AB64-ASA1-AA8,23,321 632.76 (2) (a) No claim for loss incurred or disability commencing after 2 years
22from the date of issue of the policy may be reduced or denied on the ground that a
23disease or physical condition existed prior to the effective date of coverage, unless the
24condition was excluded from coverage by name or specific description by a provision
25effective on the date of loss. This paragraph does not apply to a group health benefit

1plan, as defined in s. 632.745 (9), which is subject to s. 632.746, a disability insurance
2policy, as defined in s. 632.895 (1) (a), or a self-insured health plan, as defined in s.
3632.85 (1) (c)
.
AB64-ASA1-AA8,23,94 (ac) 1. Notwithstanding par. (a), no No claim or loss incurred or disability
5commencing after 12 months from the date of issue of under an individual disability
6insurance policy, as defined in s. 632.895 (1) (a), may be reduced or denied on the
7ground that a disease or physical condition existed prior to the effective date of
8coverage, unless the condition was excluded from coverage by name or specific
9description by a provision effective on the date of the loss
.
AB64-ASA1-AA8,23,1510 2. Except as provided in subd. 3., an An individual disability insurance policy,
11as defined in s. 632.895 (1) (a), other than a short-term policy subject to s. 632.7495
12(4) and (5),
may not define a preexisting condition more restrictively than a condition,
13whether physical or mental, regardless of the cause of the condition, for which
14medical advice, diagnosis, care, or treatment was recommended or received within
1512 months before the effective date of coverage
.
AB64-ASA1-AA8,2220f 16Section 2220f. 632.76 (2) (ac) 3. of the statutes is repealed.
AB64-ASA1-AA8,1 17Section 1. 632.795 (4) (a) of the statutes is amended to read:
AB64-ASA1-AA8,24,418 632.795 (4) (a) An insurer subject to sub. (2) shall provide coverage under the
19same policy form and for the same premium as it originally offered in the most recent
20enrollment period, subject only to the medical underwriting used in that enrollment
21period. Unless otherwise prescribed by rule, the insurer may apply deductibles,
22preexisting condition limitations, waiting periods , or other limits only to the extent
23that they would have been applicable had coverage been extended at the time of the
24most recent enrollment period and with credit for the satisfaction or partial
25satisfaction of similar provisions under the liquidated insurer's policy or plan. The

1insurer may exclude coverage of claims that are payable by a solvent insurer under
2insolvency coverage required by the commissioner or by the insurance regulator of
3another jurisdiction. Coverage shall be effective on the date that the liquidated
4insurer's coverage terminates.
AB64-ASA1-AA8,2220h 5Section 2220h. 632.897 (11) (a) of the statutes is amended to read:
AB64-ASA1-AA8,24,146 632.897 (11) (a) Notwithstanding subs. (2) to (10), the commissioner may
7promulgate rules establishing standards requiring insurers to provide continuation
8of coverage for any individual covered at any time under a group policy who is a
9terminated insured or an eligible individual under any federal program that
10provides for a federal premium subsidy for individuals covered under continuation
11of coverage under a group policy, including rules governing election or extension of
12election periods, notice, rates, premiums, premium payment, application of
13preexisting condition exclusions,
election of alternative coverage, and status as an
14eligible individual, as defined in s. 149.10 (2t), 2011 stats.”.
AB64-ASA1-AA8,24,15 1526. Page 925, line 14: after that line insert:
AB64-ASA1-AA8,24,16 16 Section 2218t. 609.896 of the statutes is created to read:
AB64-ASA1-AA8,24,18 17609.896 Preventive services. Defined network plans and preferred provider
18plans are subject to s. 632.895 (13m).
AB64-ASA1-AA8,2218w 19Section 2218w. 632.895 (8) (d) of the statutes is amended to read:
AB64-ASA1-AA8,25,220 632.895 (8) (d) Coverage is required under this subsection despite whether the
21woman shows any symptoms of breast cancer. Except as provided in pars. (b), (c), and
22(e), coverage under this subsection may only be subject to exclusions and limitations,
23including deductibles, copayments and restrictions on excessive charges, that are
24applied to other radiological examinations covered under the disability insurance

1policy. Coverage under this subsection may not be subject to any deductibles,
2copayments, or coinsurance.
