SB201,36,1514 635.25 (1) (a) 2. Must comply with any other eligibility requirements specified
15by the plan board under s. 635.25 (1) (a) 2., 1993 stats., or by the board.
SB201, s. 95 16Section 95. 635.25 (1) (b) of the statutes is amended to read:
SB201,36,2017 635.25 (1) (b) Except as provided in ss. 645.43 and 646.35, an a small employer
18that purchases a policy under this subchapter containing the basic benefits and that
19ceases to be eligible to participate in the plan during a policy period shall retain
20coverage under the plan policy to the end of the policy period.
SB201, s. 96 21Section 96. 635.25 (1m) of the statutes is amended to read:
SB201,36,2522 635.25 (1m) Notwithstanding sub. (1), an a small employer is not eligible to
23participate in the plan purchase a policy under this subchapter containing the basic
24benefits
if all of the individuals to be covered under the plan policy may be covered
25by a single under an individual policy providing individual single or family coverage.
SB201, s. 97
1Section 97. 635.25 (2) of the statutes is amended to read:
SB201,37,42 635.25 (2) Employes and dependents. (a) All eligible employes of an eligible
3small employer that participates in the plan purchases a policy under this
4subchapter
are eligible for coverage under the plan policy, subject to the policy terms.
SB201,37,65 (b) Any dependent of an eligible employe who is covered under the plan policy
6is also eligible for coverage under the plan policy, subject to the policy terms.
SB201, s. 98 7Section 98. 635.254 of the statutes is amended to read:
SB201,37,12 8635.254 Employer premium contribution. (1) An A small employer that
9participates in the plan purchases a policy under this subchapter shall pay a
10premium contribution of not less than 50% of the premium rate on behalf of an
11eligible employe with individual single coverage and not less than 40% of the
12premium rate on behalf of an eligible employe with family coverage.
SB201,37,15 13(2) An A small employer under sub. (1) shall withhold from the earnings of an
14employe with coverage under the plan policy under this subchapter the amount of
15premium not contributed by the small employer under sub. (1).
SB201,37,20 16(3) For an eligible employe who obtains coverage under the health insurance
17risk-sharing plan under s. 619.12 (2) (e) 2., an a small employer under sub. (1) shall
18pay a premium contribution to the health insurance risk-sharing plan that is equal
19to the amount that the small employer would pay on behalf of the employe for
20coverage under the plan policy under this subchapter.
SB201, s. 99 21Section 99. 635.26 (1) of the statutes is amended to read:
SB201,38,222 635.26 (1) (a) Except as provided in subs. (2m) to (4) (5), a small employer
23insurer shall provide coverage under the plan a policy under this subchapter,
24regardless of health status condition or claims experience, to an eligible small

1employer and to all of its eligible employes and their dependents if all of the following
2apply:
SB201,38,43 1. The small employer agrees to pay the premium required for coverage under
4the plan policy.
SB201,38,75 2. The small employer agrees to comply with all other plan policy provisions
6that apply generally to a policyholder or an insured without regard to health status
7condition or claims experience.
SB201,38,128 (b) Except as provided in subs. (2m) to (4) (5), a small employer insurer shall
9provide coverage under the plan a policy under this subchapter, regardless of health
10status condition or claims experience, to an eligible employe who becomes eligible for
11coverage after the commencement of the small employer's coverage, and to the
12eligible employe's dependents, if all of the following apply:
SB201,38,1413 1. The employe applies for coverage under the plan policy before the expiration
14of any applicable enrollment period, if any, required under the plan policy.
SB201,38,1615 2. The small employer agrees to pay the premium required for coverage of the
16employe under the plan policy.
SB201, s. 100 17Section 100. 635.26 (1m) of the statutes is amended to read:
SB201,38,2118 635.26 (1m) A small employer insurer shall be in compliance with sub. (1) if
19it issues a policy that complies with the plan and the minimum benefit standards
20determined by the plan board under s. 635.23 (1) (c), 1993 stats., or the board under
21s. 635.23 (1) (c) but that includes only the basic benefits.
