SB201, s. 25 20Section 25. 635.02 (1r) of the statutes is created to read:
SB201,13,2121 635.02 (1r) "Board" means the comprehensive health care board.
SB201, s. 26 22Section 26. 635.02 (2) of the statutes is amended to read:
SB201,14,423 635.02 (2) "Case characteristics" means the demographic, actuarially based
24characteristics of the employes of a small employer, and the employer, if covered
25members of a group or of an individual, such as age, sex gender, geographic location

1area and occupation, used by a small employer an insurer to determine premium
2rates for a small employer health benefit plan. "Case characteristics" does not
3include loss or claim history, health status condition, duration of coverage or other
4factors related to claim claims experience.
SB201, s. 27 5Section 27. 635.02 (3) of the statutes is repealed and recreated to read:
SB201,14,106 635.02 (3) "Community rate" means a uniform rate determined in such a
7manner that all insured individuals with the same level of coverage and plan design
8pay the same rate for that coverage, without regard to case characteristics or to loss
9or claim history, health condition, duration of coverage or other factors related to
10claims experience.
SB201, s. 28 11Section 28. 635.02 (3f) of the statutes is amended to read:
SB201,14,1912 635.02 (3f) "Eligible employe" means an employe who works on a full-time
13basis and has a normal work week of 30 or more hours. The term includes a sole
14proprietor, a business owner, including the owner of a farm business, a partner of a
15partnership, a member of a limited liability company and an independent contractor
16if the sole proprietor, business owner, partner, member or independent contractor is
17included as an employe under a health benefit plan of a small an employer, but the
18term does not include an employe who works on a part-time, temporary or substitute
19basis.
SB201, s. 29 20Section 29. 635.02 (3h) of the statutes is created to read:
SB201,14,2121 635.02 (3h) "Employer" means any of the following:
SB201,15,222 (a) An individual, firm, corporation, partnership, limited liability company or
23association that is actively engaged in a business enterprise in this state, including
24a farm business, and that employs in this state not fewer than 2 nor more than 100
25eligible employes. In determining the number of eligible employes, employers that

1are affiliated, or that are eligible to file a combined tax return for purposes of state
2taxation, shall be considered one employer.
SB201,15,43 (b) A municipality, as defined in s. 16.70 (8), that employs not fewer than 2 nor
4more than 100 eligible employes.
SB201, s. 30 5Section 30. 635.02 (3j) of the statutes is amended to read:
SB201,15,86 635.02 (3j) "Established geographic service area" means a geographic area
7within which a small employer an insurer provides coverage and that has been
8approved by the commissioner.
SB201, s. 31 9Section 31. 635.02 (3m) of the statutes is amended to read:
SB201,15,1810 635.02 (3m) "Health benefit plan" means any hospital or medical policy or
11certificate, and includes a conversion health insurance policy. "Health benefit plan"
12does not include accident-only, credit, dental, vision, medicare supplement,
13medicare replacement, long-term care, or disability income insurance, coverage
14issued as a supplement to liability insurance, worker's compensation or similar
15insurance, automobile medical payment insurance, specified disease policies,
16hospital indemnity policies, as defined in s. 632.895 (1) (c), policies or certificates
17issued under the health insurance risk-sharing plan or an alternative plan under
18subch. II of ch. 619
or other insurance exempted by rule of the commissioner.
SB201, s. 32 19Section 32. 635.02 (4g) of the statutes is created to read:
SB201,16,320 635.02 (4g) "Insurer" means an insurer that is authorized to do business in this
21state, in one or more lines of insurance that includes health insurance, and that
22offers group health benefit plans covering eligible employes of one or more employers
23in this state, or that sells individual health benefit plans to individuals who are
24residents of this state. The term includes a health maintenance organization, as
25defined in s. 609.01 (2), a preferred provider plan, as defined in s. 609.01 (4), and an

1insurer operating as a cooperative association organized under ss. 185.981 to
2185.985, but does not include a limited service health organization, as defined in s.
3609.01 (3).
SB201, s. 33 4Section 33. 635.02 (4m) of the statutes is repealed.
SB201, s. 34 5Section 34. 635.02 (5) of the statutes is repealed.
SB201, s. 35 6Section 35. 635.02 (5m) (d) of the statutes is created to read:
SB201,16,87 635.02 (5m) (d) The health insurance risk-sharing plan or an alternative plan
8under subch. II of ch. 619.
SB201, s. 36 9Section 36. 635.02 (6) of the statutes is repealed.
SB201, s. 37 10Section 37. 635.02 (6m) of the statutes is amended to read:
SB201,16,1411 635.02 (6m) "Restricted network provision" means a provision of a health
12benefit plan that conditions the payment of benefits, in whole or in part, on obtaining
13services or articles from health care providers that have contracted with the small
14employer
insurer to provide health care services or articles to covered individuals.
