AB304: Bill Text

Health claims experience

Under current law, an insurer must provide aggregate claims experience information, upon request, to the policyholder of a group health insurance policy and to an employer that provides health care coverage to its employees through a multiple-employer trust. This requirement applies only if the policyholder or employer provides coverage under the policy for at least 50 individuals, excluding individuals who are covered as dependents. Information must be provided for the current policy period and for up to two immediately preceding policy periods if the insurer provided coverage during those periods, but information is not required to be provided for any period of time that is before 18 months before the date of the request. The insurer must provide the information within 30 days after receiving the request and may not charge for providing the information one time in a 12-month period but may charge for additional requests during that time period.

This bill does the following:

1. Requires a local governmental unit, which includes a city, village, town, county, school district, sewerage district, drainage district, and any other political subdivision of the state, that requests aggregate group health claims experience that an insurer is required to provide to notify DEG when the local governmental unit requests the information.

2. Requires an insurer to provide to DEG the aggregate group health claims experience information that it provides to a local governmental unit at the same time that the insurer provides the information to the local governmental unit.

3. Requires OCI to develop, by rule, a uniform form for insurers to use when providing aggregate group health claims experience information to local governmental units and requires insurers to use the form when providing the information to local governmental units and to DEG.

4. Requires DEG to make the aggregate group health claims experience information that it receives from insurers available to the public.

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:

AB304, s. 1 Section 1. 22.07 (10) of the statutes is created to read:

AB304,4,8 22.07 (10) Make available to the public without charge to local governmental units, the information received from local governmental units under s. 66.0137 (5) (c) in a manner determined by the department to enable the general public to make meaningful comparisons of the bids received. The department shall specify the format that local governmental units shall use in submitting the information and shall make information about the format readily available to local governmental units.

AB304, s. 2 Section 2. 22.07 (11) of the statutes is created to read:

AB304,5,3 22.07 (11) Make available to the public the aggregate group health claims experience information received from insurers under s. 632.797 (1) (d) in the manner determined by the department.

AB304, s. 3 Section 3. 40.02 (25) (bm) of the statutes is amended to read:

AB304,5,12 40.02 (25) (bm) For the purpose of long-term care insurance, in addition to any state annuitant under s. 40.02 (54m), any employee of the state who received a salary or wages from an employer in the previous calendar year, and any participant who was at one time employed by the state who receives a lump sum payment under s. 40.25 (1) which would have been an immediate annuity if paid as an annuity, if the employee is a resident of this state and meets all of the requirements for an immediate annuity including filing of an application, whether or not final administrative action has been taken.

AB304, s. 4 Section 4. 62.61 of the statutes is renumbered 62.61 (1) and amended to read:

AB304,6,4 62.61 (1) Health insurance; 1st class cities. The common council of a 1st class city may, by ordinance or resolution, provide for, including the payment of premiums of, general hospital, surgical and group insurance for both active and retired city officers and city employees and their respective dependents in private companies, or may, by ordinance or resolution, elect to offer to all of its employees a health care coverage plan through a program offered by the group insurance board under ch. 40. Municipalities which elect to participate under s. 40.51 (7) are subject to the applicable sections of ch. 40 instead of this section subsection. Contracts for insurance under this section subsection may be entered into for active officers and employees separately from contracts for retired officers and employees. Appropriations may be made for the purpose of financing insurance under this section subsection. Moneys accruing to a fund to finance insurance under this section subsection, by investment or otherwise, may not be diverted for any other purpose than those for which the fund was set up or to defray management expenses of the fund or to partially pay premiums to reduce costs to the city or to persons covered by the insurance, or both.

AB304, s. 5 Section 5. 62.61 (2) of the statutes is created to read:

AB304,6,9 62.61 (2) If a 1st class city solicits bids to provide health care coverage under sub. (1), the 1st class city shall use the uniform local governmental health care coverage request-for-proposals form developed by the commissioner of insurance under s. 601.41 (10) to solicit the bids.

AB304, s. 6 Section 6. 62.61 (3) of the statutes is created to read:

AB304,6,16 62.61 (3) A 1st class city shall submit information about a bid it receives to the department of electronic government in the format specified under s. 22.07 (10) no later than 30 days after the bid is received or, in the case of a sealed bid, no later than 30 days after the bid is opened. At the time the information is submitted to the department of electronic government, the 1st class city shall do at least one of the following:

AB304,6,17 (a) Post the same information on the city's Internet site, if any.

AB304,6,19 (b) Post notice on the city's Internet site, if any, that the information has been submitted to the department of electronic government.