AB64-ASA1-AA8,2219b 3Section 2219b. 632.895 (13m) of the statutes is created to read:
AB64-ASA1-AA8,25,54 632.895 (13m) Preventive services. (a) In this section, “self-insured health
5plan” has the meaning given in s. 632.85 (1) (c).
AB64-ASA1-AA8,25,76 (b) Every disability insurance policy and every self-insured health plan shall
7provide coverage for all of the following preventive services:
AB64-ASA1-AA8,25,88 1. Mammography in accordance with sub. (8).
AB64-ASA1-AA8,25,109 2. Genetic breast cancer screening and counseling and preventive medication
10for adult women at high risk for breast cancer.
AB64-ASA1-AA8,25,1211 3. Papanicolaou test for cancer screening for women 21 years of age or older
12with an intact cervix.
AB64-ASA1-AA8,25,1413 4. Human papillomavirus testing for women who have attained the age of 30
14years but have not attained the age of 66 years.
AB64-ASA1-AA8,25,1515 5. Colorectal cancer screening in accordance with sub. (16m).
AB64-ASA1-AA8,25,1816 6. Annual tomography for lung cancer screening for adults who have attained
17the age of 55 years but have not attained the age of 80 years and who have health
18histories demonstrating a risk for lung cancer.
AB64-ASA1-AA8,25,2019 7. Skin cancer screening for individuals who have attained the age of 10 years
20but have not attained the age of 22 years.
AB64-ASA1-AA8,25,2221 8. Counseling for skin cancer prevention for adults who have attained the age
22of 18 years but have not attained the age of 25 years.
AB64-ASA1-AA8,25,2423 9. Abdominal aortic aneurysm screening for men who have attained the age of
2465 years but have not attained the age of 75 years and who have ever smoked.
AB64-ASA1-AA8,26,3
110. Hypertension screening for adults and blood pressure testing for adults, for
2children under the age of 3 years who are at high risk for hypertension, and for
3children 3 years of age or older.
AB64-ASA1-AA8,26,64 11. Lipid disorder screening for minors 2 years of age or older, high risk women
520 years of age or older, men age 20 years of age or older at high risk for lipid
6disorders, and all men 35 years of age or older.
AB64-ASA1-AA8,26,97 12. Aspirin therapy for cardiovascular health for adults who have attained the
8age of 55 years but have not attained the age of 80 years and for men who have
9attained the age of 45 years but have not attained the age of 55 years.
AB64-ASA1-AA8,26,1110 13. Behavioral counseling for cardiovascular health for adults who are
11overweight or obese and who have risk factors for cardiovascular disease.
AB64-ASA1-AA8,26,1212 14. Type II diabetes screening for adults with elevated blood pressure.
AB64-ASA1-AA8,26,1413 15. Depression screening for minors 11 years of age or older and for adults when
14follow-up supports are available.
AB64-ASA1-AA8,26,1615 16. Hepatitis B screening for minors at high risk for infection and adults at high
16risk for infection.
AB64-ASA1-AA8,26,1817 17. Hepatitis C screening for adults at high risk for infection and one time
18hepatitis C screening for adults born in 1945 to 1965.
AB64-ASA1-AA8,26,2219 18. Obesity screening and management for all minors and adults with a body
20mass index indicating obesity, counseling and behavioral interventions for obese
21minors who are 6 years of age or older, and referral for intervention for obesity for
22adults with a body mass index of 30 kilograms per square meter or higher.
AB64-ASA1-AA8,26,2423 19. Osteoporosis screening for all women 65 years of age or older and for women
24at high risk for osteoporosis under the age of 65 years.
AB64-ASA1-AA8,26,2525 20. Immunizations in accordance with sub. (14).
AB64-ASA1-AA8,27,3
121. Anemia screening for individuals 6 months of age or older and iron
2supplements for individuals at high risk for anemia and who have attained the age
3of 6 months but have not attained the age of 12 months.
