AB365-SSA3,69 14Section 69. 177.075 (3) of the statutes is repealed.
AB365-SSA3,70 15Section 70. 230.03 (3) of the statutes is amended to read:
AB365-SSA3,25,2516 230.03 (3) “Agency" means any board, commission, committee, council, or
17department in state government or a unit thereof created by the constitution or
18statutes if such board, commission, committee, council, department, unit, or the
19head thereof, is authorized to appoint subordinate staff by the constitution or
20statute, except the Board of Regents of the University of Wisconsin System, a
21legislative or judicial board, commission, committee, council, department, or unit
22thereof or an authority created under subch. II of ch. 114 or subch. III of ch. 656 or
23under ch. 231, 232, 233, 234, 237, 238, or 279. “Agency" does not mean any local unit
24of government or body within one or more local units of government that is created
25by law or by action of one or more local units of government.
AB365-SSA3,71
1Section 71. 230.80 (4) of the statutes is amended to read:
AB365-SSA3,26,82 230.80 (4) “Governmental unit" means any association, authority, board,
3commission, department, independent agency, institution, office, society, or other
4body in state government created or authorized to be created by the constitution or
5any law, including the legislature, the office of the governor, and the courts, excluding
6the Health Insurance Risk-Sharing Plan Authority
. “Governmental unit" does not
7mean any political subdivision of the state or body within one or more political
8subdivisions that is created by law or by action of one or more political subdivisions.
AB365-SSA3,72 9Section 72. 230.90 (1) (c) of the statutes is amended to read:
AB365-SSA3,26,1710 230.90 (1) (c) “Governmental unit" means any association, authority, board,
11commission, department, independent agency, institution, office, society or other
12body in state government created or authorized to be created by the constitution or
13any law, including the legislature, the office of the governor and the courts.
14“Governmental unit" does not mean the University of Wisconsin Hospitals and
15Clinics Authority, the Health Insurance Risk-Sharing Plan Authority, or any
16political subdivision of the state or body within one or more political subdivisions
17which is created by law or by action of one or more political subdivisions.
AB365-SSA3,73 18Section 73 . 601.41 (1) of the statutes is amended to read:
AB365-SSA3,26,2219 601.41 (1) Duties. The commissioner shall administer and enforce chs. 600 to
20655 and ss. 59.52 (11) (c), 66.0137 (4) and (4m), 100.203, and 120.13 (2) (b) to (g), and
21656.15
and shall act as promptly as possible under the circumstances on all matters
22placed before the commissioner.
AB365-SSA3,74 23Section 74 . 601.415 (12) of the statutes is amended to read:
AB365-SSA3,27,3
1601.415 (12) Health Insurance Risk-Sharing Plan. The commissioner shall
2perform the duties specified to be performed by the commissioner in s. 149.13, 2011
3stats., and s. 656.15 and under 2013 Wisconsin Act 20, section 9122 (1L) (b) 8.
AB365-SSA3,75 4Section 75 . 601.64 (1) of the statutes is amended to read:
AB365-SSA3,27,115 601.64 (1) Injunctions and restraining orders. The commissioner may
6commence an action in circuit court in the name of the state to restrain by temporary
7or permanent injunction or by temporary restraining order any violation of chs. 600
8to 655 or s. 149.13, 2011 stats., or s. 656.15, any rule promulgated under chs. 600 to
9655, or any order issued under s. 601.41 (4). The commissioner need not show
10irreparable harm or lack of an adequate remedy at law in an action commenced
11under this subsection.
AB365-SSA3,76 12Section 76 . 601.64 (3) (a) of the statutes is amended to read:
AB365-SSA3,27,1613 601.64 (3) (a) Restitutionary forfeiture. Whoever violates an effective order
14issued under s. 601.41 (4), any insurance statute or rule, or s. 149.13, 2011 stats., or
15s. 656.15
shall forfeit to the state twice the amount of any profit gained from the
16violation, in addition to any other forfeiture or penalty imposed.
