SB443,4,1716 185.981 (10) A sickness care plan that is operated by a cooperative association
17and that provides maternity coverage is subject to s. 632.893.
SB443, s. 11 18Section 11. 185.983 (1) (intro.) of the statutes is amended to read:
SB443,4,2419 185.983 (1) (intro.)  Every such voluntary nonprofit sickness care plan shall be
20exempt from chs. 600 to 646, with the exception of ss. 601.04, 601.13, 601.31, 601.41,
21601.42, 601.43, 601.44, 601.45, 611.67, 619.04, 628.34 (10), 631.89, 631.93, 632.72
22(2), 632.775, 632.79, 632.795, 632.87 (2m), (3), (4) and (5), 632.893, 632.895 (5), (9)
23and (10), 632.896 and 632.897 (10), subch. II of ch. 619 and chs. 609, 630, 635, 645
24and 646, but the sponsoring association shall:
SB443, s. 12 25Section 12. 185.983 (1m) of the statutes is amended to read:
SB443,5,7
1185.983 (1m) In addition to ss. 601.04, 601.31, 632.79 and 632.895 (5), the
2commissioner of insurance may by rule subject a medicare supplement policy as
3defined in s. 600.03 (28r), a medicare replacement policy as defined in s. 600.03 (28p)
4or a long-term care insurance policy as defined in s. 600.03 (28g) sold by a voluntary
5nonprofit sickness care plan to other provisions of chs. 600 to 646, except the
6commissioner may not subject a medicare supplement policy, a medicare
7replacement policy or a long-term care insurance policy to s. 632.893 or 632.895 (8).
SB443, s. 13 8Section 13. 609.76 of the statutes is created to read:
SB443,5,10 9609.76 Infertility coverage. Except as provided in s. 49.45 (20m), health
10maintenance organizations and preferred provider plans are subject to s. 632.893.
SB443, s. 14 11Section 14. 619.14 (3) (q) of the statutes is amended to read:
SB443,5,1312 619.14 (3) (q) Any other health insurance coverage, only to the extent required
13under subch. VI of ch. 632 and not excluded under sub. (4).
SB443, s. 15 14Section 15. 619.14 (4) (n) of the statutes is created to read:
SB443,5,1615 619.14 (4) (n) Any charge for performing a procedure for the diagnosis or
16treatment of infertility.
SB443, s. 16 17Section 16. 632.893 of the statutes is created to read:
SB443,5,19 18632.893 Required coverage of diagnosis and treatment of infertility.
19(1) Definitions. In this section:
SB443,5,2020 (a) "Disability insurance policy" has the meaning given in s. 632.895 (1) (a).
SB443,5,2321 (b) "Gamete intrafallopian tube transfer" means a procedure in which a
22mixture containing both egg and sperm is directly transferred to the fallopian tube,
23where fertilization occurs.
SB443,6,3
1(c) "Infertility" means the inability to conceive or produce conception after
2engaging in unprotected sexual intercourse over a period of at least one year, or the
3inability to carry a pregnancy to live birth.
SB443,6,64 (d) "In vitro fertilization" means a procedure in which an egg and sperm are
5combined in a laboratory dish, where fertilization occurs, and the fertilized and
6dividing egg is transferred to the uterus or cryopreserved for future use.
SB443,6,97 (e) "Nonexperimental procedure" means a clinical procedure that is recognized
8as safe and effective by the American Society for Reproductive Medicine or the
9American College of Obstetricians and Gynecologists.
SB443,6,1310 (f) "Zygote intrafallopian tube transfer" means a procedure in which an egg and
11sperm are combined in a laboratory dish, where fertilization occurs, and the
12fertilized egg is transferred to the fallopian tube at the pronuclear stage before cell
13division takes place.
SB443,6,18 14(2) Required coverage. Except as provided in subs. (3) and (5) and s. 49.45
15(20m), every disability insurance policy, and every self-insured health plan of the
16state or a county, city, village, town or school district, that provides maternity
17coverage shall provide coverage of any nonexperimental procedure for the diagnosis
18and treatment of infertility.
SB443,6,21 19(3) Conditional requirements for certain procedures. The coverage
20requirement under sub. (2) applies to in vitro fertilization, gamete intrafallopian
21tube transfer or zygote intrafallopian tube transfer only if all of the following apply:
SB443,6,2422 (a) The covered individual has tried other less costly and medically appropriate
23nonexperimental procedures for the treatment of infertility and has been unable to
24carry a pregnancy to live birth.
SB443,7,5
1(b) The covered individual has undergone fewer than 4 completed oocyte
2retrievals at any time in connection with any infertility procedure or procedures, or
3has undergone fewer than 2 completed oocyte retrievals at any time in connection
4with any infertility procedure or procedures after a live birth following a completed
5oocyte retrieval.
SB443,7,96 (c) The procedure is performed at a medical facility that conforms to the
7standards and guidelines of the American Association of Tissue Banks and of the
8American Society for Reproductive Medicine or the American College of
9Obstetricians and Gynecologists.
SB443,7,12 10(4) Copayments and deductibles. The coverage required under this section
11may not be subject to copayments or deductibles that are greater than any
12copayments or deductibles that apply to maternity coverage under the policy or plan.
SB443,7,13 13(5) Exclusion. This section does not apply to any of the following:
SB443,7,1514 (a) A medicare replacement policy, a medicare supplement policy or a
15long-term care insurance policy.
SB443,7,1816 (b) The mandatory health insurance risk-sharing plan under ch. 619 and any
17alternative plans offered under s. 619.145 to persons eligible for coverage under s.
18619.12.
SB443, s. 17 19Section 17. Initial applicability.
SB443,7,20 20(1) This act first applies to all of the following:
SB443,7,23 21(a) Except as provided in paragraphs (b) and (c) , disability insurance policies
22that are issued or renewed, and self-insured health plans that are established,
23extended, modified or renewed, on the effective date of this paragraph.
SB443,8,3
1(b) Disability insurance policies covering employes who are affected by a
2collective bargaining agreement containing provisions inconsistent with this act
3that are issued or renewed on the earlier of the following:
SB443,8,4 41. The day on which the collective bargaining agreement expires.
SB443,8,6 52. The day on which the collective bargaining agreement is extended, modified
6or renewed.
SB443,8,9 7(c) Self-insured health plans covering employes who are affected by a
8collective bargaining agreement containing provisions inconsistent with this act
9that are established, extended, modified or renewed on the earlier of the following:
SB443,8,10 101. The day on which the collective bargaining agreement expires.
SB443,8,12 112. The day on which the collective bargaining agreement is extended, modified
12or renewed.
SB443, s. 18 13Section 18. Effective date.
SB443,8,15 14(1) This act takes effect on the first day of the 5th month beginning after
15publication.
SB443,8,1616 (End)
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