SB369: Bill Text

LRB-4019/3

PJK:wlj:jf

1999 - 2000 LEGISLATURE

1999 Senate BILL 369

February 8, 2000 - Introduced by Senators Burke, Clausing, Cowles, Darling, Erpenbach, Grobschmidt, Moore, Plache, Robson, Roessler, Rosenzweig, Rude and Wirch, cosponsored by Representatives Cullen, Wasserman, Balow, Berceau, Bock, Boyle, Carpenter, Kelso, J. Lehman, Miller, Musser, Pocan, Richards, Schneider, Travis, Turner, Young and Ziegelbauer. Referred to Insurance, Tourism, Transportation and Corrections.

SB369,1,5 An Act to amend 40.51 (8), 40.51 (8m), 185.981 (4t) and 185.983 (1) (intro.); and to create 111.91 (2) (kc), 609.89, 609.90, 631.17 and 631.95 of the statutes; relating to: prohibiting certain insurance practices on the basis of domestic abuse, providing written reasons for coverage denial and prohibiting collective bargaining by the state with respect to the prohibitions.

Analysis by the Legislative Reference Bureau

This bill prohibits an insurer from refusing to provide or renew coverage to a person or a group, or from canceling a person's or group's coverage, under any type of insurance policy on the basis that the person or a group member has been, or that the insurer has reason to believe that the person or a group member is, a victim of child or domestic abuse or that a member of the person's or a group member's family has been, or that the insurer has reason to believe that a member of the person's or a group member's family is, a victim of child or domestic abuse. (Under the statutes, domestic abuse refers to abuse of an adult family or household member.) The bill provides, however, that for life, disability income or long-term care insurance an insurer may refuse to issue a policy that would name as beneficiary a person who is or was, or who the insurer has reason to believe is or was, a perpetrator of child or domestic abuse against the person who would be the insured under the policy. An insurer also may refuse to issue a life, disability income or long-term care insurance policy to a person who lacks an insurable interest in the person who would be the insured under the policy.

Under the bill, an insurer is prohibited from using as a factor in determining rates, or any other aspect of insurance coverage, the knowledge or suspicion that a person or group member has been or is a victim of child or domestic abuse or that a member of the person's or a group member's family has been or is a victim of child or domestic abuse. The bill provides, however, that in establishing premiums for a health insurance policy (called disability insurance policy in the statutes) an insurer may inquire about and use information related to a person's existing medical condition, regardless of whether the condition was caused by child or domestic abuse.

The bill prohibits a health insurer from excluding or limiting coverage to a person or a group under a health insurance policy, or from denying a claim, for services or items related to the treatment of injury or disease resulting from child or domestic abuse on the basis that the person or a group member has been, or that the insurer has reason to believe that the person or a group member is, a victim of child or domestic abuse or that a member of the person's or a group member's family has been, or that the insurer has reason to believe that a member of the person's or a group member's family is, a victim of child or domestic abuse.

A life insurer is prohibited from denying or limiting benefits to a beneficiary in the event that the death of the person whose life is insured results from child or domestic abuse on the basis that the person whose life is insured has been, or that the insurer has reason to believe that the person whose life is insured is, a victim of child or domestic abuse or that a member of the family of the person whose life is insured has been, or that the insurer has reason to believe that a member of the family of the person whose life is insured is, a victim of child or domestic abuse. A life insurer may, however, deny or limit benefits to a beneficiary who perpetrates child or domestic abuse that results in the death of the person whose life is insured.

An insurer providing property insurance coverage that excludes coverage for loss or damage resulting from intentional acts is prohibited from denying a claim based on property loss or damage resulting from acts of child or domestic abuse if the insured making the claim did not cooperate in or contribute to the creation of the loss or damage and if the person who caused the loss or damage is criminally prosecuted for the acts that caused the loss or damage.

With certain exceptions, the bill prohibits a person employed by an insurer or contracting with an insurer from using, disclosing or transferring certain personal information related to child or domestic abuse, such as information about whether a person or group member, or a member of the person's or group member's family, is or has been or is believed to be or to have been a victim of child or domestic abuse. With certain exceptions, the bill also prohibits a person employed by an insurer or contracting with an insurer from disclosing or transferring information related to the telephone number or address of a person or group member who is an insured or applicant for insurance, or a member of the family of a person or group member who is an insured or applicant for insurance, and who is or has been or who is believed to be or to have been a victim of child or domestic abuse.