SB201, s. 101 22Section 101. 635.26 (1s) of the statutes is amended to read:
SB201,39,223 635.26 (1s) Nothing in sub. (1) prohibits a small employer insurer that provides
24coverage under sub. (1) from imposing preexisting condition provisions, waiting

1period requirements, or other provisions or requirements related to health status
2condition or claims experience, that are permitted or required under the plan policy.
SB201, s. 102 3Section 102. 635.26 (4) of the statutes is amended to read:
SB201,39,84 635.26 (4) A small employer insurer that offers health insurance coverage
5exclusively to a single category or limited categories of eligible small employers is
6required to comply
may, with the prior approval of the commissioner, limit its
7compliance
with sub. (1) only as to that single category or those limited categories
8of eligible small employers.
SB201, s. 103 9Section 103. 635.26 (5) of the statutes is created to read:
SB201,39,1110 635.26 (5) (a) In this subsection, "municipal" means county, city, village, town
11or school district.
SB201,39,1612 (b) Subsection (1) does not require a small employer insurer to issue coverage
13that the small employer insurer is not authorized to issue under its bylaws, charter
14or certificate of incorporation or authority if the small employer insurer is authorized
15under its bylaws, charter or certificate of incorporation or authority to issue coverage
16only to state or municipal employes and former employes and their dependents.
SB201, s. 104 17Section 104. 635.272 (1) of the statutes is amended to read:
SB201,39,2218 635.272 (1) Contracting health care providers. A health care provider that
19contracts with a small employer insurer to provide services to individuals with
20coverage under the plan a policy under this subchapter shall accept amounts payable
21under the contract for the basic benefits under the policy as payment in full for those
22services. This subsection does not affect liability for deductibles or copayments.
SB201, s. 105 23Section 105. 635.28 of the statutes is amended to read:
SB201,40,2 24635.28 (title) Liability of state and plan board. Neither the state nor the
25plan board is liable for any obligation arising under the plan. Plan board Board

1members are immune from civil liability for acts or omissions while performing in
2the performance of
their duties under this subchapter.
SB201, s. 106 3Section 106. 635.29 of the statutes is amended to read:
SB201,40,7 4635.29 (title) Exemption from required coverage Applicability of health
5insurance mandates
. The health insurance mandates apply to the plan under this
6subchapter only to the extent determined by the plan board under s. 635.23 (1) (b),
71993 stats., or the board
under s. 635.23 (1) (b).
SB201, s. 107 8Section 107 . Nonstatutory provisions; insurance.
SB201,40,15 9(1)  Comprehensive health care board; initial membership. Notwithstanding
10the length of terms specified for the members of the comprehensive health care board
11under section 15.735 (3) (b) of the statutes, as created by this act, and the manner
12of appointment specified for the members of the board under section 15.07 (1) (b) of
13the statutes, the following initial members of the board shall be appointed by the
14governor by the first day of the 4th month beginning after the effective date of this
15subsection for the following terms:
SB201,40,18 16(a)  Four members, 2 of whom represent employers, one of whom represents
17eligible employes and one of whom represents a purchasing coalition, for terms
18expiring on May 1, 1996.
SB201,40,21 19(b)  Four members, one of whom represents employers, one of whom represents
20eligible employes, one of whom represents a labor organization and one of whom
21represents a purchasing coalition, for terms expiring on May 1, 1997.
SB201,40,24 22(c)  Four members, 2 of whom represent employers, one of whom represents
23eligible employes and one of whom represents a purchasing coalition, for terms
24expiring on May 1, 1998.
SB201,40,25 25(2)  Studies.
