SB201: Bill Text

SB201,36,15 635.25 (1) (a) 2. Must comply with any other eligibility requirements specified by the plan board under s. 635.25 (1) (a) 2., 1993 stats., or by the board.

SB201, s. 95 Section 95. 635.25 (1) (b) of the statutes is amended to read:

SB201,36,20 635.25 (1) (b) Except as provided in ss. 645.43 and 646.35, an a small employer that purchases a policy under this subchapter containing the basic benefits and that ceases to be eligible to participate in the plan during a policy period shall retain coverage under the plan policy to the end of the policy period.

SB201, s. 96 Section 96. 635.25 (1m) of the statutes is amended to read:

SB201,36,25 635.25 (1m) Notwithstanding sub. (1), an a small employer is not eligible to participate in the plan purchase a policy under this subchapter containing the basic benefits if all of the individuals to be covered under the plan policy may be covered by a single under an individual policy providing individual single or family coverage.

SB201, s. 97 Section 97. 635.25 (2) of the statutes is amended to read:

SB201,37,4 635.25 (2) Employes and dependents. (a) All eligible employes of an eligible small employer that participates in the plan purchases a policy under this subchapter are eligible for coverage under the plan policy, subject to the policy terms.

SB201,37,6 (b) Any dependent of an eligible employe who is covered under the plan policy is also eligible for coverage under the plan policy, subject to the policy terms.

SB201, s. 98 Section 98. 635.254 of the statutes is amended to read:

SB201,37,12 635.254 Employer premium contribution. (1) An A small employer that participates in the plan purchases a policy under this subchapter shall pay a premium contribution of not less than 50% of the premium rate on behalf of an eligible employe with individual single coverage and not less than 40% of the premium rate on behalf of an eligible employe with family coverage.

SB201,37,15 (2) An A small employer under sub. (1) shall withhold from the earnings of an employe with coverage under the plan policy under this subchapter the amount of premium not contributed by the small employer under sub. (1).

SB201,37,20 (3) For an eligible employe who obtains coverage under the health insurance risk-sharing plan under s. 619.12 (2) (e) 2., an a small employer under sub. (1) shall pay a premium contribution to the health insurance risk-sharing plan that is equal to the amount that the small employer would pay on behalf of the employe for coverage under the plan policy under this subchapter.

SB201, s. 99 Section 99. 635.26 (1) of the statutes is amended to read:

SB201,38,2 635.26 (1) (a) Except as provided in subs. (2m) to (4) (5), a small employer insurer shall provide coverage under the plan a policy under this subchapter, regardless of health status condition or claims experience, to an eligible small employer and to all of its eligible employes and their dependents if all of the following apply:

SB201,38,4 1. The small employer agrees to pay the premium required for coverage under the plan policy.

SB201,38,7 2. The small employer agrees to comply with all other plan policy provisions that apply generally to a policyholder or an insured without regard to health status condition or claims experience.

SB201,38,12 (b) Except as provided in subs. (2m) to (4) (5), a small employer insurer shall provide coverage under the plan a policy under this subchapter, regardless of health status condition or claims experience, to an eligible employe who becomes eligible for coverage after the commencement of the small employer's coverage, and to the eligible employe's dependents, if all of the following apply:

SB201,38,14 1. The employe applies for coverage under the plan policy before the expiration of any applicable enrollment period, if any, required under the plan policy.

SB201,38,16 2. The small employer agrees to pay the premium required for coverage of the employe under the plan policy.

SB201, s. 100 Section 100. 635.26 (1m) of the statutes is amended to read:

SB201,38,21 635.26 (1m) A small employer insurer shall be in compliance with sub. (1) if it issues a policy that complies with the plan and the minimum benefit standards determined by the plan board under s. 635.23 (1) (c), 1993 stats., or the board under s. 635.23 (1) (c) but that includes only the basic benefits.

SB201, s. 101 Section 101. 635.26 (1s) of the statutes is amended to read:

SB201,39,2 635.26 (1s) Nothing in sub. (1) prohibits a small employer insurer that provides coverage under sub. (1) from imposing preexisting condition provisions, waiting period requirements, or other provisions or requirements related to health status condition or claims experience, that are permitted or required under the plan policy.

SB201, s. 102 Section 102. 635.26 (4) of the statutes is amended to read:

SB201,39,8 635.26 (4) A small employer insurer that offers health insurance coverage exclusively to a single category or limited categories of eligible small employers is required to comply may, with the prior approval of the commissioner, limit its compliance with sub. (1) only as to that single category or those limited categories of eligible small employers.

SB201, s. 103 Section 103. 635.26 (5) of the statutes is created to read:

SB201,39,11 635.26 (5) (a) In this subsection, "municipal" means county, city, village, town or school district.

SB201,39,16 (b) Subsection (1) does not require a small employer insurer to issue coverage that the small employer insurer is not authorized to issue under its bylaws, charter or certificate of incorporation or authority if the small employer insurer is authorized under its bylaws, charter or certificate of incorporation or authority to issue coverage only to state or municipal employes and former employes and their dependents.