AB304,6,23 (c) Post or publish as a class 1 notice under ch. 985 a statement that the information has been submitted to the department of electronic government and will be available on the state's Internet site, if any, or a statement that the information may be viewed at a specified location in the 1st class city, or both.

AB304, s. 7 Section 7. 66.0137 (1) of the statutes is amended to read:

AB304,7,4 66.0137 (1) Definition. In this section, "local governmental unit" means a city, village, town, county, school district (as enumerated in s. 67.01 (5)), sewerage district, drainage district, and, without limitation because of enumeration, any other political subdivision of the state.

AB304, s. 8 Section 8. 66.0137 (5) of the statutes is renumbered 66.0137 (5) (a) amended to read:

AB304,7,16 66.0137 (5) (a) The state or a local governmental unit may provide for the payment of premiums for hospital, surgical and other health and accident insurance and life insurance for employees and officers and their spouses and dependent children. A local governmental unit may also provide for the payment of premiums for hospital and surgical care for its retired employees. In addition, a local governmental unit may, by ordinance or resolution, elect to offer to all of its employees a health care coverage plan through a program offered by the group insurance board under ch. 40. A local governmental unit that elects to participate under s. 40.51 (7) is subject to the applicable sections of ch. 40 instead of this subsection paragraph.

AB304, s. 9 Section 9. 66.0137 (5) (b) and (c) of the statutes are created to read:

AB304,7,21 66.0137 (5) (b) If a local governmental unit solicits bids to provide health care coverage under par. (a), the local governmental unit shall use the uniform local governmental health care coverage request-for-proposals form developed by the commissioner of insurance under s. 601.41 (10) to solicit the bids.

AB304,8,2 (c) A local governmental unit shall submit information about a bid it receives to the department of electronic government in the format specified under s. 22.07 (10) no later than 30 days after the bid is received or, in the case of a sealed bid, no later than 30 days after the bid is opened. At the time the information is submitted to the department of electronic government, the local governmental unit shall do at least one of the following:

AB304,8,3 1. Post the same information on the local government's Internet site, if any.

AB304,8,6 2. Post notice on the local government's Internet site, if any, that the information has been submitted to the department of electronic government and will be available on the state's Internet site, if any.

AB304,8,10 3. Post or publish as a class 1 notice under ch. 985 a statement that the information has been submitted to the department of electronic government and will be available on the state's Internet site, if any, or a statement that the information may be viewed at a specified location in the local governmental unit, or both.

AB304, s. 10 Section 10. 111.70 (1) (a) of the statutes is amended to read:

AB304,9,9 111.70 (1) (a) "Collective bargaining" means the performance of the mutual obligation of a municipal employer, through its officers and agents, and the representative of its municipal employees in a collective bargaining unit, to meet and confer at reasonable times, in good faith, with the intention of reaching an agreement, or to resolve questions arising under such an agreement, with respect to wages, hours and conditions of employment, and with respect to a requirement of the municipal employer for a municipal employee to perform law enforcement and fire fighting services under s. 61.66, except as provided in sub. (4) (m) , (n), and (o) and s. 40.81 (3) and except that a municipal employer shall not meet and confer with respect to any proposal to diminish or abridge the rights guaranteed to municipal employees under ch. 164. The duty to bargain, however, does not compel either party to agree to a proposal or require the making of a concession. Collective bargaining includes the reduction of any agreement reached to a written and signed document. The municipal employer shall not be required to bargain on subjects reserved to management and direction of the governmental unit except insofar as the manner of exercise of such functions affects the wages, hours and conditions of employment of the municipal employees in a collective bargaining unit. In creating this subchapter the legislature recognizes that the municipal employer must exercise its powers and responsibilities to act for the government and good order of the jurisdiction which it serves, its commercial benefit and the health, safety and welfare of the public to assure orderly operations and functions within its jurisdiction, subject to those rights secured to municipal employees by the constitutions of this state and of the United States and by this subchapter.

AB304, s. 11 Section 11. 111.70 (4) (c) 2m. of the statutes is created to read:

AB304,9,18 111.70 (4) (c) 2m. `Factors used in arbitration to settle disputes.' If the parties to a dispute agree to have the commission or any other appropriate agency serve as arbitrator to resolve the dispute and if the commission or any other appropriate agency compares the wages, hours, and conditions of employment of the municipal employees involved in the arbitration proceedings with the wages, hours, and conditions of employment of any other employees, the commission or other appropriate agency shall compare the wages, hours, and conditions of employment as a whole, rather than as individual elements.