AB365-SSA3,77 17Section 77 . 601.64 (3) (c) of the statutes is amended to read:
AB365-SSA3,27,2518 601.64 (3) (c) Forfeiture for violation of statute or rule. Whoever violates an
19insurance statute or rule or s. 149.13, 2011 stats., or s. 656.15 intentionally aids a
20person in violating an insurance statute or rule or s. 149.13, 2011 stats., or s. 656.15
21or knowingly permits a person over whom he or she has authority to violate an
22insurance statute or rule or s. 149.13, 2011 stats., or s. 656.15 shall forfeit to the state
23not more than $1,000 for each violation. If the statute or rule imposes a duty to make
24a report to the commissioner, each week of delay in complying with the duty is a new
25violation.
AB365-SSA3,78
1Section 78. 601.64 (4) of the statutes is amended to read:
AB365-SSA3,28,72 601.64 (4) Criminal penalty. Whoever intentionally violates or intentionally
3permits any person over whom he or she has authority to violate or intentionally aids
4any person in violating any insurance statute or rule of this state, s. 149.13, 2011
5stats., or s. 656.15 or any effective order issued under s. 601.41 (4) is guilty of a Class
6I felony, unless a specific penalty is provided elsewhere in the statutes. Intent has
7the meaning expressed under s. 939.23.
AB365-SSA3,79 8Section 79. 613.03 (5) of the statutes is created to read:
AB365-SSA3,28,119 613.03 (5) Health Insurance Risk-Sharing Plan. Service insurance
10corporations organized or operating under this chapter are subject to the
11requirements that apply to insurers and insurance under ch. 656.
AB365-SSA3,80 12Section 80. 631.20 (1) (c) 5m. of the statutes is created to read:
AB365-SSA3,28,1313 631.20 (1) (c) 5m. A form filed under ch. 656.
AB365-SSA3,81 14Section 81. 631.20 (2) (g) of the statutes is created to read:
AB365-SSA3,28,1615 631.20 (2) (g) In the case of a policy form under ch. 656, that any of the following
16applies:
AB365-SSA3,28,1817 1. The benefit design is not comparable to a typical comprehensive individual
18health insurance policy offered in the private sector market in this state.
AB365-SSA3,28,2119 2. The benefit levels are not generally reflective of and commensurate with
20comprehensive health insurance coverage offered in the private individual market
21in this state.
AB365-SSA3,28,2322 3. The copayments, deductibles, and coinsurance are not actuarially equivalent
23to comprehensive individual plans and would create undue financial hardship.
AB365-SSA3,28,2524 4. It is inconsistent with the purpose of providing health care coverage to those
25unable to obtain coverage in the private market.
AB365-SSA3,82
1Section 82. 631.36 (7) (c) of the statutes is created to read:
AB365-SSA3,29,42 631.36 (7) (c) Notice of cancellation or nonrenewal required under sub. (2) (b)
3or (4) is not effective unless the notice contains the notice required under s. 632.784,
4if applicable.
AB365-SSA3,83 5Section 83. 632.7495 (4) (c) of the statutes is amended to read:
AB365-SSA3,29,136 632.7495 (4) (c) The coverage term aggregated with all consecutive periods of
7the insurer's coverage of the insured by individual health benefit plan coverage not
8required to be renewed under this subsection does not exceed 18 months. For
9purposes of this paragraph, coverage periods are consecutive if there are no more
10than 63 days between the coverage periods. This paragraph does not apply if
11provisions of the federal Patient Protection and Affordable Care Act, P.L. 111-148,
12under 42 USC 300gg to 300gg-4 are no longer enforceable or no longer preempt state
13law relating to individual health insurance policies.
