AB365-SSA2-SA2,27 12Section 27. 632.746 (5) of the statutes is repealed.
AB365-SSA2-SA2,28 13Section 28. 632.746 (8) (a) (intro.) of the statutes is amended to read:
AB365-SSA2-SA2,8,1714 632.746 (8) (a) (intro.) A health maintenance organization that offers a group
15health benefit plan and that does not impose any preexisting condition exclusion
16under sub. (1)
with respect to a particular coverage option may impose an affiliation
17period for that coverage option, but only if all of the following apply:
AB365-SSA2-SA2,29 18Section 29. 632.76 (2) (a) and (ac) 1. and 2. of the statutes are amended to read:
AB365-SSA2-SA2,9,219 632.76 (2) (a) No claim for loss incurred or disability commencing after 2 years
20from the date of issue of the policy may be reduced or denied on the ground that a
21disease or physical condition existed prior to the effective date of coverage, unless the
22condition was excluded from coverage by name or specific description by a provision
23effective on the date of loss. This paragraph does not apply to a group health benefit
24plan, as defined in s. 632.745 (9), which is subject to s. 632.746 , a disability insurance

1policy, as defined in s. 632.895 (1) (a), or a self-insured health plan, as defined in s.
2632.85 (1) (c)
.
AB365-SSA2-SA2,9,83 (ac) 1. Notwithstanding par. (a), no No claim or loss incurred or disability
4commencing after 12 months from the date of issue of under an individual disability
5insurance policy, as defined in s. 632.895 (1) (a), may be reduced or denied on the
6ground that a disease or physical condition existed prior to the effective date of
7coverage, unless the condition was excluded from coverage by name or specific
8description by a provision effective on the date of the loss
.
AB365-SSA2-SA2,9,149 2. Except as provided in subd. 3., an An individual disability insurance policy,
10as defined in s. 632.895 (1) (a), other than a short-term policy subject to s. 632.7495
11(4) and (5),
may not define a preexisting condition more restrictively than a condition,
12whether physical or mental, regardless of the cause of the condition, for which
13medical advice, diagnosis, care, or treatment was recommended or received within
1412 months before the effective date of coverage
.
AB365-SSA2-SA2,30 15Section 30. 632.76 (2) (ac) 3. of the statutes is repealed.
AB365-SSA2-SA2,31 16Section 31. 632.795 (4) (a) of the statutes is amended to read:
AB365-SSA2-SA2,9,2517 632.795 (4) (a) An insurer subject to sub. (2) shall provide coverage under the
18same policy form and for the same premium as it originally offered in the most recent
19enrollment period, subject only to the medical underwriting used in that enrollment
20period. Unless otherwise prescribed by rule, the insurer may apply deductibles,
21preexisting condition limitations, waiting periods , or other limits only to the extent
22that they would have been applicable had coverage been extended at the time of the
23most recent enrollment period and with credit for the satisfaction or partial
24satisfaction of similar provisions under the liquidated insurer's policy or plan. The
25insurer may exclude coverage of claims that are payable by a solvent insurer under

1insolvency coverage required by the commissioner or by the insurance regulator of
2another jurisdiction. Coverage shall be effective on the date that the liquidated
3insurer's coverage terminates.
AB365-SSA2-SA2,32 4Section 32. 632.883 of the statutes is created to read:
AB365-SSA2-SA2,10,8 5632.883 Lifetime and annual limits. (1) No group or individual disability
6insurance policy, as defined in s. 632.895 (1) (a), and no self-insured health plan, as
7defined in s. 632.745 (24), may impose a lifetime limit on the dollar value of benefits
8provided under the policy or plan.
AB365-SSA2-SA2,10,11 9(2) No group or individual disability insurance policy, as defined in s. 632.895
10(1) (a), and no self-insured health plan, as defined in s. 632.745 (24), may impose an
11annual limit on the dollar value of benefits under the policy or plan.