SB201,41,1
1(a)  The comprehensive health care board shall study all of the following:
SB201,41,10 21.  The feasibility of an electronic central claim and data clearinghouse to
3which insurers and health care providers would have access. The comprehensive
4health care board shall also study the feasibility of using such a clearinghouse to
5collect data on patient outcomes and health care delivery costs and for research. In
6conjunction with these issues, the comprehensive health care board shall study
7appropriate measures for ensuring confidentiality of patient information under the
8clearinghouse method of data collection and transmission. The comprehensive
9health care board shall submit the results of and recommendations from this study
10as provided under paragraph (c) no later than January 1, 1997.
SB201,41,21 112. Alternative approaches to address individual responsibility, including a
12requirement that all residents of the state obtain health insurance coverage. As part
13of the study, the comprehensive health care board shall examine the likelihood that
14a federal waiver would be granted, or that federal legislation would be enacted, that
15would allow for coverage of medical assistance recipients under individual health
16insurance policies and that would allow for use of federal financial participation
17under the medical assistance program to help subsidize the cost of health insurance
18premiums for low-income individuals. The comprehensive health care board shall
19submit recommendations as provided under paragraph (c) no later than 15 months
20after the effective date of this subdivision. The legislature shall seek to implement
21the board's recommendations by January 1, 1999.
SB201,42,2 22(b)  The commissioner of insurance shall study the feasibility of modifying
23community rates by taking into account an insured's successful use of preventive
24health care, efficient and effective health care consumption and healthy lifestyle
25choices in reducing the insured's health care costs. The commissioner shall submit

1the results of and recommendations from this study as provided under paragraph (c)
2no later than January 1, 1997.
SB201,42,5 3(c)  The comprehensive health care board and the commissioner shall submit
4the results of the studies and any recommendations to the legislature in the manner
5provided under section 13.172 (2) of the statutes and to the governor.
SB201,42,12 6(3) Reinsurance program. No later than 6 months after the effective date of this
7subsection, the comprehensive health care board shall submit proposed legislation
8to the appropriate standing committees of the legislature, as designated by the
9presiding officer of each house, that provides for a reinsurance program for insurers
10that are subject to the market reform requirements under chapter 635 of the
11statutes, as affected by this act. The reinsurance program shall contain at least all
12of the following features:
SB201,42,14 13(a)  The reinsurance program shall be optional, but an insurer that
14participates shall participate for a minimum of 2 years.
SB201,42,17 15(b)  An insurer that participates shall provide coverage under the reinsurance
16program for all health benefit plans that the insurer issues or renews and that are
17subject to subchapter I of chapter 635 of the statutes, as affected by this act.
SB201,42,20 18(c) The commissioner of insurance shall administer the reinsurance program
19and shall provide for an open enrollment period from January 1 to February 1 every
202 years.
SB201,42,22 21(d)  A participating insurer shall be required to select one of the following as
22the insurer's threshold amount for a 2-year period:
SB201,42,23 231.  Per individual per year, $50,000.
SB201,42,24 242.  Per individual per year, $150,000.
SB201,42,25 253.  Per individual per year, $250,000.
SB201,43,3
1(e)  The commissioner of insurance shall be required to reimburse a
2participating insurer for 80% of the amount of claims for covered expenses that
3exceeds the insurer's threshold amount.
SB201,43,11 4(f)  The commissioner of insurance shall be required to appoint a reinsurance
5technical committee, consisting of at least 3 qualified and disinterested persons, to
6determine annually on an actuarial basis the premium that each insurer
7participating in the reinsurance program shall pay for coverage under the
8reinsurance program. In determining the premium, the committee shall take into
9consideration the insurer's threshold amount. Each participating insurer shall pay
10the premium to the commissioner of insurance for deposit in a health reinsurance
11fund.
SB201,43,15 12(g)  The commissioner of insurance shall be authorized to impose an
13assessment against each insurer participating in the reinsurance program if the
14commissioner determines that moneys in the health reinsurance fund will be
15insufficient to reimburse insurers.
SB201, s. 108 16Section 108 . Initial applicability; insurance.
