AB365-SSA2-SA2,1,9 9 Section 1. 40.51 (8) of the statutes is amended to read:
AB365-SSA2-SA2,2,210 40.51 (8) Every health care coverage plan offered by the state under sub. (6)
11shall comply with ss. 631.89, 631.90, 631.93 (2), 631.95, 632.72 (2), 632.728, 632.746
12(1) to (8) and (10), 632.747, 632.748, 632.798, 632.83, 632.835, 632.85, 632.853,

1632.855, 632.867, 632.87 (3) to (6), 632.883, 632.885, 632.89, 632.895 (5m) and (8) to
2(17), and 632.896.
AB365-SSA2-SA2,2 3Section 2. 40.51 (8m) of the statutes is amended to read:
AB365-SSA2-SA2,2,74 40.51 (8m) Every health care coverage plan offered by the group insurance
5board under sub. (7) shall comply with ss. 631.95, 632.728, 632.746 (1) to (8) and (10),
6632.747, 632.748, 632.798, 632.83, 632.835, 632.85, 632.853, 632.855, 632.867,
7632.883, 632.885, 632.89, and 632.895 (11) (8) and (10) to (17).
AB365-SSA2-SA2,3 8Section 3. 49.45 (23) (a) of the statutes is amended to read:
AB365-SSA2-SA2,2,169 49.45 (23) (a) The department shall request a waiver from the secretary of the
10federal department of health and human services to permit the department to
11conduct a demonstration project to provide health care coverage to adults who are
12under the age of 65, who have family incomes not to exceed 100 133 percent of the
13poverty line before application of the 5 percent income disregard under 42 CFR
14435.603 (d)
, except as provided in s. 49.471 (4g), and who are not otherwise eligible
15for medical assistance under this subchapter, the Badger Care health care program
16under s. 49.665, or Medicare under 42 USC 1395 et seq.
AB365-SSA2-SA2,4 17Section 4. 49.471 (1) (cr) of the statutes is created to read:
AB365-SSA2-SA2,2,1918 49.471 (1) (cr) “Enhanced federal medical assistance percentage" means a
19federal medical assistance percentage described under 42 USC 1396d (y) or (z).
AB365-SSA2-SA2,5 20Section 5. 49.471 (4) (a) 4. b. of the statutes is amended to read:
AB365-SSA2-SA2,2,2321 49.471 (4) (a) 4. b. The Except as provided in sub. (4g), the individual's family
22income does not exceed 100 133 percent of the poverty line before application of the
235 percent income disregard under 42 CFR 435.603 (d)
.
AB365-SSA2-SA2,6 24Section 6. 49.471 (4g) of the statutes is created to read:
AB365-SSA2-SA2,3,9
149.471 (4g) Medicaid expansion; federal medical assistance percentage. (a)
2For services provided to individuals described under sub. (4) (a) 4. and s. 49.45 (23),
3the department shall comply with all federal requirements to qualify for the highest
4available enhanced federal medical assistance percentage. The department shall
5submit any amendment to the state medical assistance plan, request for a waiver of
6federal Medicaid law, or other approval request required by the federal government
7to provide services to the individuals described under sub. (4) (a) 4. and s. 49.45 (23)
8and qualify for the highest available enhanced federal medical assistance
9percentage.
AB365-SSA2-SA2,3,2110 (b) If the department does not qualify for an enhanced federal medical
11assistance percentage, or if the enhanced federal medical assistance percentage
12obtained by the department is lower than printed in federal law as of July 1, 2013,
13for individuals eligible under sub. (4) (a) 4. or s. 49.45 (23), the department shall
14submit to the joint committee on finance a fiscal analysis comparing the cost to
15maintain coverage for adults who are not pregnant and not elderly with family
16incomes of up to 133 percent of the poverty line to the cost of limiting eligibility to
17those adults with family incomes of up to 100 percent of the poverty line. The
18department may reduce income eligibility for adults who are not pregnant and not
19elderly from family incomes of up to 133 percent of the poverty line to family incomes
20of up to 100 percent of the poverty line only if this reduction in income eligibility
21levels is approved by the joint committee on finance.
AB365-SSA2-SA2,7 22Section 7. 66.0137 (4) of the statutes, as affected by 2017 Wisconsin Act 30,
23is amended to read:
AB365-SSA2-SA2,4,524 66.0137 (4) Self-insured health plans. If a city, including a 1st class city, or
25a village provides health care benefits under its home rule power, or if a town

1provides health care benefits, to its officers and employees on a self-insured basis,
2the self-insured plan shall comply with ss. 49.493 (3) (d), 631.89, 631.90, 631.93 (2),
3632.728, 632.746 (1) and (10) (a) 2. and (b) 2., 632.747 (3), 632.798, 632.85, 632.853,
4632.855, 632.867, 632.87 (4) to (6), 632.883, 632.885, 632.89, 632.895 (9) (8) to (17),
5632.896, and 767.513 (4).