AB365-SSA2-SA2,33 12Section 33. 632.895 (8) (d) of the statutes is amended to read:
AB365-SSA2-SA2,10,1913 632.895 (8) (d) Coverage is required under this subsection despite whether the
14woman shows any symptoms of breast cancer. Except as provided in pars. (b), (c), and
15(e), coverage under this subsection may only be subject to exclusions and limitations,
16including deductibles, copayments and restrictions on excessive charges, that are
17applied to other radiological examinations covered under the disability insurance
18policy. Coverage under this subsection may not be subject to any deductibles,
19copayments, or coinsurance.
AB365-SSA2-SA2,34 20Section 34. 632.895 (13m) of the statutes is created to read:
AB365-SSA2-SA2,10,2221 632.895 (13m) Preventive services. (a) In this section, “self-insured health
22plan” has the meaning given in s. 632.85 (1) (c).
AB365-SSA2-SA2,10,2423 (b) Every disability insurance policy and every self-insured health plan shall
24provide coverage for all of the following preventive services:
AB365-SSA2-SA2,10,2525 1. Mammography in accordance with sub. (8).
AB365-SSA2-SA2,11,2
12. Genetic breast cancer screening and counseling and preventive medication
2for adult women at high risk for breast cancer.
AB365-SSA2-SA2,11,43 3. Papanicolaou test for cancer screening for women 21 years of age or older
4with an intact cervix.
AB365-SSA2-SA2,11,65 4. Human papillomavirus testing for women who have attained the age of 30
6years but have not attained the age of 66 years.
AB365-SSA2-SA2,11,77 5. Colorectal cancer screening in accordance with sub. (16m).
AB365-SSA2-SA2,11,108 6. Annual tomography for lung cancer screening for adults who have attained
9the age of 55 years but have not attained the age of 80 years and who have health
10histories demonstrating a risk for lung cancer.
AB365-SSA2-SA2,11,1211 7. Skin cancer screening for individuals who have attained the age of 10 years
12but have not attained the age of 22 years.
AB365-SSA2-SA2,11,1413 8. Counseling for skin cancer prevention for adults who have attained the age
14of 18 years but have not attained the age of 25 years.
AB365-SSA2-SA2,11,1615 9. Abdominal aortic aneurysm screening for men who have attained the age of
1665 years but have not attained the age of 75 years and who have ever smoked.
AB365-SSA2-SA2,11,1917 10. Hypertension screening for adults and blood pressure testing for adults, for
18children under the age of 3 years who are at high risk for hypertension, and for
19children 3 years of age or older.
AB365-SSA2-SA2,11,2220 11. Lipid disorder screening for minors 2 years of age or older, high risk women
2120 years of age or older, men age 20 years of age or older at high risk for lipid
22disorders, and all men 35 years of age or older.
AB365-SSA2-SA2,11,2523 12. Aspirin therapy for cardiovascular health for adults who have attained the
24age of 55 years but have not attained the age of 80 years and for men who have
25attained the age of 45 years but have not attained the age of 55 years.
AB365-SSA2-SA2,12,2
113. Behavioral counseling for cardiovascular health for adults who are
2overweight or obese and who have risk factors for cardiovascular disease.
AB365-SSA2-SA2,12,33 14. Type II diabetes screening for adults with elevated blood pressure.
AB365-SSA2-SA2,12,54 15. Depression screening for minors 11 years of age or older and for adults when
5follow-up supports are available.
AB365-SSA2-SA2,12,76 16. Hepatitis B screening for minors at high risk for infection and adults at high
7risk for infection.
AB365-SSA2-SA2,12,98 17. Hepatitis C screening for adults at high risk for infection and one time
9hepatitis C screening for adults born in 1945 to 1965.
AB365-SSA2-SA2,12,1310 18. Obesity screening and management for all minors and adults with a body
11mass index indicating obesity, counseling and behavioral interventions for obese
12minors who are 6 years of age or older, and referral for intervention for obesity for
13adults with a body mass index of 30 kilograms per square meter or higher.
AB365-SSA2-SA2,12,1514 19. Osteoporosis screening for all women 65 years of age or older and for women
15at high risk for osteoporosis under the age of 65 years.