SB201, s. 38 15Section 38. 635.02 (7) (intro.) and (a) of the statutes are consolidated,
16renumbered 635.02 (7) and amended to read:
SB201,16,2317 635.02 (7) "Small employer" means any of the following: (a) An individual,
18firm, corporation, partnership, limited liability company or association that is
19actively engaged in a business enterprise in this state, including a farm business,
20and
an employer that employs in this state not fewer than 2 nor more than 25 eligible
21employes. In determining the number of eligible employes, employers that are
22affiliated, or that are eligible to file a combined tax return for purposes of state
23taxation, shall be considered one employer.
SB201, s. 39 24Section 39. 635.02 (7) (b) of the statutes is repealed.
SB201, s. 40 25Section 40. 635.02 (8) of the statutes is repealed.
SB201, s. 41
1Section 41. 635.03 of the statutes is created to read:
SB201,17,3 2635.03 Duties of the board. In addition to any other duties specifically
3required under this subchapter, the board shall do all of the following:
SB201,17,4 4(1) Perform the duties required under subch. II.
SB201,17,5 5(2) Provide data or technical assistance to any purchasing coalition.
SB201,17,7 6(3) Develop quality outcomes measures, quality and practice pattern
7standards and health plan performance criteria.
SB201,17,8 8(4) Provide information on technology assessment to any purchasing coalition.
SB201,17,10 9(5) Recommend cost containment measures and provide assessments of health
10care needs to any purchasing coalition.
SB201, s. 42 11Section 42. 635.05 of the statutes is repealed and recreated to read:
SB201,17,15 12635.05 Community rating. (1) Except as provided in subs. (2) and (4), an
13insurer shall charge a community rate for coverage under a health benefit plan that
14is subject to this subchapter and that is issued or renewed on or after the effective
15date of this subsection .... [revisor inserts date].
SB201,17,18 16(2) Subject to rate bands prescribed by the commissioner by rule, the
17community rate under sub. (1) may be modified by taking into account the following
18factors:
SB201,17,1919 (a) The insured's age.
SB201,17,2020 (b) The insured's gender.
SB201,17,2221 (c) The insured's geographic area, which may not include less than an entire
22county.
SB201,17,2323 (d) The insured's tobacco use.
SB201,17,2524 (e) Whether the insured's coverage is single coverage or a type of family
25coverage.
SB201,18,3
1(3) For each of the following factors, the rate bands prescribed by the
2commissioner by rule may not restrict the ratio of the highest variance to the lowest
3variance to a ratio that is less than the ratio shown after each factor:
SB201,18,44 (a) For age, a ratio of 2.5.
SB201,18,55 (b) For gender, a ratio of 1.2.
SB201,18,66 (c) For geographic area, a ratio of 1.2.
SB201,18,9 7(4) An insurer may provide a rate discount for healthy lifestyle choices on the
8part of an insured individual that, given the individual's health condition, tend to
9reduce the risk of loss.
SB201, s. 43 10Section 43. 635.06 of the statutes is created to read:
SB201,18,18 11635.06 Transition by rule. Notwithstanding s. 635.05 (1) and (2), the
12commissioner may promulgate rules that permit an insurer to vary from the
13community rate required under s. 635.05 (1) and modified under s. 635.05 (2) within
14restrictions provided in the rules. The restrictions provided in the rules shall be
15reasonably designed to provide for an orderly transition to the community rates
16required under s. 635.05 (1) and modified under s. 635.05 (2) for all health benefit
17plans subject to this subchapter by no later than the first day of the 12th month
18beginning after the effective date of this section .... [revisor inserts date].
SB201, s. 44 19Section 44. 635.07 (1) (intro.), (b), (d) and (e) of the statutes are amended to
20read:
SB201,19,221 635.07 (1) (intro.) Notwithstanding s. 631.36 (2) to (4m), a health benefit plan
22or policy subject to this subchapter may not be canceled by an insurer before the
23expiration of the agreed term, and shall be renewable to the employer and all
24employes
policyholder and all insureds and dependents eligible under the terms of

1the health benefit plan or policy at the expiration of the agreed term at the option of
2the small employer policyholder, except for any of the following reasons:
SB201,19,53 (b) Fraud or misrepresentation by the small employer policyholder, or, with
4respect to coverage for an insured individual, fraud or misrepresentation by the that
5insured individual.
SB201,19,76 (d) The number of individuals covered under the health benefit plan or policy
7is less than the number required by the health benefit plan or policy.
SB201,19,88 (e) The small employer is no longer actively engaged in a business enterprise.
SB201, s. 45 9Section 45. 635.07 (1) (f) of the statutes is created to read:
SB201,19,1110 635.07 (1) (f) The health benefit plan is an individual policy and the
11commissioner permits cancellation or nonrenewal of such a policy by rule.
SB201, s. 46 12Section 46. 635.07 (2) of the statutes is amended to read:
SB201,19,1513 635.07 (2) Notwithstanding sub. (1), a small employer an insurer may elect not
14to renew a health insurance benefit plan or policy subject to this subchapter if the
15small employer insurer complies with all of the following:
SB201,19,1816 (a) The small employer insurer ceases to renew all other health benefit plans
17or policies subject to this subchapter that are issued to all other small employers in
18the same class of business
.