SB201, s. 104 Section 104. 635.272 (1) of the statutes is amended to read:

SB201,39,22 635.272 (1) Contracting health care providers. A health care provider that contracts with a small employer insurer to provide services to individuals with coverage under the plan a policy under this subchapter shall accept amounts payable under the contract for the basic benefits under the policy as payment in full for those services. This subsection does not affect liability for deductibles or copayments.

SB201, s. 105 Section 105. 635.28 of the statutes is amended to read:

SB201,40,2 635.28 (title) Liability of state and plan board. Neither the state nor the plan board is liable for any obligation arising under the plan. Plan board Board members are immune from civil liability for acts or omissions while performing in the performance of their duties under this subchapter.

SB201, s. 106 Section 106. 635.29 of the statutes is amended to read:

SB201,40,7 635.29 (title) Exemption from required coverage Applicability of health insurance mandates. The health insurance mandates apply to the plan under this subchapter only to the extent determined by the plan board under s. 635.23 (1) (b), 1993 stats., or the board under s. 635.23 (1) (b).

SB201, s. 107 Section 107 . Nonstatutory provisions; insurance.

SB201,40,15 (1)  Comprehensive health care board; initial membership. Notwithstanding the length of terms specified for the members of the comprehensive health care board under section 15.735 (3) (b) of the statutes, as created by this act, and the manner of appointment specified for the members of the board under section 15.07 (1) (b) of the statutes, the following initial members of the board shall be appointed by the governor by the first day of the 4th month beginning after the effective date of this subsection for the following terms:

SB201,40,18 (a)  Four members, 2 of whom represent employers, one of whom represents eligible employes and one of whom represents a purchasing coalition, for terms expiring on May 1, 1996.

SB201,40,21 (b)  Four members, one of whom represents employers, one of whom represents eligible employes, one of whom represents a labor organization and one of whom represents a purchasing coalition, for terms expiring on May 1, 1997.

SB201,40,24 (c)  Four members, 2 of whom represent employers, one of whom represents eligible employes and one of whom represents a purchasing coalition, for terms expiring on May 1, 1998.

SB201,40,25 (2)  Studies.

SB201,41,1 (a)  The comprehensive health care board shall study all of the following:

SB201,41,10 1.  The feasibility of an electronic central claim and data clearinghouse to which insurers and health care providers would have access. The comprehensive health care board shall also study the feasibility of using such a clearinghouse to collect data on patient outcomes and health care delivery costs and for research. In conjunction with these issues, the comprehensive health care board shall study appropriate measures for ensuring confidentiality of patient information under the clearinghouse method of data collection and transmission. The comprehensive health care board shall submit the results of and recommendations from this study as provided under paragraph (c) no later than January 1, 1997.

SB201,41,21 2. Alternative approaches to address individual responsibility, including a requirement that all residents of the state obtain health insurance coverage. As part of the study, the comprehensive health care board shall examine the likelihood that a federal waiver would be granted, or that federal legislation would be enacted, that would allow for coverage of medical assistance recipients under individual health insurance policies and that would allow for use of federal financial participation under the medical assistance program to help subsidize the cost of health insurance premiums for low-income individuals. The comprehensive health care board shall submit recommendations as provided under paragraph (c) no later than 15 months after the effective date of this subdivision. The legislature shall seek to implement the board's recommendations by January 1, 1999.

SB201,42,2 (b)  The commissioner of insurance shall study the feasibility of modifying community rates by taking into account an insured's successful use of preventive health care, efficient and effective health care consumption and healthy lifestyle choices in reducing the insured's health care costs. The commissioner shall submit the results of and recommendations from this study as provided under paragraph (c) no later than January 1, 1997.

SB201,42,5 (c)  The comprehensive health care board and the commissioner shall submit the results of the studies and any recommendations to the legislature in the manner provided under section 13.172 (2) of the statutes and to the governor.

SB201,42,12 (3) Reinsurance program. No later than 6 months after the effective date of this subsection, the comprehensive health care board shall submit proposed legislation to the appropriate standing committees of the legislature, as designated by the presiding officer of each house, that provides for a reinsurance program for insurers that are subject to the market reform requirements under chapter 635 of the statutes, as affected by this act. The reinsurance program shall contain at least all of the following features:

SB201,42,14 (a)  The reinsurance program shall be optional, but an insurer that participates shall participate for a minimum of 2 years.

SB201,42,17 (b)  An insurer that participates shall provide coverage under the reinsurance program for all health benefit plans that the insurer issues or renews and that are subject to subchapter I of chapter 635 of the statutes, as affected by this act.

SB201,42,20 (c) The commissioner of insurance shall administer the reinsurance program and shall provide for an open enrollment period from January 1 to February 1 every 2 years.

SB201,42,22 (d)  A participating insurer shall be required to select one of the following as the insurer's threshold amount for a 2-year period:

SB201,42,23 1.  Per individual per year, $50,000.

