SB201,17,5 5(2) Provide data or technical assistance to any purchasing coalition.
SB201,17,7 6(3) Develop quality outcomes measures, quality and practice pattern
7standards and health plan performance criteria.
SB201,17,8 8(4) Provide information on technology assessment to any purchasing coalition.
SB201,17,10 9(5) Recommend cost containment measures and provide assessments of health
10care needs to any purchasing coalition.
SB201, s. 42 11Section 42. 635.05 of the statutes is repealed and recreated to read:
SB201,17,15 12635.05 Community rating. (1) Except as provided in subs. (2) and (4), an
13insurer shall charge a community rate for coverage under a health benefit plan that
14is subject to this subchapter and that is issued or renewed on or after the effective
15date of this subsection .... [revisor inserts date].
SB201,17,18 16(2) Subject to rate bands prescribed by the commissioner by rule, the
17community rate under sub. (1) may be modified by taking into account the following
18factors:
SB201,17,1919 (a) The insured's age.
SB201,17,2020 (b) The insured's gender.
SB201,17,2221 (c) The insured's geographic area, which may not include less than an entire
22county.
SB201,17,2323 (d) The insured's tobacco use.
SB201,17,2524 (e) Whether the insured's coverage is single coverage or a type of family
25coverage.
SB201,18,3
1(3) For each of the following factors, the rate bands prescribed by the
2commissioner by rule may not restrict the ratio of the highest variance to the lowest
3variance to a ratio that is less than the ratio shown after each factor:
SB201,18,44 (a) For age, a ratio of 2.5.
SB201,18,55 (b) For gender, a ratio of 1.2.
SB201,18,66 (c) For geographic area, a ratio of 1.2.
SB201,18,9 7(4) An insurer may provide a rate discount for healthy lifestyle choices on the
8part of an insured individual that, given the individual's health condition, tend to
9reduce the risk of loss.
SB201, s. 43 10Section 43. 635.06 of the statutes is created to read:
SB201,18,18 11635.06 Transition by rule. Notwithstanding s. 635.05 (1) and (2), the
12commissioner may promulgate rules that permit an insurer to vary from the
13community rate required under s. 635.05 (1) and modified under s. 635.05 (2) within
14restrictions provided in the rules. The restrictions provided in the rules shall be
15reasonably designed to provide for an orderly transition to the community rates
16required under s. 635.05 (1) and modified under s. 635.05 (2) for all health benefit
17plans subject to this subchapter by no later than the first day of the 12th month
18beginning after the effective date of this section .... [revisor inserts date].
SB201, s. 44 19Section 44. 635.07 (1) (intro.), (b), (d) and (e) of the statutes are amended to
20read:
SB201,19,221 635.07 (1) (intro.) Notwithstanding s. 631.36 (2) to (4m), a health benefit plan
22or policy subject to this subchapter may not be canceled by an insurer before the
23expiration of the agreed term, and shall be renewable to the employer and all
24employes
policyholder and all insureds and dependents eligible under the terms of

1the health benefit plan or policy at the expiration of the agreed term at the option of
2the small employer policyholder, except for any of the following reasons:
SB201,19,53 (b) Fraud or misrepresentation by the small employer policyholder, or, with
4respect to coverage for an insured individual, fraud or misrepresentation by the that
5insured individual.
SB201,19,76 (d) The number of individuals covered under the health benefit plan or policy
7is less than the number required by the health benefit plan or policy.
SB201,19,88 (e) The small employer is no longer actively engaged in a business enterprise.
SB201, s. 45 9Section 45. 635.07 (1) (f) of the statutes is created to read:
SB201,19,1110 635.07 (1) (f) The health benefit plan is an individual policy and the
11commissioner permits cancellation or nonrenewal of such a policy by rule.
SB201, s. 46 12Section 46. 635.07 (2) of the statutes is amended to read:
SB201,19,1513 635.07 (2) Notwithstanding sub. (1), a small employer an insurer may elect not
14to renew a health insurance benefit plan or policy subject to this subchapter if the
15small employer insurer complies with all of the following:
SB201,19,1816 (a) The small employer insurer ceases to renew all other health benefit plans
17or policies subject to this subchapter that are issued to all other small employers in
18the same class of business
.
SB201,19,2119 (b) The small employer insurer provides notice to all affected small employers
20policyholders and to the commissioner in each state in which an affected insured
21individual resides not later than one year before termination of coverage.
SB201,19,2422 (c) The small employer insurer does not establish a new class of business issue
23a health benefit plan subject to this subchapter
earlier than 5 years after the
24nonrenewal of the health benefit plans or policies.
SB201,20,6
1(d) The small employer insurer does not transfer or otherwise provide coverage
2to a small employer policyholder from the nonrenewed class of business unless the
3small employer insurer offers to transfer or provide coverage to all affected small
4employers
policyholders from the nonrenewed class of business without regard to
5case characteristics, claim claims experience, health status condition or duration of
6coverage.