AB365-SSA2-SA2,8 6Section 8. 120.13 (2) (g) of the statutes, as affected by 2017 Wisconsin Act 30,
7is amended to read:
AB365-SSA2-SA2,4,118 120.13 (2) (g) Every self-insured plan under par. (b) shall comply with ss.
949.493 (3) (d), 631.89, 631.90, 631.93 (2), 632.728, 632.746 (1) and (10) (a) 2. and (b)
102., 632.747 (3), 632.798, 632.85, 632.853, 632.855, 632.867, 632.87 (4) to (6), 632.883,
11632.885, 632.89, 632.895 (9) (8) to (17), 632.896, and 767.513 (4).
AB365-SSA2-SA2,9 12Section 9. 185.983 (1) (intro.) of the statutes is amended to read:
AB365-SSA2-SA2,4,2013 185.983 (1) (intro.) Every voluntary nonprofit health care plan operated by a
14cooperative association organized under s. 185.981 shall be exempt from chs. 600 to
15646, with the exception of ss. 601.04, 601.13, 601.31, 601.41, 601.42, 601.43, 601.44,
16601.45, 611.26, 611.67, 619.04, 623.11, 623.12, 628.34 (10), 631.17, 631.89, 631.93,
17631.95, 632.72 (2), 632.728, 632.745 to 632.749, 632.775, 632.79, 632.795, 632.798,
18632.85, 632.853, 632.855, 632.867, 632.87 (2) to (6), 632.883, 632.885, 632.89,
19632.895 (5) and (8) to (17), 632.896, and 632.897 (10) and chs. 609, 620, 630, 635, 645,
20and 646, but the sponsoring association shall:
AB365-SSA2-SA2,10 21Section 10. 609.713 of the statutes is created to read:
AB365-SSA2-SA2,4,23 22609.713 Essential health benefits. Defined network plans and preferred
23provider plans are subject to s. 632.895 (14m).
AB365-SSA2-SA2,11 24Section 11. 609.845 of the statutes is created to read:
AB365-SSA2-SA2,5,2
1609.845 Lifetime and annual limits. Limited service health organizations,
2preferred provider plans, and defined network plans are subject to s. 632.883.
AB365-SSA2-SA2,12 3Section 12. 609.847 of the statutes is created to read:
AB365-SSA2-SA2,5,6 4609.847 Preexisting condition discrimination prohibited. Limited
5service health organizations, preferred provider plans, and defined network plans
6are subject to s. 632.728.
AB365-SSA2-SA2,13 7Section 13. 609.896 of the statutes is created to read:
AB365-SSA2-SA2,5,9 8609.896 Preventive services. Defined network plans and preferred provider
9plans are subject to s. 632.895 (13m).
AB365-SSA2-SA2,14 10Section 14. 625.12 (1) (a) of the statutes is amended to read:
AB365-SSA2-SA2,5,1211 625.12 (1) (a) Past and prospective loss and expense experience within and
12outside of this state, except as provided in s. 632.728.
AB365-SSA2-SA2,15 13Section 15. 625.12 (1) (e) of the statutes is amended to read:
AB365-SSA2-SA2,5,1514 625.12 (1) (e) Subject to s. ss. 632.365 and 632.728, all other relevant factors,
15including the judgment of technical personnel.
AB365-SSA2-SA2,16 16Section 16. 625.12 (2) of the statutes is amended to read:
AB365-SSA2-SA2,5,2517 625.12 (2) Classification. Risks Except as provided in s. 632.728, risks may
18be classified in any reasonable way for the establishment of rates and minimum
19premiums, except that no classifications may be based on race, color, creed or
20national origin, and classifications in automobile insurance may not be based on
21physical condition or developmental disability as defined in s. 51.01 (5). Subject to
22s. ss. 632.365 and 632.728, rates thus produced may be modified for individual risks
23in accordance with rating plans or schedules that establish reasonable standards for
24measuring probable variations in hazards, expenses, or both. Rates may also be
25modified for individual risks under s. 625.13 (2).
