise.

(b) Any program that would not otherwise be an employe welfare benefit plan and that is established or maintained by a partnership, to the extent that the program provides medical care, including items and services paid for as medical care, to present or former partners of the partnership or to their dependents, as defined under the terms of the program, directly or through insurance, reimbursement or otherwise.

27,4818jm Section 4818jm. 619.10 (3j) of the statutes, as created by 1997 Wisconsin Act .... (this act), is renumbered 149.10 (3j).

27,4819 Section 4819 . 619.10 (3m) and (4) of the statutes are renumbered 149.10 (3m) and (4).

27,4820 Section 4820 . 619.10 (4m) of the statutes is renumbered 149.10 (4m).

27,4821 Section 4821 . 619.10 (5) of the statutes is renumbered 149.10 (5) and amended to read:

149.10 (5) “Insurer" means any person or association of persons, including a health maintenance organization, limited service health organization or preferred provider plan offering or insuring health services on a prepaid basis, including, but not limited to, policies of health insurance issued by a currently licensed insurer, as defined in s. 600.03 (27), nonprofit hospital or medical service plans under ch. 613, cooperative medical service plans under s. 185.981, or other entity whose primary function is to provide diagnostic, therapeutic or preventive services to a defined population in return for a premium paid on a periodic basis. “Insurer" includes any person providing health services coverage for individuals on a self-insurance basis without the intervention of other entities, as well as any person providing health insurance coverage under a medical reimbursement plan to persons. “Insurer" does not include a plan under ch. 613 which offers only dental care.

27,4822 Section 4822 . 619.10 (6) and (7) of the statutes are renumbered 149.10 (6) and (7).

27,4823 Section 4823 . 619.10 (8) of the statutes is renumbered 149.10 (8) and amended to read:

149.10 (8) “Plan" means the health care insurance plan established and administered under this subchapter chapter.

27,4824 Section 4824 . 619.10 (9) of the statutes is renumbered 149.10 (9) and amended to read:

149.10 (9) “Resident" means a person who has been legally domiciled in this state for a period of at least 30 days or, with respect to an eligible individual, an individual who resides in this state. For purposes of this subchapter chapter, legal domicile is established by living in this state and obtaining a Wisconsin motor vehicle operator's license, registering to vote in Wisconsin or filing a Wisconsin income tax return. A child is legally domiciled in this state if the child lives in this state and if at least one of the child's parents or the child's guardian is legally domiciled in this state. A person with a developmental disability or another disability which prevents the person from obtaining a Wisconsin motor vehicle operator's license, registering to vote in Wisconsin, or filing a Wisconsin income tax return, is legally domiciled in this state by living in this state for 30 days.

27,4825 Section 4825 . 619.11 of the statutes is renumbered 149.11 and amended to read:

149.11 (title) Establishment Operation of plan. The commissioner department shall promulgate rules establishing for the operation of a plan of health insurance coverage for an eligible person which satisfies the requirements of this chapter.

27,4825c Section 4825c. 619.115 of the statutes is created to read:

619.115 Rules relating to creditable coverage. The commissioner shall promulgate rules that specify how creditable coverage is to be aggregated for purposes of s. 619.10 (2t) (a) and that determine the creditable coverage to which s. 619.10 (2t) (b) and (d) applies. The rules shall comply with section 2701 (c) of P.L. 104-191.