AB365-SSA3,84 14Section 84. 632.784 of the statutes is created to read:
AB365-SSA3,29,21 15632.784 Notice of Health Insurance Risk-Sharing Plan. (1) If an insurer
16issues one or more of the following or takes any other action based wholly or partially
17on medical underwriting considerations which is likely to render any person eligible
18under s. 656.12 for coverage under ch. 656, the insurer shall notify all persons
19affected of the existence of the mandatory health insurance risk-sharing plan under
20ch. 656, as well as the eligibility requirements and method of applying for coverage
21under the plan:
AB365-SSA3,29,2222 (a) A notice of rejection or cancellation of coverage.
AB365-SSA3,30,223 (b) A notice of reduction or limitation of coverage, including restrictive riders,
24if the effect of the reduction or limitation is to substantially reduce coverage

1compared to the coverage available to a person considered a standard risk for the
2type of coverage provided by the plan.
AB365-SSA3,30,53 (c) A notice of increase in premium exceeding the premium then in effect for
4the insured person by 50 percent or more, unless the increase applies to substantially
5all of the insurer's health insurance policies then in effect.
AB365-SSA3,30,86 (d) A notice of premium for a policy not yet in effect which exceeds the premium
7applicable to a person considered a standard risk by 50 percent or more for the types
8of coverage provided by the plan.
AB365-SSA3,30,10 9(2) Any notice issued under sub. (1) shall also state the reasons for the rejection,
10termination, cancellation, or imposition of underwriting restrictions.
AB365-SSA3,85 11Section 85. 646.01 (1) (a) 2. k. of the statutes is amended to read:
AB365-SSA3,30,1212 646.01 (1) (a) 2. k. Risk-sharing plans under ch. chs. 619 and 656.
AB365-SSA3,86 13Section 86 . Chapter 656 of the statutes is created to read:
AB365-SSA3,30,1514 Chapter 656
15 Health insurance risk-sharing plans
AB365-SSA3,30,1716 SUBCHAPTER I
17 general provisions
AB365-SSA3,30,18 18656.01 Definitions. In this chapter:
AB365-SSA3,30,19 19(1) “Authority” means the Health Insurance Risk-Sharing Plan Authority.
AB365-SSA3,30,20 20(2) “Board” means the board of directors of the authority.
AB365-SSA3,30,21 21(3) “Church plan” has the meaning given in 29 USC 1002 (33).
AB365-SSA3,30,22 22(4) “Commissioner” means the commissioner of insurance.
AB365-SSA3,30,23 23(5) “Creditable coverage” has the meaning given in s. 632.745 (4).
AB365-SSA3,31,3
1(6) “Eligible person” means a person who is certified as eligible under s. 656.12
2(1), whether or not the person is legally responsible for the payment of medical
3expenses incurred on the person's behalf.
AB365-SSA3,31,4 4(7) “Federal continuation provision” has the meaning given in s. 632.745 (8).
AB365-SSA3,31,7 5(8) “Federal governmental plan” means a benefit program established or
6maintained for its employees by the government of the United States or by any
7agency or instrumentality of the government of the United States.
AB365-SSA3,31,9 8(9) “Fund” means the Health Insurance Risk-Sharing Plan fund under s.
9656.10 (2).
AB365-SSA3,31,10 10(10) “Governmental plan” has the meaning given under 29 USC 1002 (32).
AB365-SSA3,31,11 11(11) “Group health plan” has the meaning given in s. 632.745 (10).
AB365-SSA3,31,13 12(12) “Health care coverage revenue” means any of the following, but does not
13include payments to health maintenance organizations under s. 49.45 (59) (a):
AB365-SSA3,31,1414 (a) Premiums received for health care coverage.
AB365-SSA3,31,1515 (b) Subscriber contract charges received for health care coverage.
AB365-SSA3,31,1716 (c) Health maintenance organization, limited service health organization, or
17preferred provider plan charges received for health care coverage.