AB365-SSA2-SA2,17
1Section 17. 625.15 (1) of the statutes is amended to read:
AB365-SSA2-SA2,6,92 625.15 (1) Rate making. An Except as provided in s. 632.728, an insurer may
3itself establish rates and supplementary rate information for one or more market
4segments based on the factors in s. 625.12 and, if the rates are for motor vehicle
5liability insurance, subject to s. 632.365, or the insurer may use rates and
6supplementary rate information prepared by a rate service organization, with
7average expense factors determined by the rate service organization or with such
8modification for its own expense and loss experience as the credibility of that
9experience allows.
AB365-SSA2-SA2,18 10Section 18. 628.34 (3) (a) of the statutes is amended to read:
AB365-SSA2-SA2,6,1711 628.34 (3) (a) No insurer may unfairly discriminate among policyholders by
12charging different premiums or by offering different terms of coverage except on the
13basis of classifications related to the nature and the degree of the risk covered or the
14expenses involved, subject to ss. 632.365, 632.728, 632.746 and 632.748. Rates are
15not unfairly discriminatory if they are averaged broadly among persons insured
16under a group, blanket or franchise policy, and terms are not unfairly discriminatory
17merely because they are more favorable than in a similar individual policy.
AB365-SSA2-SA2,19 18Section 19. 632.728 of the statutes is created to read:
AB365-SSA2-SA2,6,20 19632.728 Coverage of persons with preexisting conditions; guaranteed
20issue.
(1) Definitions. In this section:
AB365-SSA2-SA2,6,2121 (a) “Disability insurance policy” has the meaning given in s. 632.895 (1) (a).
AB365-SSA2-SA2,6,2222 (b) “Self-insured health plan” has the meaning given in s. 632.85 (1) (c).
AB365-SSA2-SA2,7,3 23(2) Guaranteed issue. Every individual disability insurance policy shall accept
24every individual and every group disability insurance policy shall accept every
25employer in this state that applies for coverage, regardless of whether or not any

1employee or individual has a preexisting condition. A disability insurance policy
2may restrict enrollment in coverage described in this subsection to open or special
3enrollment periods.
AB365-SSA2-SA2,7,10 4(3) Rate setting and cost-sharing discrimination prohibited. For the purpose
5of setting rates or premiums for coverage under a group or individual disability
6insurance policy or a self-insured health plan and for the purpose of setting any
7deductibles, copayments, or coinsurance under a group or individual disability
8insurance policy or a self-insured health plan, the policy or plan may not consider
9whether an individual, including a dependent, who would be covered under the plan
10has a preexisting condition.
AB365-SSA2-SA2,7,18 11(4) Short-term plans. This section and ss. 632.746 and 632.76 apply to every
12short-term, limited-duration health insurance policy. In this subsection,
13“short-term, limited-duration health insurance policy” means health coverage that
14is provided under a contract with an insurer, has an expiration date specified in the
15contract that is less than 12 months after the original effective date of the contract,
16and, taking into account renewals or extensions, has a duration of no longer than 36
17months in total. “Short-term, limited-duration health insurance policy” includes
18any short-term policy subject to s. 632.7495 (4).
AB365-SSA2-SA2,20 19Section 20. 632.746 (1) (a) of the statutes is renumbered 632.746 (1) and
20amended to read:
AB365-SSA2-SA2,8,221 632.746 (1) Subject to subs. (2) and (3), an An insurer that offers a group health
22benefit plan may, with respect to a participant or beneficiary under the plan, not
23impose a preexisting condition exclusion only if the exclusion relates to a condition,
24whether physical or mental, regardless of the cause of the condition, for which
25medical advice, diagnosis, care or treatment was recommended or received within

1the 6-month period ending on the participant's or beneficiary's enrollment date
2under the plan
on a participant or beneficiary under the plan.
AB365-SSA2-SA2,21 3Section 21. 632.746 (1) (b) of the statutes is repealed.
AB365-SSA2-SA2,22 4Section 22. 632.746 (2) (a) of the statutes is amended to read:
AB365-SSA2-SA2,8,75 632.746 (2) (a) An insurer offering a group health benefit plan may not treat
6genetic information as a preexisting condition under sub. (1) without a diagnosis of
7a condition related to the information
.
AB365-SSA2-SA2,23 8Section 23. 632.746 (2) (c), (d) and (e) of the statutes are repealed.
AB365-SSA2-SA2,24 9Section 24. 632.746 (3) (a) of the statutes is repealed.
AB365-SSA2-SA2,25 10Section 25. 632.746 (3) (d) 1. of the statutes is renumbered 632.746 (3) (d).
AB365-SSA2-SA2,26 11Section 26. 632.746 (3) (d) 2. and 3. of the statutes are repealed.
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.
Loading...
Loading...