LRBs0135/1
PJK:kjf:cph
2003 - 2004 LEGISLATURE
ASSEMBLY SUBSTITUTE AMENDMENT 1,
TO 2003 ASSEMBLY BILL 362
September 9, 2003 - Offered by
Committee on Insurance.
AB362-ASA1,1,3
1An Act to renumber and amend 632.895 (6);
to amend 632.81; and
to create
2632.895 (6) (b) of the statutes;
relating to: coverage of prescription drugs for
3the treatment of diabetes under Medicare supplement policies.
Analysis by the Legislative Reference Bureau
Under current law, health insurance policies that cover expenses for the
treatment of diabetes are required to provide coverage for the installation and use
of an insulin infusion pump, for all other equipment and supplies used in the
treatment of diabetes, including insulin and other prescription medication, and for
diabetic self-management education programs. The required coverage may be
subject to any exclusions, limitations, deductibles, and coinsurance provisions that
apply generally under the policy or plan, with the exception that insulin infusion
pump coverage may be limited to the purchase of one pump per year.
Medicare supplement policies are required by administrative rule to provide
coverage for at least 80% of the charges for prescription drugs after a drug deductible
of no more than $6,250 per calendar year. The requirement applies to coverage of
prescription drugs for the treatment of diabetes, also. This substitute amendment
provides that coverage of prescription medication for the treatment of diabetes under
a Medicare supplement policy may not be subject to any deductibles, copayments, or
coinsurance.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
AB362-ASA1,2,9
2632.81 Minimum standards for certain disability policies. The Subject
3to s. 632.895 (6) (b), the commissioner may by rule establish minimum standards for
4benefits, claims payments, marketing practices, compensation arrangements
, and
5reporting practices for
medicare Medicare supplement policies,
medicare Medicare 6replacement policies
, and long-term care insurance policies.
The Except as provided
7in s. 632.895 (6) (b), the commissioner may by rule exempt from the minimum
8standards certain types of coverage, if the commissioner finds the exemption is not
9adverse to the interests of policyholders and certificate holders.
AB362-ASA1, s. 2
10Section
2. 632.895 (6) of the statutes is renumbered 632.895 (6) (intro.) and
11amended to read:
AB362-ASA1,2,2012
632.895
(6) Equipment and supplies for treatment of diabetes. (intro.) Every
13disability insurance policy
which that provides coverage of expenses incurred for
14treatment of diabetes shall provide coverage for expenses incurred by the
15installation and use of an insulin infusion pump, coverage for all other equipment
16and supplies, including insulin or any other prescription medication, used in the
17treatment of diabetes, and coverage of diabetic self-management education
18programs. Coverage required under this subsection shall be subject to the same
19exclusions, limitations, deductibles, and coinsurance provisions of the policy as other
20covered expenses, except
that insulin as follows:
AB362-ASA1,3,3
1(a) Insulin infusion pump coverage may be limited to the purchase of one pump
2per year and the insurer may require the insured to use a pump for 30 days before
3purchase.
AB362-ASA1, s. 3
4Section
3. 632.895 (6) (b) of the statutes is created to read:
AB362-ASA1,3,75
632.895
(6) (b) If the policy is a Medicare supplement policy, coverage of
6prescription medication for the treatment of diabetes may not be subject to any
7deductibles, copayments, or coinsurance.
AB362-ASA1,3,109
(1) This act first applies to Medicare supplement policies that are issued or
10renewed on the effective date of this subsection.
AB362-ASA1,3,1312
(1)
This act takes effect on the first day of the 4th month beginning after
13publication.