AB64-ASA1-AA8,27,54 22. Fluoride varnish for prevention of tooth decay for minors at the age of
5eruption of their primary teeth.
AB64-ASA1-AA8,27,76 23. Fluoride supplements for prevention of tooth decay for minors 6 months of
7age or older who do not have fluoride in their water source.
AB64-ASA1-AA8,27,88 24. Gonorrhea prophylaxis treatment for newborns.
AB64-ASA1-AA8,27,99 25. Health history and physical exams for prenatal visits and for minors.
AB64-ASA1-AA8,27,1110 26. Length and weight measurements for newborns and height and weight
11measurements for minors.
AB64-ASA1-AA8,27,1312 27. Head circumference and weight for length measurements for newborns and
13minors who have not attained the age of 3 years.
AB64-ASA1-AA8,27,1414 28. Body mass index for minors 2 years of age or older.
AB64-ASA1-AA8,27,1615 29. Blood pressure measurements for minors 3 years of age or older and a blood
16pressure risk assessment at birth.
AB64-ASA1-AA8,27,1817 30. Risk assessment and referral for oral health issues for minors who have
18attained the age of 6 months but have not attained the age of 7 years.
AB64-ASA1-AA8,27,2019 31. Blood screening for newborns and minors who have not attained age 2
20months.
AB64-ASA1-AA8,27,2121 32. Screening for critical congenital health defect for newborns.
AB64-ASA1-AA8,27,2222 33. Lead screenings in accordance with sub. (10).
AB64-ASA1-AA8,27,2423 34. Metabolic and hemoglobin screening and screening for phenylketonuria,
24sickle cell anemia, and congenital hypothyroidism for minors including newborns.
AB64-ASA1-AA8,28,2
135. Tuberculin skin test based on risk assessment for minors one month of age
2or older.
AB64-ASA1-AA8,28,43 36. Tobacco counseling and cessation interventions for individuals who are 5
4years of age or older.
AB64-ASA1-AA8,28,65 37. Vision and hearing screening and assessment for minors including
6newborns.
AB64-ASA1-AA8,28,87 38. Sexually transmitted infection and human immunodeficiency virus
8counseling for sexually active minors.
AB64-ASA1-AA8,28,119 39. Risk assessment for sexually transmitted infection for minors who are 10
10years of age or older and screening for sexually transmitted infection for minors who
11are 16 years of age or older.
AB64-ASA1-AA8,28,1212 40. Alcohol misuse screening and counseling for minors 11 years of age or older.
AB64-ASA1-AA8,28,1413 41. Autism screening for minors who have attained the age of 18 months but
14have not attained the age of 25 months.
AB64-ASA1-AA8,28,1515 42. Developmental screening and surveillance for minors including newborns.
AB64-ASA1-AA8,28,1616 43. Psychosocial and behavioral assessment for minors including newborns.
AB64-ASA1-AA8,28,1817 44. Alcohol misuse screening and counseling for pregnant adults and a risk
18assessment for all adults.
AB64-ASA1-AA8,28,2019 45. Fall prevention and counseling and preventive medication for fall
20prevention for community-dwelling adults 65 years of age or older.
AB64-ASA1-AA8,28,2121 46. Screening and counseling for intimate partner violence for adult women.
AB64-ASA1-AA8,28,2422 47. Well-woman visits for women who have attained the age of 18 years but
23have not attained the age of 65 years and well-woman visits for recommended
24preventive services, preconception care, and prenatal care.
AB64-ASA1-AA8,29,2
148. Counseling on, consultations with a trained provider on, and equipment
2rental for breastfeeding for pregnant and lactating women.
AB64-ASA1-AA8,29,33 49. Folic acid supplement for adult women with reproductive capacity.
AB64-ASA1-AA8,29,44 50. Iron deficiency anemia screening for pregnant and lactating women.
AB64-ASA1-AA8,29,65 51. Preeclampsia preventive medicine for pregnant adult women at high risk
6for preeclampsia.
