CHAPTER 149
Mandatory health insurance risk-sharing plan
149.10 Definitions.
149.11 Operation of plan.
149.115 Rules relating to creditable coverage.
149.12 Eligibility determination.
149.125 Health insurance risk-sharing plan fund.
149.13 Participation of insurers.
149.14 Coverage.
149.143 Payment of plan costs.
149.144 Adjustments to insurer assessments and provider payment rates for premium and deductible reductions.
149.145 Program budget.
149.146 Choice of coverage.
149.15 Board of governors.
149.16 Plan administrator.
149.165 Reductions in premiums for low-income eligible persons.
149.17 Contents of plan.
149.175 Waiver or exemption from provisions prohibited.
149.18 Chapters 600 to 645 applicable.
149.20 Rule-making in consultation with board.
149.10 149.10 Definitions. In this chapter:
149.10(2) (2) "Board" means the board of governors established under s. 149.15.
149.10(2c) (2c) "Church plan" has the meaning given in section 3 (33) of the federal Employee Retirement Income Security Act of 1974.
149.10(2f) (2f) "Commissioner" means the commissioner of insurance.
149.10(2j) (2j)
149.10(2j)(a)(a) Except as provided in par. (b), "creditable coverage" means coverage under any of the following:
149.10(2j)(a)1. 1. A group health plan.
149.10(2j)(a)2. 2. Health insurance.
149.10(2j)(a)3. 3. Part A or part B of title XVIII of the federal Social Security Act.
149.10(2j)(a)4. 4. Title XIX of the federal Social Security Act, except for coverage consisting solely of benefits under section 1928 of that act.
149.10(2j)(a)5. 5. Chapter 55 of title 10 of the United States Code.
149.10(2j)(a)6. 6. A medical care program of the federal Indian health service or of an American Indian tribal organization.
149.10(2j)(a)7. 7. A state health benefits risk pool.
149.10(2j)(a)8. 8. A health plan offered under chapter 89 of title 5 of the United States Code.
149.10(2j)(a)9. 9. A public health plan.
149.10(2j)(a)10. 10. A health coverage plan under section 5 (e) of the federal Peace Corps Act, 22 USC 2504 (e).
149.10(2j)(b) (b) "Creditable coverage" does not include coverage consisting solely of coverage of excepted benefits, as defined in section 2791 (c) of P.L. 104-191.
149.10(2m) (2m) "Department" means the department of health and family services.
149.10(2t) (2t) "Eligible individual" means an individual for whom all of the following apply:
149.10(2t)(a) (a) The aggregate of the individual's periods of creditable coverage is 18 months or more.
149.10(2t)(b) (b) The individual's most recent period of creditable coverage was under a group health plan, governmental plan, federal governmental plan or church plan, or under any health insurance offered in connection with any of those plans.
149.10(2t)(c) (c) The individual does not have creditable coverage and is not eligible for coverage under a group health plan, part A or part B of title XVIII of the federal Social Security Act or a state plan under title XIX of the federal Social Security Act or any successor program.
149.10(2t)(d) (d) The individual's most recent period of creditable coverage was not terminated for any reason related to fraud or intentional misrepresentation of material fact or a failure to pay premiums.
149.10(2t)(e) (e) If the individual was offered the option of continuation coverage under a federal continuation provision or similar state program, the individual elected the continuation coverage.
149.10(2t)(f) (f) The individual has exhausted any continuation coverage under par. (e).
149.10(3) (3) "Eligible person" means a resident of this state who qualifies under s. 149.12 whether or not the person is legally responsible for the payment of medical expenses incurred on the person's behalf.
149.10(3c) (3c) "Federal continuation provision" means any of the following:
149.10(3c)(a) (a) Section 4980B of the Internal Revenue Code of 1986, except for section 4980B (f) (1) of that code insofar as it relates to pediatric vaccines.
149.10(3c)(b) (b) Part 6 of subtitle B of title I of the federal Employee Retirement Income Security Act of 1974, except for section 609 of that act.
149.10(3c)(c) (c) Title XXII of P.L. 104-191.
149.10(3d) (3d) "Federal governmental plan" means a benefit program established or maintained for its employes by the government of the United States or by any agency or instrumentality of the government of the United States.
149.10(3g) (3g) "Governmental plan" has the meaning given under section 3 (32) of the federal Employee Retirement Income Security Act of 1974.
149.10(3j) (3j) "Group health plan" means any of the following:
149.10(3j)(a) (a) An employe welfare plan, as defined in section 3 (1) of the federal Employee Retirement Security Act of 1974, to the extent that the employe welfare plan provides medical care, including items and services paid for as medical care, to employes or to their dependents, as defined under the terms of the employe welfare plan, directly or through insurance, reimbursement or otherwise.
149.10(3j)(b) (b) Any program that would not otherwise be an employe welfare benefit plan and that is established or maintained by a partnership, to the extent that the program provides medical care, including items and services paid for as medical care, to present or former partners of the partnership or to their dependents, as defined under the terms of the program, directly or through insurance, reimbursement or otherwise.
149.10(3m) (3m) "Health care coverage revenue" means any of the following:
149.10(3m)(a) (a) Premiums received for health care coverage.
149.10(3m)(b) (b) Subscriber contract charges received for health care coverage.
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This is an archival version of the Wis. Stats. database for 1997. See Are the Statutes on this Website Official?