AB304, s. 12 Section 12. 111.70 (4) (cm) 7r. d. of the statutes is amended to read:

AB304,9,24 111.70 (4) (cm) 7r. d. Comparison of wages, hours and conditions of employment of the municipal employees involved in the arbitration proceedings with the wages, hours and conditions of employment of other employees performing similar services. In making this comparison, the arbitrator or arbitration panel shall consider wages, hours, and conditions of employment as a whole, rather than as individual elements.

AB304, s. 13 Section 13. 111.70 (4) (cm) 7r. e. of the statutes is amended to read:

AB304,10,6 111.70 (4) (cm) 7r. e. Comparison of the wages, hours and conditions of employment of the municipal employees involved in the arbitration proceedings with the wages, hours and conditions of employment of other employees generally in public employment in the same community and in comparable communities. In making this comparison, the arbitrator or arbitration panel shall consider wages, hours, and conditions of employment as a whole, rather than as individual elements.

AB304, s. 14 Section 14. 111.70 (4) (cm) 7r. f. of the statutes is amended to read:

AB304,10,13 111.70 (4) (cm) 7r. f. Comparison of the wages, hours and conditions of employment of the municipal employees involved in the arbitration proceedings with the wages, hours and conditions of employment of other employees in private employment in the same community and in comparable communities. In making this comparison, the arbitrator or arbitration panel shall consider wages, hours, and conditions of employment as a whole, rather than as individual elements.

AB304, s. 15 Section 15. 111.70 (4) (cm) 7r. g. of the statutes is amended to read:

AB304,10,17 111.70 (4) (cm) 7r. g. The average consumer prices for goods and services, commonly known as the cost of living, including specifically average housing costs and other costs significantly affecting the quality of life.

AB304, s. 16 Section 16. 111.70 (4) (cm) 7r. h. of the statutes is amended to read:

AB304,10,24 111.70 (4) (cm) 7r. h. The overall compensation presently received by the municipal employees, including direct wage compensation, vacation, holidays and excused time, insurance and pensions, medical and hospitalization benefits, the continuity and stability of employment, and all other benefits received. In making this comparison, the arbitrator or arbitration panel shall consider wages, hours, and conditions of employment as a whole, rather than as individual elements.

AB304, s. 17 Section 17. 111.70 (4) (jm) 4m. of the statutes is created to read:

AB304,11,6 111.70 (4) (jm) 4m. For the purpose of setting wages and determining hours and conditions of employment under subd. 4., if the arbitrator compares the wages, hours, and conditions of employment with the wages, hours, and conditions of employment of other employees performing similar services or in the same community or comparable communities, the arbitrator shall consider wages, hours, and conditions of employment as a whole, rather than as individual elements.

AB304, s. 18 Section 18. 111.70 (4) (n) of the statutes is created to read:

AB304,11,19 111.70 (4) (n) Municipal employer-initiated change in health care coverage plan provider. 1. Notwithstanding the terms of a collective bargaining agreement, a municipal employer may unilaterally change its employees' health care coverage plan provider without the consent of any affected employee in the collective bargaining unit if the benefits provided by the new health care coverage plan provider are substantially similar to those provided by the former health care coverage plan provider and if the persons who provide health care coverage under the new plan are the same as under the former plan. Any such unilateral change in health care coverage plan provider is not a violation of a collective bargaining agreement or a prohibited practice under sub. (3) (a) and, for purposes of a qualified economic offer, satisfies the requirement to maintain fringe benefits under sub. (1) (nc).

AB304,11,25 2. Any moneys saved by a municipal employer as a result of a change in health care coverage plan provider under subd. 1. shall be used to increase the wages paid to the affected employees during the period covered by their collective bargaining agreement and wage-related costs resulting from the increase in wages. Any such increase in wages and wage-related costs by the municipal employer is not a prohibited practice under sub. (3) (a).

AB304, s. 19 Section 19. 111.70 (4) (o) of the statutes is created to read:

AB304,12,9 111.70 (4) (o) Prohibited subject of collective bargaining. 1. A municipal employer is prohibited from bargaining collectively with respect to the employer's selection of a health care coverage plan if the municipal employer offers to enroll the employees in a health care coverage plan under s. 40.51 (7) or in a health care coverage plan that is substantially similar to a plan offered under s. 40.51 (7). The commission shall use the criteria in rules promulgated by the commissioner of insurance under s. 601.41 (12) to determine if health care coverage plans are substantially similar.

AB304,12,11 2. This paragraph does not apply to a municipal employer with respect to its school district professional employees.