SB201,19,2119 (b) The small employer insurer provides notice to all affected small employers
20policyholders and to the commissioner in each state in which an affected insured
21individual resides not later than one year before termination of coverage.
SB201,19,2422 (c) The small employer insurer does not establish a new class of business issue
23a health benefit plan subject to this subchapter
earlier than 5 years after the
24nonrenewal of the health benefit plans or policies.
SB201,20,6
1(d) The small employer insurer does not transfer or otherwise provide coverage
2to a small employer policyholder from the nonrenewed class of business unless the
3small employer insurer offers to transfer or provide coverage to all affected small
4employers
policyholders from the nonrenewed class of business without regard to
5case characteristics, claim claims experience, health status condition or duration of
6coverage.
SB201, s. 47 7Section 47. 635.07 (3) of the statutes is amended to read:
SB201,20,108 635.07 (3) This section does not apply to a health benefit plan or policy subject
9to this subchapter if the small employer insurer that issued the policy health benefit
10plan
is in liquidation.
SB201, s. 48 11Section 48. 635.09 of the statutes is repealed.
SB201, s. 49 12Section 49. 635.11 (intro.), (1) and (4) of the statutes are amended to read:
SB201,20,16 13635.11 Disclosure of rating factors and renewability provisions. (intro.)
14Before the sale of a health benefit plan or policy subject to this subchapter, a small
15employer
an insurer shall disclose to a small employer an applicant all of the
16following:
SB201,20,18 17(1) The small employer insurer's right to increase premium rates and the
18factors limiting the amount of increase.
SB201,20,19 19(4) The small employer's A policyholder's renewability rights.
SB201, s. 50 20Section 50. 635.13 (1) of the statutes is amended to read:
SB201,20,2521 635.13 (1) Records. A small employer insurer shall maintain at its principal
22place of business complete and detailed records relating to its rating methods and
23practices and its renewal underwriting methods and practices, and shall make the
24records available to the commissioner and the small employer insurance or the board
25upon request.
SB201, s. 51
1Section 51. 635.13 (1) of the statutes, as affected by 1995 Wisconsin Act ....
2(this act), is repealed and recreated to read:
SB201,21,63 635.13 (1) Records. An insurer shall maintain at its principal place of business
4complete and detailed records relating to its rating methods and practices and its
5renewal underwriting methods and practices, and shall make the records available
6to the commissioner or the board upon request.
SB201, s. 52 7Section 52. 635.13 (2) of the statutes is amended to read:
SB201,21,108 635.13 (2) Certification. A small employer An insurer shall file with the
9commissioner on or before May 1 annually an actuarial opinion by a member of the
10American academy of actuaries certifying all of the following:
SB201,21,1211 (a) That the small employer insurer is in compliance with the rate provisions
12of s. 635.05 and any rules promulgated under s. 635.06.
SB201,21,1413 (b) That the small employer insurer's rating methods are based on generally
14accepted and sound actuarial principles, policies and procedures.
SB201,21,1815 (c) That the opinion is based on the actuary's examination of the small employer
16insurer's records and a review of the small employer insurer's actuarial assumptions
17and statistical methods used in setting rates and procedures used in implementing
18rating plans.
SB201, s. 53 19Section 53. 635.15 of the statutes is repealed and recreated to read:
SB201,21,24 20635.15 Guaranteed issue. (1) Group health benefit plans. (a) Except as
21provided in sub. (3), an insurer shall provide coverage under a group health benefit
22plan that is subject to this subchapter to an employer and to all of the employer's
23eligible employes and their dependents, regardless of health condition or claims
24experience, if all of the following apply:
SB201,22,2
11. The insurer has in force a health benefit plan that is subject to this
2subchapter.
SB201,22,43 2. The employer agrees to pay the premium required for coverage under the
4group health benefit plan.
SB201,22,75 3. The employer agrees to comply with all other provisions of the group health
6benefit plan that apply generally to a policyholder or an insured without regard to
7health condition or claims experience.
SB201,22,108 (b) An insurer shall provide coverage under a group health benefit plan that
9is subject to this subchapter to all of the following, regardless of health condition or
10claims experience:
SB201,22,1211 1. An eligible employe who becomes eligible for coverage after the
12commencement of the employer's coverage, and the eligible employe's dependents.
SB201,22,1613 2. An eligible employe who was excluded from coverage, including an eligible
14employe with coverage under the health insurance risk-sharing plan or an
15alternative plan under subch. II of ch. 619 on or before the effective date of this
16subdivision .... [revisor inserts date], and the eligible employe's dependents.
SB201,22,2017 3. An eligible employe's dependent who was excluded from coverage, including
18an eligible employe's dependent with coverage under the health insurance
19risk-sharing plan or an alternative plan under subch. II of ch. 619 on or before the
20effective date of this subdivision .... [revisor inserts date].
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