AB1-SSA1,13,14 143. "Covered person" means a person who has coverage under the plan.
AB1-SSA1,13,15 154. "Medicare" has the meaning given in section 149.10 (7) of the statutes.
AB1-SSA1,13,17 165. "Medicare Advantage" has the meaning given in section INS 3.39 (3) (r),
17Wisconsin Administrative Code.
AB1-SSA1,13,19 186. "Medicare replacement policy" has the meaning given in section 600.03 (28p)
19of the statutes.
AB1-SSA1,13,21 207. "Medicare supplement policy" has the meaning given in section 600.03 (28r)
21of the statutes.
AB1-SSA1,13,22 228. "Office" means the office of the commissioner of insurance.
AB1-SSA1,13,24 239. "Plan" means the Health Insurance Risk-Sharing Plan under subchapter II
24of chapter 149 of the statutes.
AB1-SSA1,14,4
1(b) Extension of the plan and authority. Notwithstanding any statute,
2administrative rule, or provision of a policy or contract or of the plan to the contrary,
3the dissolution of the plan and the authority as provided in 2013 Wisconsin Act 20,
4section 9122 (1L), is modified as follows:
AB1-SSA1,14,6 51. `Coverage provisions.' Notwithstanding 2013 Wisconsin Act 20, section 9122
6(1L) (b)
1. b., all of the following apply:
AB1-SSA1,14,19 7a. A covered person whose coverage under the plan was in effect on December
81, 2013, who paid his or her December premium, and who, if eligible for Medicare,
9had not enrolled in Medicare Advantage during the federal open enrollment period
10in 2013 may elect to obtain a policy under the plan by making a timely payment of
11the January 2014 premium. The covered person must maintain the same policy
12benefits, including the same deductible amount, that were in effect on December 1,
132013. A new deductible period will commence on January 1, 2014. The premium for
14January 2014 must be paid no later than February 1, 2014. Thereafter, the covered
15person must pay premiums in accordance with the terms of the contract for coverage,
16which may not extend beyond 11:59 p.m. on March 31, 2014. Any medical claims that
17the covered person incurs after December 31, 2013, and before the plan receives the
18premium payment for January 2014 shall be held in abeyance and the plan shall not
19be responsible for payment until the premium payment is received.
AB1-SSA1,15,2 20b. If a covered person's coverage under the plan is funded under a contract with
21the federal department of health and human services, the covered person's coverage
22will end as provided in 2013 Wisconsin Act 20, section 9122 (1L) (b) 1. b., unless the
23federal department of health and human services issues a contract amendment that
24extends the contract and coverage to a date later than December 31, 2013, and the
25terms of the contract amendment are such that the federal government will be

1financially liable for all costs related to the operation of the contract that exceed
2member premium collections.
AB1-SSA1,15,17 3c. If the requirements under subdivision 1 . b. are satisfied, a covered person
4whose coverage is funded under a contract with the federal department of health and
5human services, whose coverage under the plan was in effect on December 1, 2013,
6who paid his or her December premium, and who had not enrolled in Medicare
7Advantage during the federal open enrollment period in 2013 may elect to obtain a
8policy under the plan by making a timely payment of the January 2014 premium.
9The covered person must maintain the same policy benefits, including the same
10deductible amount, that were in effect on December 1, 2013. A new deductible period
11will commence on January 1, 2014. The premium for January 2014 must be paid no
12later than February 1, 2014. Thereafter, the covered person must pay premiums in
13accordance with the terms of the contract for coverage, which may not extend beyond
1411:59 p.m. on March 31, 2014. Any medical claims that the covered person incurs
15after December 31, 2013, and before the plan receives the premium payment for
16January 2014 shall be held in abeyance and the plan shall not be responsible for
17payment until the premium payment is received.
AB1-SSA1,15,21 18d. No later than February 1, 2014, the authority shall provide notice that
19coverage shall terminate on March 31, 2014, to all covered persons, all insurers and
20providers that are affected by the termination of the coverage, the office, the
21legislative audit bureau, and the insurers described in paragraph (c) 1 .
AB1-SSA1,16,5 222. `Provider claims.' Providers of medical services and devices and prescription
23drugs to covered persons whose coverage is extended as provided in this paragraph
24must file claims for payment no later than June 1, 2014. Any claim filed after that
25date is not payable and may not be charged to the covered person who received the