AB304, s. 20 Section 20. 111.77 (6) (dm) of the statutes is created to read:

AB304,12,15 111.77 (6) (dm) In making the comparison of wages, hours, and conditions of employment under par (d), the arbitrator shall consider wages, hours, and conditions of employment as a whole, rather than as individual elements.

AB304, s. 21 Section 21. 601.41 (10) of the statutes is created to read:

AB304,12,22 601.41 (10) Local government health care coverage request-for-proposals form. The commissioner shall by rule develop a uniform local government health care coverage request-for-proposals form that a local governmental unit must use under s. 66.0137 (5) (b) if the local governmental unit solicits bids for health care coverage. The commissioner shall publish a notice in the Wisconsin Administrative Register that states the effective date of the rule required under this subsection.

AB304, s. 22 Section 22. 601.41 (11) of the statutes is created to read:

AB304,13,5 601.41 (11) Local government health care claims experience form. The commissioner shall by rule develop a uniform local government health claims experience form that an insurer must use under s. 632.797 (1) (d). The form may not require the disclosure of information that identifies an individual or that is confidential under s. 51.30, 146.82, or 252.15 or any applicable federal law. The commissioner shall publish a notice in the Wisconsin Administrative Register that states the effective date of the rule required under this subsection.

AB304, s. 23 Section 23. 601.41 (12) of the statutes is created to read:

AB304,13,11 601.41 (12) Substantially similar health care coverage plan. The commissioner shall promulgate rules, that set out a standardized summary of benefits provided under health care coverage plans, including plans offered under s. 40.51 (7), for use in determining whether a health care coverage plan is substantially similar to a plan offered under s. 40.51 (7).

AB304, s. 24 Section 24. 610.66 of the statutes is created to read:

AB304,13,16 610.66 Local government health care coverage request-for-proposals form. Every insurer shall use the uniform local government health care coverage request-for-proposals form developed by the commissioner under s. 601.41 (10) when submitting a bid to a local governmental unit under s. 66.0137 (5) (b).

AB304, s. 25 Section 25. 632.797 (1) (d) of the statutes is created to read:

AB304,13,19 632.797 (1) (d) 1. "Local governmental unit" has the meaning given in s. 66.0137 (1).

AB304,13,23 2. A policyholder or employer that is a local governmental unit and that requests information under par. (a) that an insurer is required to provide under this section shall notify the department of electronic government when it makes the request for the information.

AB304,14,2 3. An insurer that is required to provide the information under par. (a) to a local governmental unit shall also provide the information to the department of electronic government at the same time as the insurer provides the information to the local governmental unit.

AB304,14,6 4. The insurer shall use the uniform local government health claims experience form developed by the commissioner under s. 601.41 (11) to submit the claims experience information to the local governmental unit and to the department of electronic government.

AB304,14,9 5. If the insurer fails to provide the information to the department of electronic government by the deadline specified in par. (b), the department of electronic government may report the failure to the commissioner.

AB304, s. 26 Section 26. 632.797 (5) of the statutes is amended to read:

AB304,14,13 632.797 (5) An insurer is not required under sub. (1) to provide information that identifies an individual or that is confidential under s. 51.30, 146.82, or 252.15 or any applicable federal law.

AB304, s. 27 Section 27 . Nonstatutory provisions.

AB304,14,15 (1) Group insurance board study.

AB304,14,18 (a) The group insurance board shall consult with representatives of group insurance plans regarding the feasibility of developing the following plans for employers to offer their employees under section 40.51 (7) of the statutes:

AB304,14,20 1. A group health insurance plan with at least 3 cost levels, for the purpose of offering a greater choice of plans based on cost to employers and employees.

AB304,14,22 2. A low-cost health insurance plan that provides coverage for catastrophic illness or injury.

AB304,14,25 (b) The group insurance board shall report its findings under paragraph (a) to the governor and to the legislature in the manner provided under section 13.172 (2) of the statutes no later than July 1, 2003.

AB304,15,1 (2) Interagency task force on bulk purchasing of prescription drugs.

AB304,15,4 (a) The secretary of administration shall organize, and provide staff support for, an interagency task force on bulk purchasing of prescription drugs consisting of the heads of the following state agencies or their designees:

AB304,15,5 1. department of administration.

AB304,15,6 2. department of health and family services.

AB304,15,7 3. department of employee trust funds.

AB304,15,8 4. department of veterans affairs.

AB304,15,9 5. department of corrections.

AB304,15,10 6. board of regents of the University of Wisconsin System.