AB365-SSA3,31,1918 (d) The sum of benefits paid and administrative costs incurred for health care
19coverage under a medical reimbursement plan.
AB365-SSA3,31,25 20(13) “Health insurance” means surgical, medical, hospital, major medical, and
21other health service coverage provided on an expense-incurred basis and fixed
22indemnity policies. “Health insurance” does not include ancillary coverage such as
23income continuation, short-term, accident only, credit insurance, automobile
24medical payment coverage, coverage issued as a supplement to liability coverage,
25loss of time, or accident benefits.
AB365-SSA3,32,1
1(14) “Health maintenance organization” has the meaning given in s. 609.01 (2).
AB365-SSA3,32,3 2(15) “HIV” means any strain of human immunodeficiency virus, which causes
3acquired immunodeficiency syndrome.
AB365-SSA3,32,4 4(16) “Insurance” has the meaning given in s. 600.03 (25).
AB365-SSA3,32,6 5(17) “Insurer” has the meaning given in s. 600.03 (27) and does not include a
6plan under ch. 613 which offers only dental care.
AB365-SSA3,32,8 7(18) “Limited service health organization” has the meaning given in s. 609.01
8(3).
AB365-SSA3,32,10 9(19) “Medical Assistance program” means the health care benefit program
10provided under subch. IV of ch. 49.
AB365-SSA3,32,11 11(20) “Policy” has the meaning given in s. 600.03 (35).
AB365-SSA3,32,16 12(21) “Preexisting condition exclusion” means, with respect to coverage, a
13limitation or exclusion of benefits relating to a condition of an individual that existed
14before the individual's date of enrollment for coverage, whether or not the individual
15received any medical advice or recommendation, diagnosis, care, or treatment
16related to the condition before that date.
AB365-SSA3,32,17 17(22) “Preferred provider plan” has the meaning given in s. 609.01 (4).
AB365-SSA3,32,18 18(23) “Premium” has the meaning given in s. 600.03 (38).
AB365-SSA3,32,22 19656.03 Applicability. This chapter applies only if provisions of the federal
20Patient Protection and Affordable Care Act, P.L. 111-148, under 42 USC 300gg to
21300gg-4 are no longer enforceable or no longer preempt state law relating to
22individual health insurance policies.
AB365-SSA3,33,2 23656.05 Immunity. No liability may be imposed on any of the following for an
24act or omission in the performance of any powers and duties under this chapter,

1unless the person asserting liability proves the act or omission constitutes willful
2misconduct:
AB365-SSA3,33,3 3(1) The authority, plan, or board.
AB365-SSA3,33,4 4(2) Any agent, employee, or director of the authority, plan, or board.
AB365-SSA3,33,5 5(3) Any participating insurer.
AB365-SSA3,33,6 6(4) The commissioner.
AB365-SSA3,33,7 7(5) Any of the commissioner's agents, employees, or representatives.
AB365-SSA3,33,108 SUBCHAPTER II
9 health insurance risk-sharing
10 plan provisions
AB365-SSA3,33,13 11656.10 Administration of plan. (1) Authority. The authority shall be
12responsible for the operation of the plan and, subject to ss. 656.43 (3) and 656.47, may
13enter into contracts for the plan's administration.
AB365-SSA3,33,16 14(2) Fund. (a) The authority shall pay the operating administrative expenses
15of the plan from the fund, which shall be outside the state treasury and which shall
16consist of all of the following:
AB365-SSA3,33,1717 1. Insurer assessments paid under s. 656.15.
AB365-SSA3,33,1818 2. Premiums paid by eligible persons.
AB365-SSA3,33,1919 3. Moneys received from the federal government as grants for high-risk pools.
AB365-SSA3,33,2020 4. The earnings resulting from investments under par. (b).
AB365-SSA3,33,2121 5. Any other moneys received by the authority.
AB365-SSA3,33,2322 (b) The authority controls assets of the fund, including investment of assets of
23the fund.
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