1service, device, or drug. Except for copayments, coinsurance, or deductibles required
2under the plan, consistent with sections 149.14 (3) and 149.142 (2m) of the statutes,
3a provider may not bill a covered person who receives a covered service or article and
4shall accept as payment in full the payment rate determined under section 149.142
5(1) of the statutes.
AB1-SSA1,16,6 63. `Grievances and review.'
AB1-SSA1,16,9 7a. Any grievance by a covered person whose coverage is extended as provided
8in this paragraph must be in writing and received no later than July 1, 2014, or be
9barred.
AB1-SSA1,16,13 10b. A covered person whose coverage is extended as provided in this paragraph
11who submits a grievance after March 31, 2014, must request an independent review,
12if any, with respect to the grievance no later than August 1, 2014, or be barred from
13requesting an independent review with respect to the grievance.
AB1-SSA1,16,14 144. `Payment of plan costs.'
AB1-SSA1,16,18 15a. To the extent possible, the authority shall pay plan costs incurred in 2013
16and 2014 and all other costs associated with operating and dissolving the plan that
17are incurred before administrative responsibility for the dissolution of the plan is
18transferred to the office on February 28, 2014.
AB1-SSA1,16,19 19b. All provider claims shall be adjudicated by September 30, 2014.
AB1-SSA1,16,24 20c. The authority, before March 1, 2014, and the office, on and after March 1,
212014, but no later than July 1, 2014, shall determine whether an assessment of
22insurers under section 149.13 of the statutes is necessary to cover in full the plan's
23expenses related to operations, winding up operations, and dissolution of the plan.
24Any such assessment shall be based on the 2013 filed plan assessment form.
AB1-SSA1,17,5
1d. No later than 30 days before distribution of any surplus remaining after the
2dissolution of the plan, or within 30 days after completion of the dissolution of the
3plan if there is no surplus to distribute, the office shall submit a final report to the
4joint committee on finance on the operation and dissolution of the plan, including the
5proposed distribution of any remaining surplus.
AB1-SSA1,17,6 65. `Dissolution notice, claims, and updates.'
AB1-SSA1,17,16 7a. On behalf of the commissioner, the authority shall provide notice of the plan's
8dissolution to all persons known, or reasonably expected from the plan's records, to
9have claims against the plan, including all covered persons. Notwithstanding 2013
10Wisconsin Act 20
, section 9122 (1L) (b) 10. a., the notice shall be sent by 1st class mail
11to the last-known addresses no later than February 1, 2014. Notice to potential
12claimants of the plan shall require the claimants to file their claims, together with
13proofs of claims, by June 1, 2014. The notice shall be consistent with any relevant
14terms of the policies under the plan and contracts and with section 645.47 (1) (a) of
15the statutes. The notice shall serve as final notice consistent with section 645.47 (3)
16of the statutes.
AB1-SSA1,18,2 17b. Proofs of all claims must be filed with the office in the form provided by the
18office consistent with the proof of claim, as applicable, under section 645.62 of the
19statutes, on or before the last day for filing specified in the notice. For good cause
20shown, the office shall permit a claimant to make a late filing if the existence of the
21claim was not known to the claimant and the claimant files the claim within 30 days
22after learning of the claim, but not later than September 1, 2014. Any such late claim
23that would have been payable under the policy under the plan if it had been filed
24timely and that was not covered by a succeeding insurer shall be permitted unless

1the claimant had actual notice of the termination of the plan or the notice was mailed
2to the claimant by 1st class mail at least 10 days before the insured event occurred.
AB1-SSA1,18,33 (c) Medicare supplement and replacement policy issuance.
AB1-SSA1,18,7 41. In addition to the requirement under 2013 Wisconsin Act 20, section 9122
5(1m)
, an insurer offering a Medicare supplement policy or a Medicare replacement
6policy in this state shall provide coverage under the policy to any individual who
7satisfies all of the following:
AB1-SSA1,18,8 8a. The individual is eligible for Medicare.
AB1-SSA1,18,9 9b. The individual had coverage under the plan.
AB1-SSA1,18,10 10c. The individual's coverage under the plan terminated on March 31, 2014.
AB1-SSA1,18,12 11d. The individual applies for coverage under the policy before 63 days after the
12date specified in subdivision 1 . c.
AB1-SSA1,18,13 13e. The individual pays the premium for the coverage under the policy.
AB1-SSA1,18,16 142. An insurer under subdivision 1. may not deny coverage to any individual who
15satisfies the criteria under subdivision 1 . a. to e . on the basis of health status, receipt
16of health care, claims experience, or medical condition including disability.
AB1-SSA1,18,19 173. In addition to any other notice requirements to insurers, no later than
18February 1, 2014, the authority shall provide notice to the insurers described in
19subdivision 1. of the requirements under this paragraph.
AB1-SSA1,18,22 20(2m) Medical Assistance eligibility; temporary extension. Beginning on
21January 1, 2014, the department of health services shall do all of the following until
22April 1, 2014:
AB1-SSA1,19,323 (a) Allow individuals whose family income does not exceed 200 percent of the
24federal poverty line, who were receiving benefits under section 49.471 (4) (a) 4. or (b)
254. of the statutes on December 31, 2013, and who would otherwise be eligible for

1benefits under section 49.471 (4) (a) 4. of the statutes except for the income limit to
2be eligible to continue receiving benefits under section 49.471 (4) (a) 4. of the
3statutes.
AB1-SSA1,19,84 (b) Allow individuals whose family income does not exceed 200 percent of the
5federal poverty line, who were receiving benefits under section 49.45 (23) of the
6statutes as of December 31, 2013, and who would otherwise be eligible for benefits
7under section 49.45 (23) of the statutes except for the income limit to be eligible to
8continue receiving benefits under section 49.45 (23) of the statutes.
AB1-SSA1,33 9Section 33. Effective dates. This act takes effect on the day after publication,
10except as follows:
AB1-SSA1,19,1211 (1) Health Insurance Risk-Sharing Plan. The treatment of section 895.514
12(2) and (3) (a) and (b) of the statutes takes effect on January 1, 2015.
AB1-SSA1,19,1513 (2) Medical Assistance eligibility. The treatment of sections 49.45 (23) (a) (by
14Section 2) and 49.471 (1) (cr), (4) (a) 4. b., and (4g) of the statutes takes effect on
15January 1, 2014.
AB1-SSA1,19,1716 (3) Reconciliation with 2011 Wisconsin Act 32. The treatment of section 49.45
17(23) (a) (by Section 3 ) of the statutes takes effect on January 1, 2015.
Loading...
Loading...