LRB-5113/2
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1995 - 1996 LEGISLATURE
February 26, 1996 - Introduced by Representatives Ladwig, Kelso, Gunderson,
Hahn, Zukowski, Owens, Nass, Vrakas, Urban, Handrick, Olsen, F. Lasee,
Wirch, Plache, Baldus, Baldwin, Bell, Black, Notestein, Wasserman
and
Plombon, cosponsored by Senators Burke and Chvala. Referred to Committee
on Insurance, Securities and Corporate Policy.
AB965,1,4 1An Act to amend 40.51 (8), 60.23 (25), 66.184, 111.70 (1) (a), 120.13 (2) (g),
2185.981 (4t), 185.983 (1) (intro.) and 619.14 (4) (a); and to create 40.51 (8m),
3111.70 (4) (n), 111.91 (2) (k), 609.79 and 632.895 (11) of the statutes; relating
4to:
requiring insurance coverage of breast reconstruction.
Analysis by the Legislative Reference Bureau
This bill requires health care plans that provide coverage of a mastectomy to
provide coverage of breast reconstruction that is incident to the mastectomy. The
coverage requirement applies to both individual and group health insurance policies
and plans, including health maintenance organizations, limited service health
organizations, preferred provider plans and cooperative sickness care associations;
to health plans offered by the state to its employes, including a self-insured plan; and
to self-insured health plans of counties, cities, towns, villages and school districts.
The requirement may be subject to any limitations, exclusions or cost-sharing
provisions that apply generally under the policy or plan.
For further information see the state and local fiscal estimate, which will be
printed as an appendix to this bill.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
AB965, s. 1 5Section 1. 40.51 (8) of the statutes is amended to read:
AB965,1,86 40.51 (8) Every health care coverage plan offered by the state under sub. (6)
7shall comply with ss. 631.89, 631.90, 631.93 (2), 632.72 (2), 632.87 (3) to (5), 632.895
8(5m) and (8) to (10) (11) and 632.896.
AB965, s. 2
1Section 2. 40.51 (8m) of the statutes is created to read:
AB965,2,32 40.51 (8m) Every health care coverage plan offered by the group insurance
3board under sub. (7) shall comply with s. 632.895 (11).
AB965, s. 3 4Section 3. 60.23 (25) of the statutes is amended to read:
AB965,2,75 60.23 (25) Self-insured health plans. Provide health care benefits to its
6officers and employes on a self-insured basis if the self-insured plan complies with
7ss. 631.89, 631.90, 631.93 (2), 632.87 (4) and (5), 632.895 (9) and (11) and 632.896.
AB965, s. 4 8Section 4. 66.184 of the statutes is amended to read:
AB965,2,14 966.184 Self-insured health plans. If a city, including a 1st class city, or a
10village provides health care benefits under its home rule power, or if a town provides
11health care benefits, to its officers and employes on a self-insured basis, the
12self-insured plan shall comply with ss. 49.493 (3) (d), 631.89, 631.90, 631.93 (2),
13632.87 (4) and (5), 632.895 (9) and (10) to (11), 632.896, 767.25 (4m) (d) and 767.51
14(3m) (d).
AB965, s. 5 15Section 5. 111.70 (1) (a) of the statutes, as affected by 1995 Wisconsin Act 27,
16is amended to read:
AB965,3,1417 111.70 (1) (a) "Collective bargaining" means the performance of the mutual
18obligation of a municipal employer, through its officers and agents, and the
19representative of its municipal employes in a collective bargaining unit, to meet and
20confer at reasonable times, in good faith, with the intention of reaching an
21agreement, or to resolve questions arising under such an agreement, with respect to
22wages, hours and conditions of employment, and with respect to a requirement of the
23municipal employer for a municipal employe to perform law enforcement and fire
24fighting services under s. 61.66, except as provided in sub. (4) (m) and (n) and s. 40.81
25(3) and except that a municipal employer shall not meet and confer with respect to

1any proposal to diminish or abridge the rights guaranteed to municipal employes
2under ch. 164. The duty to bargain, however, does not compel either party to agree
3to a proposal or require the making of a concession. Collective bargaining includes
4the reduction of any agreement reached to a written and signed document. The
5municipal employer shall not be required to bargain on subjects reserved to
6management and direction of the governmental unit except insofar as the manner
7of exercise of such functions affects the wages, hours and conditions of employment
8of the municipal employes in a collective bargaining unit. In creating this subchapter
9the legislature recognizes that the municipal employer must exercise its powers and
10responsibilities to act for the government and good order of the jurisdiction which it
11serves, its commercial benefit and the health, safety and welfare of the public to
12assure orderly operations and functions within its jurisdiction, subject to those
13rights secured to municipal employes by the constitutions of this state and of the
14United States and by this subchapter.