The bill requires an insurer that denies coverage to a person or group under any type of insurance policy to advise the applicant in writing of the reasons for the denial. Insurers are already required under current law to specify in a cancellation or nonrenewal notice the basis for the cancellation or nonrenewal of an insurance policy.

Finally, the bill gives an insurer immunity from any civil or criminal liability for actions that, in the bill, are exceptions to the specified prohibited actions, including: 1) denying life insurance benefits to a beneficiary who is the perpetrator of child or domestic abuse that results in the death of the insured; 2) refusing to issue a life insurance policy that names as a beneficiary a person who is or was, or who the insurer has reason to believe is or was, a perpetrator of child or domestic abuse against the person who would be the insured under the policy; 3) refusing to name as a beneficiary under a life, disability income or long-term care insurance policy a person who is or was, or who the insurer has reason to believe is or was, a perpetrator of child or domestic abuse against the person who would be the insured under the policy; and 4) inquiring about and using information related to a person's medical condition, regardless of whether the condition was caused by child or domestic abuse, for the purpose of establishing premiums under a health insurance policy and for various other insurance-related purposes under a life, disability income or long-term care insurance policy. The bill also gives an insurer immunity from civil and criminal liability for the death of, or injury to, an insured resulting from child or domestic abuse.

Current law contains two provisions that are somewhat similar to provisions in the bill. An insurer may not condition the provision of insurance coverage on, or consider in the determination of rates or any other aspect of insurance coverage, whether a person has obtained, or the results of, a test for the presence of human immunodeficiency virus (HIV), antigen or nonantigenic products of HIV or an antibody to HIV, or whether a person or a member of the person's family has obtained, or the results of, a genetic test.

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:

SB369, s. 1 Section 1. 40.51 (8) of the statutes is amended to read:

SB369,3,5 40.51 (8) Every health care coverage plan offered by the state under sub. (6) shall comply with ss. 631.89, 631.90, 631.93 (2), 631.95, 632.72 (2), 632.746 (1) to (8) and (10), 632.747, 632.748, 632.85, 632.853, 632.855, 632.87 (3) to (5), 632.895 (5m) and (8) to (13) and 632.896.

SB369, s. 2 Section 2. 40.51 (8m) of the statutes is amended to read:

SB369,4,3 40.51 (8m) Every health care coverage plan offered by the group insurance board under sub. (7) shall comply with ss. 631.95, 632.746 (1) to (8) and (10), 632.747, 632.748, 632.85, 632.853, 632.855 and 632.895 (11) to (13).

SB369, s. 3 Section 3. 111.91 (2) (kc) of the statutes is created to read:

SB369,4,5 111.91 (2) (kc) Compliance with the insurance requirements under s. 631.95.

SB369, s. 4 Section 4. 185.981 (4t) of the statutes is amended to read:

SB369,4,10 185.981 (4t) A sickness care plan operated by a cooperative association is subject to ss. 252.14, 631.17, 631.89, 631.95, 632.72 (2), 632.745 to 632.749, 632.85, 632.853, 632.855, 632.87 (2m), (3), (4) and (5), 632.895 (10) to (13) and 632.897 (10) and chs. 149 and 155.

SB369, s. 5 Section 5. 185.983 (1) (intro.) of the statutes is amended to read:

SB369,4,17 185.983 (1) (intro.) Every such voluntary nonprofit sickness care plan shall be exempt from chs. 600 to 646, with the exception of ss. 601.04, 601.13, 601.31, 601.41, 601.42, 601.43, 601.44, 601.45, 611.67, 619.04, 628.34 (10), 631.17, 631.89, 631.93, 631.95, 632.72 (2), 632.745 to 632.749, 632.775, 632.79, 632.795, 632.85, 632.853, 632.855, 632.87 (2m), (3), (4) and (5), 632.895 (5) and (9) to (13), 632.896 and 632.897 (10) and chs. 609, 630, 635, 645 and 646, but the sponsoring association shall:

SB369, s. 6 Section 6. 609.89 of the statutes is created to read:

SB369,4,21 609.89 Written reason for coverage denial. Limited service health organizations, preferred provider plans and managed care plans are subject to s. 631.17.

SB369, s. 7 Section 7. 609.90 of the statutes is created to read:

SB369,4,25 609.90 Restrictions related to domestic abuse. Limited service health organizations, preferred provider plans and managed care plans are subject to s. 631.95.

