LRB-4583/2
PJK:rs&kmg:jf
2001 - 2002 LEGISLATURE
March 4, 2002 - Introduced by Representatives Richards, Berceau, Plouff,
Turner
and Wasserman. Referred to Committee on Health.
AB885,1,2 1An Act to create 609.40 of the statutes; relating to: requiring defined network
2plans to provide notice regarding reproductive health care services.
Analysis by the Legislative Reference Bureau
This bill requires defined network plans to include a specified statement at the
beginning of each provider directory, in any provider directory posted on the defined
network plan's website, if any, and in the defined network plan's evidence of coverage
and disclosure forms. Defined network plans, which were formerly called managed
care plans in the statutes, are defined in current law as health benefit plans that
require or provide incentives for enrollees to obtain health care services from
providers that are under contract with, or managed, owned, or employed by, the
insurer offering the health benefit plan. The statement that defined network plans
must include informs enrollees and prospective enrollees that some hospitals and
other providers do not provide one or more reproductive health care services that
may be covered under the plan, including family planning, contraceptive services,
sterilization, infertility treatments, or abortion, and that the enrollee or prospective
enrollee should obtain more information before becoming an enrollee or selecting a
participating provider. The statement advises the enrollee or prospective enrollee
to call a prospective provider or the defined network plan to ensure that he or she can
obtain the health care services that he or she needs, and provides the appropriate
telephone number of the plan. A defined network plan is not required to provide the

statement in a service area in which none of the participating providers limits or
restricts any of the reproductive health care services specified in the statement.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
AB885, s. 1 1Section 1. 609.40 of the statutes is created to read:
AB885,2,4 2609.40 Notice regarding reproductive health care services. (1) Except
3as provided in subs. (2) and (3), no later than September 1, 2002, every defined
4network plan shall do all of the following:
AB885,2,65 (a) Include at the beginning of each provider directory, in at least 12-point
6boldface type, the following statement:
AB885,2,87 NOTICE REGARDING REPRODUCTIVE
8 HEALTH CARE SERVICES
AB885,2,219 SOME HOSPITALS AND OTHER PROVIDERS DO NOT PROVIDE ONE OR
10MORE OF THE FOLLOWING SERVICES THAT MAY BE COVERED UNDER THE
11PLAN CONTRACT AND THAT YOU OR A MEMBER OF YOUR FAMILY MIGHT
12NEED: FAMILY PLANNING; CONTRACEPTIVE SERVICES, INCLUDING
13EMERGENCY CONTRACEPTION; STERILIZATION, INCLUDING TUBAL
14LIGATION AT THE TIME OF LABOR AND DELIVERY; INFERTILITY
15TREATMENTS; OR ABORTION. YOU SHOULD OBTAIN MORE INFORMATION
16BEFORE YOU ENROLL OR SELECT A PARTICIPATING PROVIDER. CALL
17YOUR PROSPECTIVE DOCTOR, MEDICAL GROUP, INDEPENDENT
18PRACTICE ASSOCIATION, OR CLINIC, OR CALL .... (name of defined network
19plan) AT .... (membership services telephone number or other appropriate number
20that individuals may call for assistance), TO ENSURE THAT YOU CAN OBTAIN
21THE HEALTH CARE SERVICES THAT YOU NEED.
AB885,3,2
1(b) Place the statement under par. (a) in a prominent location in any provider
2directory posted on the defined network plan's Internet website, if any.
AB885,3,43 (c) Include the statement under par. (a) in a conspicuous place in the defined
4network plan's evidence of coverage and disclosure forms.
AB885,3,8 5(2) A defined network plan is not required to provide the statement under sub.
6(1) (a) in any service area of the defined network plan in which none of the plan's
7participating providers limits or restricts any of the reproductive health care
8services described in the statement.
AB885,3,10 9(3) The requirement under sub. (1) does not apply to a medicare supplement
10policy.
AB885,3,1111 (End)
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