AB365-SSA2-SA2,12,1616 20. Immunizations in accordance with sub. (14).
AB365-SSA2-SA2,12,1917 21. Anemia screening for individuals 6 months of age or older and iron
18supplements for individuals at high risk for anemia and who have attained the age
19of 6 months but have not attained the age of 12 months.
AB365-SSA2-SA2,12,2120 22. Fluoride varnish for prevention of tooth decay for minors at the age of
21eruption of their primary teeth.
AB365-SSA2-SA2,12,2322 23. Fluoride supplements for prevention of tooth decay for minors 6 months of
23age or older who do not have fluoride in their water source.
AB365-SSA2-SA2,12,2424 24. Gonorrhea prophylaxis treatment for newborns.
AB365-SSA2-SA2,12,2525 25. Health history and physical exams for prenatal visits and for minors.
AB365-SSA2-SA2,13,2
126. Length and weight measurements for newborns and height and weight
2measurements for minors.
AB365-SSA2-SA2,13,43 27. Head circumference and weight for length measurements for newborns and
4minors who have not attained the age of 3 years.
AB365-SSA2-SA2,13,55 28. Body mass index for minors 2 years of age or older.
AB365-SSA2-SA2,13,76 29. Blood pressure measurements for minors 3 years of age or older and a blood
7pressure risk assessment at birth.
AB365-SSA2-SA2,13,98 30. Risk assessment and referral for oral health issues for minors who have
9attained the age of 6 months but have not attained the age of 7 years.
AB365-SSA2-SA2,13,1110 31. Blood screening for newborns and minors who have not attained age 2
11months.
AB365-SSA2-SA2,13,1212 32. Screening for critical congenital health defect for newborns.
AB365-SSA2-SA2,13,1313 33. Lead screenings in accordance with sub. (10).
AB365-SSA2-SA2,13,1514 34. Metabolic and hemoglobin screening and screening for phenylketonuria,
15sickle cell anemia, and congenital hypothyroidism for minors including newborns.
AB365-SSA2-SA2,13,1716 35. Tuberculin skin test based on risk assessment for minors one month of age
17or older.
AB365-SSA2-SA2,13,1918 36. Tobacco counseling and cessation interventions for individuals who are 5
19years of age or older.
AB365-SSA2-SA2,13,2120 37. Vision and hearing screening and assessment for minors including
21newborns.
AB365-SSA2-SA2,13,2322 38. Sexually transmitted infection and human immunodeficiency virus
23counseling for sexually active minors.
AB365-SSA2-SA2,14,3
139. Risk assessment for sexually transmitted infection for minors who are 10
2years of age or older and screening for sexually transmitted infection for minors who
3are 16 years of age or older.
AB365-SSA2-SA2,14,44 40. Alcohol misuse screening and counseling for minors 11 years of age or older.
AB365-SSA2-SA2,14,65 41. Autism screening for minors who have attained the age of 18 months but
6have not attained the age of 25 months.
AB365-SSA2-SA2,14,77 42. Developmental screening and surveillance for minors including newborns.
AB365-SSA2-SA2,14,88 43. Psychosocial and behavioral assessment for minors including newborns.
AB365-SSA2-SA2,14,109 44. Alcohol misuse screening and counseling for pregnant adults and a risk
10assessment for all adults.
AB365-SSA2-SA2,14,1211 45. Fall prevention and counseling and preventive medication for fall
12prevention for community-dwelling adults 65 years of age or older.
AB365-SSA2-SA2,14,1313 46. Screening and counseling for intimate partner violence for adult women.
AB365-SSA2-SA2,14,1614 47. Well-woman visits for women who have attained the age of 18 years but
15have not attained the age of 65 years and well-woman visits for recommended
16preventive services, preconception care, and prenatal care.
AB365-SSA2-SA2,14,1817 48. Counseling on, consultations with a trained provider on, and equipment
18rental for breastfeeding for pregnant and lactating women.
AB365-SSA2-SA2,14,1919 49. Folic acid supplement for adult women with reproductive capacity.
AB365-SSA2-SA2,14,2020 50. Iron deficiency anemia screening for pregnant and lactating women.