SB201,44,2 17(1)   Market reform. The treatment of sections 111.70 (1) (a) and (4) (m), 625.12
18(2), 628.34 (3), 632.897 (2) (d) and (9) (c), 635.01, 635.02 (1), (2), (3), (3f), (3h), (3j),
19(3m), (4g), (4m), (5), (5m) (d), (6), (6m), (7) (intro.), (a) and (b) and (8), 635.05, 635.06,
20635.07 (1) (intro.), (b), (d), (e) and (f), (2) and (3), 635.09, 635.11 (ar) (intro.), (1) and
21(4), 635.13 (2), 635.15 (1), (2) and (3), 635.17 (title), (1) (a) (intro.) and 3., (ac), (am),
22(ar), (b) 1., 2. and 3. and (c), (2) and (3) and 635.18 (2), (3), (4), (5), (6), (7), (8), (9), (9m)
23and (10) and chapter 635 (title) of the statutes, the renumbering and amendment of
24sections 635.17 (1) (a) 1. and 2. and 635.18 (1) of the statutes, the repeal and
25recreation of section 635.13 (1) of the statutes and the creation of sections 635.17 (1)

1(a) 1. b. and 2. b. and 635.18 (1) (a) to (c) of the statutes first apply to all of the
2following:
SB201,44,6 3(a)  Group health benefit plans providing coverage for eligible employes, as
4defined in section 635.02 (3f) of the statutes, as affected by this act, of an employer,
5as defined in section 635.02 (3h) of the statutes, as created by this act, issued or
6renewed on the effective date of this paragraph.
SB201,44,10 7(b)  Individual health benefit plans issued on the effective date of this
8paragraph to a policyholder who is a resident of this state, or renewed on the effective
9date of this paragraph to a policyholder who is a resident of this state and who was
10a resident of this state when the policy was first issued.
SB201, s. 109 11Section 109. Effective dates; insurance. This act takes effect on the day
12after publication, except as follows:
SB201,44,23 13(1)  Market reform. The treatment of sections 111.70 (1) (a) and (4) (m),
14601.424, 625.12 (2), 628.34 (3), 632.897 (2) (d) and (9) (c), 635.01, 635.02 (1), (2), (3),
15(3f), (3h), (3j), (3m), (4g), (4m), (5), (5m) (d), (6), (6m), (7) (intro.), (a) and (b) and (8),
16635.05, 635.06, 635.07 (1) (intro.), (b), (d), (e) and (f), (2) and (3), 635.09, 635.11
17(intro.), (1) and (4), 635.13 (2), 635.15, 635.17 (title), (1) (a) (intro.) and 3., (ac), (am),
18(ar), (b) 1., 2. and 3. and (c), (2) and (3) and 635.18 (2), (3), (4), (5), (6), (7), (8), (9), (9m)
19and (10) and chapter 635 (title) of the statutes, the renumbering and amendment of
20sections 635.17 (1) (a) 1. and 2. and 635.18 (1) of the statutes, the repeal and
21recreation of section 635.13 (1) of the statutes, the creation of sections 635.17 (1) (a)
221. b. and 2. b. and 635.18 (1) (a) to (c) of the statutes and Sections 107 and 108 (1) of
23this act take effect on the first day of the 12th month beginning after publication.
SB201,45,5 24(2)  Small employer health insurance plan. The treatment of sections 15.735
25(1), 185.983 (1g), 628.36 (2) (b) 5., 632.70, 635.03, 635.20 (1), (1b), (2), (11) and (13),

1635.21, 635.23 (title), (1) (intro.), (a), (d), (dp), (dr) and (e) (intro.), 1., 2. and 3., (1m),
2(1r), (2), (3), (4) and (5), 635.25 (title), (1) (a) (intro.) and 2. and (b), (1m) and (2),
3635.254, 635.26 (1), (1m), (1s), (4) and (5), 635.272 (1), 635.28 and 635.29 of the
4statutes and the amendment of section 635.13 (1) of the statutes take effect on the
5first day of the 4th month beginning after publication.
SB201,45,66 (End)
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