SB201, s. 47 7Section 47. 635.07 (3) of the statutes is amended to read:
SB201,20,108 635.07 (3) This section does not apply to a health benefit plan or policy subject
9to this subchapter if the small employer insurer that issued the policy health benefit
10plan
is in liquidation.
SB201, s. 48 11Section 48. 635.09 of the statutes is repealed.
SB201, s. 49 12Section 49. 635.11 (intro.), (1) and (4) of the statutes are amended to read:
SB201,20,16 13635.11 Disclosure of rating factors and renewability provisions. (intro.)
14Before the sale of a health benefit plan or policy subject to this subchapter, a small
15employer
an insurer shall disclose to a small employer an applicant all of the
16following:
SB201,20,18 17(1) The small employer insurer's right to increase premium rates and the
18factors limiting the amount of increase.
SB201,20,19 19(4) The small employer's A policyholder's renewability rights.
SB201, s. 50 20Section 50. 635.13 (1) of the statutes is amended to read:
SB201,20,2521 635.13 (1) Records. A small employer insurer shall maintain at its principal
22place of business complete and detailed records relating to its rating methods and
23practices and its renewal underwriting methods and practices, and shall make the
24records available to the commissioner and the small employer insurance or the board
25upon request.
SB201, s. 51
1Section 51. 635.13 (1) of the statutes, as affected by 1995 Wisconsin Act ....
2(this act), is repealed and recreated to read:
SB201,21,63 635.13 (1) Records. An insurer shall maintain at its principal place of business
4complete and detailed records relating to its rating methods and practices and its
5renewal underwriting methods and practices, and shall make the records available
6to the commissioner or the board upon request.
SB201, s. 52 7Section 52. 635.13 (2) of the statutes is amended to read:
SB201,21,108 635.13 (2) Certification. A small employer An insurer shall file with the
9commissioner on or before May 1 annually an actuarial opinion by a member of the
10American academy of actuaries certifying all of the following:
SB201,21,1211 (a) That the small employer insurer is in compliance with the rate provisions
12of s. 635.05 and any rules promulgated under s. 635.06.
SB201,21,1413 (b) That the small employer insurer's rating methods are based on generally
14accepted and sound actuarial principles, policies and procedures.
SB201,21,1815 (c) That the opinion is based on the actuary's examination of the small employer
16insurer's records and a review of the small employer insurer's actuarial assumptions
17and statistical methods used in setting rates and procedures used in implementing
18rating plans.
SB201, s. 53 19Section 53. 635.15 of the statutes is repealed and recreated to read:
SB201,21,24 20635.15 Guaranteed issue. (1) Group health benefit plans. (a) Except as
21provided in sub. (3), an insurer shall provide coverage under a group health benefit
22plan that is subject to this subchapter to an employer and to all of the employer's
23eligible employes and their dependents, regardless of health condition or claims
24experience, if all of the following apply:
SB201,22,2
11. The insurer has in force a health benefit plan that is subject to this
2subchapter.
SB201,22,43 2. The employer agrees to pay the premium required for coverage under the
4group health benefit plan.
SB201,22,75 3. The employer agrees to comply with all other provisions of the group health
6benefit plan that apply generally to a policyholder or an insured without regard to
7health condition or claims experience.
SB201,22,108 (b) An insurer shall provide coverage under a group health benefit plan that
9is subject to this subchapter to all of the following, regardless of health condition or
10claims experience:
SB201,22,1211 1. An eligible employe who becomes eligible for coverage after the
12commencement of the employer's coverage, and the eligible employe's dependents.
SB201,22,1613 2. An eligible employe who was excluded from coverage, including an eligible
14employe with coverage under the health insurance risk-sharing plan or an
15alternative plan under subch. II of ch. 619 on or before the effective date of this
16subdivision .... [revisor inserts date], and the eligible employe's dependents.
SB201,22,2017 3. An eligible employe's dependent who was excluded from coverage, including
18an eligible employe's dependent with coverage under the health insurance
19risk-sharing plan or an alternative plan under subch. II of ch. 619 on or before the
20effective date of this subdivision .... [revisor inserts date].
SB201,22,25 21(2) Individual health benefit plans. Except as provided in sub. (3) and
22notwithstanding s. 632.897 (4) (d), an insurer shall provide coverage under an
23individual health benefit plan subject to this subchapter to an individual who is a
24resident of this state, and to the individual's dependents, regardless of health
25condition or claims experience, if all of the following apply:
SB201,23,2
1(a) The insurer has in force a health benefit plan that is subject to this
2subchapter.
SB201,23,43 (b) The individual agrees to pay the premium required for coverage under the
4individual health benefit plan.
SB201,23,75 (c) The individual agrees to comply with all other provisions of the individual
6health benefit plan that apply generally to a policyholder or an insured without
7regard to health condition or claims experience.
SB201,23,12 8(3) Exceptions to guaranteed issue. (a) An insurer that is otherwise required
9to provide coverage under sub. (1) may refuse to issue a group health benefit plan to
10an employer if all of the individuals in the employer group that are to be covered
11under the group health benefit plan may be covered under an individual health
12benefit plan providing single or family coverage.