SB201,42,24 2.  Per individual per year, $150,000.

SB201,42,25 3.  Per individual per year, $250,000.

SB201,43,3 (e)  The commissioner of insurance shall be required to reimburse a participating insurer for 80% of the amount of claims for covered expenses that exceeds the insurer's threshold amount.

SB201,43,11 (f)  The commissioner of insurance shall be required to appoint a reinsurance technical committee, consisting of at least 3 qualified and disinterested persons, to determine annually on an actuarial basis the premium that each insurer participating in the reinsurance program shall pay for coverage under the reinsurance program. In determining the premium, the committee shall take into consideration the insurer's threshold amount. Each participating insurer shall pay the premium to the commissioner of insurance for deposit in a health reinsurance fund.

SB201,43,15 (g)  The commissioner of insurance shall be authorized to impose an assessment against each insurer participating in the reinsurance program if the commissioner determines that moneys in the health reinsurance fund will be insufficient to reimburse insurers.

SB201, s. 108 Section 108 . Initial applicability; insurance.

SB201,44,2 (1)   Market reform. The treatment of sections 111.70 (1) (a) and (4) (m), 625.12 (2), 628.34 (3), 632.897 (2) (d) and (9) (c), 635.01, 635.02 (1), (2), (3), (3f), (3h), (3j), (3m), (4g), (4m), (5), (5m) (d), (6), (6m), (7) (intro.), (a) and (b) and (8), 635.05, 635.06, 635.07 (1) (intro.), (b), (d), (e) and (f), (2) and (3), 635.09, 635.11 (ar) (intro.), (1) and (4), 635.13 (2), 635.15 (1), (2) and (3), 635.17 (title), (1) (a) (intro.) and 3., (ac), (am), (ar), (b) 1., 2. and 3. and (c), (2) and (3) and 635.18 (2), (3), (4), (5), (6), (7), (8), (9), (9m) and (10) and chapter 635 (title) of the statutes, the renumbering and amendment of sections 635.17 (1) (a) 1. and 2. and 635.18 (1) of the statutes, the repeal and recreation of section 635.13 (1) of the statutes and the creation of sections 635.17 (1) (a) 1. b. and 2. b. and 635.18 (1) (a) to (c) of the statutes first apply to all of the following:

SB201,44,6 (a)  Group health benefit plans providing coverage for eligible employes, as defined in section 635.02 (3f) of the statutes, as affected by this act, of an employer, as defined in section 635.02 (3h) of the statutes, as created by this act, issued or renewed on the effective date of this paragraph.

SB201,44,10 (b)  Individual health benefit plans issued on the effective date of this paragraph to a policyholder who is a resident of this state, or renewed on the effective date of this paragraph to a policyholder who is a resident of this state and who was a resident of this state when the policy was first issued.

SB201, s. 109 Section 109. Effective dates; insurance. This act takes effect on the day after publication, except as follows:

SB201,44,23 (1)  Market reform. The treatment of sections 111.70 (1) (a) and (4) (m), 601.424, 625.12 (2), 628.34 (3), 632.897 (2) (d) and (9) (c), 635.01, 635.02 (1), (2), (3), (3f), (3h), (3j), (3m), (4g), (4m), (5), (5m) (d), (6), (6m), (7) (intro.), (a) and (b) and (8), 635.05, 635.06, 635.07 (1) (intro.), (b), (d), (e) and (f), (2) and (3), 635.09, 635.11 (intro.), (1) and (4), 635.13 (2), 635.15, 635.17 (title), (1) (a) (intro.) and 3., (ac), (am), (ar), (b) 1., 2. and 3. and (c), (2) and (3) and 635.18 (2), (3), (4), (5), (6), (7), (8), (9), (9m) and (10) and chapter 635 (title) of the statutes, the renumbering and amendment of sections 635.17 (1) (a) 1. and 2. and 635.18 (1) of the statutes, the repeal and recreation of section 635.13 (1) of the statutes, the creation of sections 635.17 (1) (a) 1. b. and 2. b. and 635.18 (1) (a) to (c) of the statutes and Sections 107 and 108 (1) of this act take effect on the first day of the 12th month beginning after publication.

SB201,45,5 (2)  Small employer health insurance plan. The treatment of sections 15.735 (1), 185.983 (1g), 628.36 (2) (b) 5., 632.70, 635.03, 635.20 (1), (1b), (2), (11) and (13), 635.21, 635.23 (title), (1) (intro.), (a), (d), (dp), (dr) and (e) (intro.), 1., 2. and 3., (1m), (1r), (2), (3), (4) and (5), 635.25 (title), (1) (a) (intro.) and 2. and (b), (1m) and (2), 635.254, 635.26 (1), (1m), (1s), (4) and (5), 635.272 (1), 635.28 and 635.29 of the statutes and the amendment of section 635.13 (1) of the statutes take effect on the first day of the 4th month beginning after publication.

SB201,45,6 (End)