AB365-SSA2-SA2,14,2221 51. Preeclampsia preventive medicine for pregnant adult women at high risk
22for preeclampsia.
AB365-SSA2-SA2,14,2423 52. Low-dose aspirin after 12 weeks of gestation for pregnant women at high
24risk for miscarriage, preeclampsia, or clotting disorders.
AB365-SSA2-SA2,14,2525 53. Screenings for hepatitis B and bacteriuria for pregnant women.
AB365-SSA2-SA2,15,2
154. Screening for gonorrhea for pregnant and sexually active females 24 years
2of age or younger and females older than 24 years of age who are at risk for infection.
AB365-SSA2-SA2,15,53 55. Screening for chlamydia for pregnant and sexually active females 24 years
4of age and younger and females older than 24 years of age who are at risk for
5infection.
AB365-SSA2-SA2,15,76 56. Screening for syphilis for pregnant women and adults who are at high risk
7for infection.
AB365-SSA2-SA2,15,108 57. Human immunodeficiency virus screening for adults who have attained the
9age of 15 years but have not attained the age of 66 years and individuals at high risk
10of infection who are younger than 15 years of age or older than 65 years of age.
AB365-SSA2-SA2,15,1111 58. All contraceptives and services in accordance with sub. (17).
AB365-SSA2-SA2,15,1312 59. Any services not already specified under this paragraph having an A or B
13rating in current recommendations from the U.S. Preventive Services Task Force.
AB365-SSA2-SA2,15,1614 60. Any preventive services not already specified under this paragraph that are
15recommended by the federal health resources and services administration's Bright
16Futures project.
AB365-SSA2-SA2,15,1917 61. Any immunizations, not already specified under sub. (14), that are
18recommended and determined to be for routine use by the Advisory Committee on
19Immunization Practices.
AB365-SSA2-SA2,15,2220 (c) Subject to par. (d), no disability insurance policy and no self-insured health
21plan may subject the coverage of any of the preventive services under par. (b) to any
22deductibles, copayments, or coinsurance under the policy or plan.
AB365-SSA2-SA2,16,223 (d) 1. If an office visit and a preventive service specified under par. (b) are billed
24separately by the health care provider, the disability insurance policy or self-insured

1health plan may apply deductibles to and impose copayments or coinsurance on the
2office visit but not on the preventive service.
AB365-SSA2-SA2,16,53 2. If the primary reason for an office visit is not to obtain a preventive service,
4the disability insurance policy or self-insured health plan may apply deductibles to
5and impose copayments or coinsurance on the office visit.
AB365-SSA2-SA2,16,146 3. If a preventive service specified under par. (b) is provided by a health care
7provider that is outside the disability insurance policy's or self-insured health plan's
8network of providers, the policy or plan may apply deductibles to and impose
9copayments or coinsurance on the office visit and the preventive service. If a
10preventive service specified under par. (b) is provided by a health care provider that
11is outside the disability insurance policy's or self-insured health plan's network of
12providers because there is no available health care provider in the policy's or plan's
13network of providers that provides the preventive service, the policy or plan may not
14apply deductibles to or impose copayments or coinsurance on preventive service.
AB365-SSA2-SA2,16,1915 4. If multiple well-woman visits described under par. (b) 47. are required to
16fulfill all necessary preventive services and are in accordance with clinical
17recommendations, the disability insurance policy or self-insured health plan may
18not apply a deductible or impose a copayment or coinsurance to any of those
19well-woman visits.
AB365-SSA2-SA2,35 20Section 35. 632.895 (14) (a) 1. i. and j. of the statutes are amended to read:
AB365-SSA2-SA2,16,2121 632.895 (14) (a) 1. i. Hepatitis A and B.
AB365-SSA2-SA2,16,2222 j. Varicella and herpes zoster.
AB365-SSA2-SA2,36 23Section 36. 632.895 (14) (a) 1. k. to o. of the statutes are created to read:
AB365-SSA2-SA2,16,2424 632.895 (14) (a) 1. k. Human papillomavirus.
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