AB64-ASA1-AA8,29,87 52. Low-dose aspirin after 12 weeks of gestation for pregnant women at high
8risk for miscarriage, preeclampsia, or clotting disorders.
AB64-ASA1-AA8,29,99 53. Screenings for hepatitis B and bacteriuria for pregnant women.
AB64-ASA1-AA8,29,1110 54. Screening for gonorrhea for pregnant and sexually active females 24 years
11of age or younger and females older than 24 years of age who are at risk for infection.
AB64-ASA1-AA8,29,1412 55. Screening for chlamydia for pregnant and sexually active females 24 years
13of age and younger and females older than 24 years of age who are at risk for
14infection.
AB64-ASA1-AA8,29,1615 56. Screening for syphilis for pregnant women and adults who are at high risk
16for infection.
AB64-ASA1-AA8,29,1917 57. Human immunodeficiency virus screening for adults who have attained the
18age of 15 years but have not attained the age of 66 years and individuals at high risk
19of infection who are younger than 15 years of age or older than 65 years of age.
AB64-ASA1-AA8,29,2020 58. All contraceptives and services in accordance with sub. (17).
AB64-ASA1-AA8,29,2221 59. Any services not already specified under this paragraph having an A or B
22rating in current recommendations from the U.S. Preventive Services Task Force.
AB64-ASA1-AA8,29,2523 60. Any preventive services not already specified under this paragraph that are
24recommended by the federal health resources and services administration's Bright
25Futures project.
AB64-ASA1-AA8,30,3
161. Any immunizations, not already specified under sub. (14), that are
2recommended and determined to be for routine use by the Advisory Committee on
3Immunization Practices.
AB64-ASA1-AA8,30,64 (c) Subject to par. (d), no disability insurance policy and no self-insured health
5plan may subject the coverage of any of the preventive services under par. (b) to any
6deductibles, copayments, or coinsurance under the policy or plan.
AB64-ASA1-AA8,30,107 (d) 1. If an office visit and a preventive service specified under par. (b) are billed
8separately by the health care provider, the disability insurance policy or self-insured
9health plan may apply deductibles to and impose copayments or coinsurance on the
10office visit but not on the preventive service.
AB64-ASA1-AA8,30,1311 2. If the primary reason for an office visit is not to obtain a preventive service,
12the disability insurance policy or self-insured health plan may apply deductibles to
13and impose copayments or coinsurance on the office visit.
AB64-ASA1-AA8,30,2214 3. If a preventive service specified under par. (b) is provided by a health care
15provider that is outside the disability insurance policy's or self-insured health plan's
16network of providers, the policy or plan may apply deductibles to and impose
17copayments or coinsurance on the office visit and the preventive service. If a
18preventive service specified under par. (b) is provided by a health care provider that
19is outside the disability insurance policy's or self-insured health plan's network of
20providers because there is no available health care provider in the policy's or plan's
21network of providers that provides the preventive service, the policy or plan may not
22apply deductibles to or impose copayments or coinsurance on preventive service.
AB64-ASA1-AA8,31,223 4. If multiple well-woman visits described under par. (b) 47. are required to
24fulfill all necessary preventive services and are in accordance with clinical
25recommendations, the disability insurance policy or self-insured health plan may

1not apply a deductible or impose a copayment or coinsurance to any of those
2well-woman visits.
AB64-ASA1-AA8,2219d 3Section 2219d. 632.895 (14) (a) 1. i. and j. of the statutes are amended to read:
AB64-ASA1-AA8,31,44 632.895 (14) (a) 1. i. Hepatitis A and B.
AB64-ASA1-AA8,31,55 j. Varicella and herpes zoster.
AB64-ASA1-AA8,2219f 6Section 2219f. 632.895 (14) (a) 1. k. to o. of the statutes are created to read:
AB64-ASA1-AA8,31,77 632.895 (14) (a) 1. k. Human papillomavirus.
AB64-ASA1-AA8,31,88 L. Meningococcal meningitis.
AB64-ASA1-AA8,31,99 m. Pneumococcal pneumonia.
Loading...
Loading...