SB201,23,1613 (b) An insurer that is otherwise required to provide coverage under sub. (2) may
14refuse to provide coverage to an individual if the individual was excluded from
15coverage under an employer's health benefit plan or self-funded health care plan for
16reasons related to the individual's health condition.
SB201,23,2017 (c) An insurer that is otherwise required to provide coverage under sub. (2) may
18refuse to provide coverage to an individual if the individual waived coverage under
19an employer's health benefit plan or self-funded health care plan for reasons related
20to the individual's health condition.
SB201,23,2221 (d) 1. In this paragraph, "municipal" means county, city, village, town or school
22district.
SB201,24,223 2. Subsections (1) and (2) do not require an insurer to issue coverage that the
24insurer is not authorized to issue under its bylaws, charter or certificate of
25incorporation or authority if the insurer is authorized under its bylaws, charter or

1certificate of incorporation or authority to issue coverage only to state or municipal
2employes and former employes and their dependents.
SB201,24,63 (e) An insurer that offers health care coverage exclusively to a single category
4or limited categories of employers may, with prior approval of the commissioner, limit
5its compliance with subs. (1) and (2) to that single category or those limited categories
6of employers.
SB201,24,87 (f) The commissioner may exempt an insurer from the requirements of sub. (1)
8or (2) if the commissioner determines that any of the following applies:
SB201,24,109 1. It is inequitable to apply sub. (1) or (2) to the insurer due to its
10disproportionate share of groups or individuals with high claims experience.
SB201,24,1211 2. It is in the public interest to exempt the insurer from the requirements under
12sub. (1) or (2) because the insurer is in financially hazardous condition.
SB201,24,1413 (g) An insurer may limit its issuance of health benefit plans under subs. (1) and
14(2) to any of the following:
SB201,24,1615 1. Group health benefit plans, and related individual conversion policies, to
16small employer groups.
SB201,24,1817 2. Group health benefit plans, and related individual conversion policies, to
18employer groups that are not small employer groups.
SB201,24,1919 3. Individual health benefit plans.
SB201, s. 54 20Section 54. 635.17 (title) of the statutes is amended to read:
SB201,24,22 21635.17 (title) Coverage requirements for small employer health benefit
22plans.
SB201, s. 55 23Section 55. 635.17 (1) (a) (intro.) of the statutes is amended to read:
SB201,25,324 635.17 (1) (a) (intro.) A group or individual health benefit plan subject to this
25subchapter may not deny, exclude or limit benefits for a covered individual for losses

1incurred more than 12 months after the effective date of the individual's coverage
2due to a preexisting condition. Such a health benefit plan may not define a
3preexisting condition more restrictively than any of the following:
SB201, s. 56 4Section 56. 635.17 (1) (a) 1. of the statutes is renumbered 635.17 (1) (a) 1. a.
5and amended to read:
SB201,25,106 635.17 (1) (a) 1. a. A With respect to a group health benefit plan, a condition
7that would have caused an ordinarily prudent person to seek medical advice,
8diagnosis, care or treatment during the 6 months immediately preceding the
9effective date of coverage and for which the individual did not seek medical advice,
10diagnosis, care or treatment
.
SB201, s. 57 11Section 57. 635.17 (1) (a) 1. b. of the statutes is created to read:
SB201,25,1612 635.17 (1) (a) 1. b. With respect to an individual health benefit plan, a condition
13that would have caused an ordinarily prudent person to seek medical advice,
14diagnosis, care or treatment during the 12 months immediately preceding the
15effective date of coverage and for which the individual did not seek medical advice,
16diagnosis, care or treatment.
SB201, s. 58 17Section 58. 635.17 (1) (a) 2. of the statutes is renumbered 635.17 (1) (a) 2. a.
18and amended to read:
SB201,25,2119 635.17 (1) (a) 2. a. A With respect to a group health benefit plan, a condition
20for which medical advice, diagnosis, care or treatment was recommended or received
21during the 6 months immediately preceding the effective date of coverage.
SB201, s. 59 22Section 59. 635.17 (1) (a) 2. b. of the statutes is created to read:
SB201,25,2523 635.17 (1) (a) 2. b. With respect to an individual health benefit plan, a condition
24for which medical advice, diagnosis, care or treatment was recommended or received
25during the 12 months immediately preceding the effective date of coverage.
SB201, s. 60
1Section 60. 635.17 (1) (a) 3. of the statutes is amended to read:
SB201,26,72 635.17 (1) (a) 3. A With respect to a group or individual health benefit plan,
3a
pregnancy existing on the effective date of coverage, except that coverage may not
4be excluded for any covered prenatal care expenses related to such a pregnancy or
5for other covered expenses related to such a pregnancy that exceed the deductible
6amount prescribed by the commissioner under par. (ac). Coverage not excluded may
7be subject to any deductibles or copayments that apply generally under the policy
.
SB201, s. 61 8Section 61. 635.17 (1) (ac) of the statutes is created to read:
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