AB965, s. 6 15Section 6. 111.70 (4) (n) of the statutes is created to read:
AB965,3,1816 111.70 (4) (n) Insurance coverage of breast reconstruction. The municipal
17employer is prohibited from bargaining collectively with respect to the provision of
18the health insurance coverage required under s. 632.895 (11).
AB965, s. 7 19Section 7. 111.91 (2) (k) of the statutes is created to read:
AB965,3,2120 111.91 (2) (k) The provision to employes of the health insurance coverage
21required under s. 632.895 (11).
AB965, s. 8 22Section 8. 120.13 (2) (g) of the statutes is amended to read:
AB965,3,2523 120.13 (2) (g) Every self-insured plan under par. (b) shall comply with ss.
2449.493 (3) (d), 631.89, 631.90, 631.93 (2), 632.87 (4) and (5), 632.895 (9) and (10) to
25(11)
, 632.896, 767.25 (4m) (d) and 767.51 (3m) (d).
AB965, s. 9
1Section 9. 185.981 (4t) of the statutes is amended to read:
AB965,4,42 185.981 (4t) A sickness care plan operated by a cooperative association is
3subject to ss. 252.14, 631.89, 632.72 (2), 632.87 (2m), (3), (4) and (5), 632.895 (10) and
4(11)
and 632.897 (10) and ch. 155.
AB965, s. 10 5Section 10. 185.983 (1) (intro.) of the statutes is amended to read:
AB965,4,116 185.983 (1) (intro.) Every such voluntary nonprofit sickness care plan shall be
7exempt from chs. 600 to 646, with the exception of ss. 601.04, 601.13, 601.31, 601.41,
8601.42, 601.43, 601.44, 601.45, 611.67, 619.04, 628.34 (10), 631.89, 631.93, 632.72
9(2), 632.775, 632.79, 632.795, 632.87 (2m), (3), (4) and (5), 632.895 (5), (9) and (10)
10to (11), 632.896 and 632.897 (10), subch. II of ch. 619 and chs. 609, 630, 635, 645 and
11646, but the sponsoring association shall:
AB965, s. 11 12Section 11. 609.79 of the statutes is created to read:
AB965,4,15 13609.79 Coverage of breast reconstruction. Health maintenance
14organizations, limited service health organizations and preferred provider plans are
15subject to s. 632.895 (11).
AB965, s. 12 16Section 12. 619.14 (4) (a) of the statutes is amended to read:
AB965,4,2017 619.14 (4) (a) Any charge for treatment for cosmetic purposes other than
18surgery for the repair or treatment of an injury or a congenital bodily defect. Breast
19reconstruction incident to a mastectomy shall not be considered treatment for
20cosmetic purposes.
AB965, s. 13 21Section 13. 632.895 (11) of the statutes is created to read:
AB965,4,2522 632.895 (11) Breast reconstruction. (a) Every disability insurance policy,
23and every self-insured health plan of the state or a county, city, village, town or school
24district, that provides coverage of the surgical procedure known as a mastectomy
25shall provide coverage of breast reconstruction incident to the mastectomy.
AB965,5,3
1(b) The coverage required under par. (a) may be subject to any limitations,
2exclusions or cost-sharing provisions that apply generally under the disability
3insurance policy or self-insured health plan.
AB965, s. 14 4Section 14. Initial applicability.
AB965,5,5 5(1) This act first applies to all of the following:
AB965,5,8 6(a) Except as provided in paragraphs (b) and (c) , disability insurance policies
7that are issued or renewed, and self-insured health plans that are established,
8extended, modified or renewed, on the effective date of this paragraph.
AB965,5,11 9(b) Disability insurance policies covering employes who are affected by a
10collective bargaining agreement containing provisions inconsistent with this act
11that are issued or renewed on the earlier of the following:
AB965,5,12 121. The day on which the collective bargaining agreement expires.
AB965,5,14 132. The day on which the collective bargaining agreement is extended, modified
14or renewed.
AB965,5,17 15(c) Self-insured health plans covering employes who are affected by a
16collective bargaining agreement containing provisions inconsistent with this act
17that are established, extended, modified or renewed on the earlier of the following:
AB965,5,18 181. The day on which the collective bargaining agreement expires.
AB965,5,20 192. The day on which the collective bargaining agreement is extended, modified
20or renewed.
AB965, s. 15 21Section 15. Effective date.
AB965,5,23 22(1) This act takes effect on the first day of the 5th month beginning after
23publication.
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