SB369, s. 8 Section 8. 631.17 of the statutes is created to read:

SB369,5,5 631.17 Written reason for coverage denial. An insurer that denies coverage under an individual or group insurance policy or a certificate of group insurance shall advise the applicant or proposed insured in writing of the reasons for the denial.

SB369, s. 9 Section 9. 631.95 of the statutes is created to read:

SB369,5,8 631.95 Restrictions on insurance practices; domestic abuse. (1) Definitions. In this section:

SB369,5,9 (a) "Abuse" has the meaning given in s. 813.122 (1) (a).

SB369,5,10 (b) "Disability insurance policy" has the meaning given in s. 632.895 (1) (a).

SB369,5,11 (c) "Domestic abuse" has the meaning given in s. 968.075 (1) (a).

SB369,5,13 (2) General prohibitions. Except as provided in sub. (3), an insurer may not do any of the following:

SB369,5,19 (a) Refuse to provide or renew coverage to a person, or cancel a person's coverage, under an individual or group insurance policy or a certificate of group insurance on the basis that the person has been, or the insurer has reason to believe that the person is, a victim of abuse or domestic abuse or that a member of the person's family has been, or the insurer has reason to believe that a member of the person's family is, a victim of abuse or domestic abuse.

SB369,6,2 (b) Refuse to provide or renew coverage to an employer or other group, or cancel an employer's or other group's coverage, under a group insurance policy on the basis that an employe or other group member has been, or the insurer has reason to believe that an employe or other group member is, a victim of abuse or domestic abuse or that a member of an employe's or other group member's family has been, or the insurer has reason to believe that a member of an employe's or other group member's family is, a victim of abuse or domestic abuse.

SB369,6,8 (c) Use as a factor in the determination of rates or any other aspect of insurance coverage under an individual or group insurance policy or a certificate of group insurance the knowledge or suspicion that a person or an employe or other group member has been or is a victim of abuse or domestic abuse or that a member of the person's or an employe's or other group member's family has been or is a victim of abuse or domestic abuse.

SB369,6,17 (d) Under an individual or group disability insurance policy or a certificate of group disability insurance, exclude or limit coverage of, or deny a claim for, health care services or items related to the treatment of injury or disease resulting from abuse or domestic abuse on the basis that a person or an employe or other group member has been, or the insurer has reason to believe that a person or an employe or other group member is, a victim of abuse or domestic abuse or that a member of the person's or an employe's or other group member's family has been, or the insurer has reason to believe that a member of the person's or an employe's or other group member's family is, a victim of abuse or domestic abuse.

SB369,6,25 (e) Under an individual or group life insurance policy or a certificate of group life insurance, deny or limit benefits in the event that the death of the person whose life is insured results from abuse or domestic abuse on the basis that the person whose life is insured has been, or the insurer has reason to believe that the person whose life is insured is, a victim of abuse or domestic abuse or that a member of the family of the person whose life is insured has been, or the insurer has reason to believe that a member of the family of the person whose life is insured is, a victim of abuse or domestic abuse.

SB369,7,8 (f) Under property insurance coverage that excludes coverage for loss or damage to property resulting from intentional acts, deny payment to an insured for a claim based on property loss or damage resulting from an act, or pattern, of abuse or domestic abuse if that insured did not cooperate in or contribute to the creation of the loss or damage and if the person who committed the act or acts that caused the loss or damage is criminally prosecuted for the act or acts. Payment to the innocent insured may be limited in accordance with his or her ownership interest in the property or reduced by payments to a mortgagee or other holder of a secured interest.

SB369,7,15 (3) Exceptions and qualifications related to prohibitions. (a) Disability insurance. In establishing premiums for an individual or group disability insurance policy or a certificate of group disability insurance, an insurer may inquire about a person's existing medical condition and, based on the opinion of a qualified actuary, as defined in s. 623.06 (1c), use information related to a person's existing medical condition, regardless of whether that condition is or may have been caused by abuse or domestic abuse.

SB369,7,19 (b) Life insurance. With respect to an individual or group life insurance policy or a certificate of group life insurance, an insurer may, on the basis of information in medical, law enforcement or court records, or on the basis of information provided by the insured, policyholder or applicant for insurance, do any of the following:

SB369,7,21 1. Deny or limit benefits under such a policy or certificate to a beneficiary who is the perpetrator of abuse or domestic abuse that results in the death of the insured.