SB201: Bill Text

SB201,32,6 635.18 (7) A 3rd-party administrator that enters into a contract, agreement or other arrangement with a small employer an insurer to provide administrative, marketing or other services related to the offering of health benefit plans subject to this subchapter to small employers or individuals in this state is subject to this subchapter as if it were a small employer an insurer.

SB201, s. 77 Section 77. 635.18 (8) of the statutes is amended to read:

SB201,32,11 635.18 (8) The commissioner may by rule establish additional standards to provide for the fair marketing and broad availability of health benefit plans subject to this subchapter to small employers and individuals in this state, including requirements designed to prevent evasion of the purposes of this chapter.

SB201, s. 78 Section 78. 635.18 (9), (9m) and (10) of the statutes are created to read:

SB201,32,16 635.18 (9) An insurer that has in force one or more health benefit plans that are included in a category under sub. (1) (a) to (c) and that are subject to this subchapter shall actively market and issue health benefit plans in that category, as provided in s. 635.15, unless the insurer complies with all of the following:

SB201,32,18 (a) Files notice with the commissioner that the insurer is ceasing to issue health benefit plans in that category.

SB201,32,20 (b) Except as provided in sub. (9m), ceases to issue health benefit plans in that category for not less than 5 years.

SB201,32,23 (c) Except as provided in sub. (9m), does not commence marketing or issuing health benefit plans in that category until the insurer files notice with the commissioner that the insurer intends to market and issue such health benefit plans.

SB201,33,2 (9m) If an insurer ceases to issue health benefit plans in the category under sub. (1) (c) but continues to issue health benefit plans in a category under sub. (1) (a) or (b), the insurer shall continue to issue individual conversion policies, as provided in s. 635.15, and sub. (9) (b) and (c) does not apply to those policies.

SB201,33,5 (10) An insurer may not cease to actively market or issue health benefit plans in all categories under sub. (1) (a) to (c) unless the insurer complies with s. 635.07 (2).

SB201, s. 79 Section 79. 635.20 (1) of the statutes is amended to read:

SB201,33,11 635.20 (1) "Basic benefits" means the minimum benefits established by the plan board under s. 635.21, 1993 stats., and s. 635.23 (1) (a), 1993 stats., or the board under ss. 635.21 and 635.23 (1) (a), and includes all health insurance mandates 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. 80 Section 80. 635.20 (1b) of the statutes is created to read:

SB201,33,13 635.20 (1b) "Board" means the comprehensive health care board.

SB201, s. 81 Section 81. 635.20 (2) of the statutes is amended to read:

SB201,33,16 635.20 (2) "Eligible small employer" means an employer that satisfies the requirements of s. 635.25 (1).

SB201, s. 82 Section 82. 635.20 (11) of the statutes is amended to read:

SB201,33,19 635.20 (11) "Plan board" means the small employer insurance board created under s. 15.735 (1), 1993 stats.

SB201, s. 83 Section 83. 635.20 (13) of the statutes is repealed and recreated to read:

SB201,34,4 635.20 (13) "Small employer insurer" means an insurer that is authorized to do business in this state, in one or more lines of insurance that includes health insurance, and that offers group health benefit plans covering eligible employes of one or more small employers in this state, or that sells 3 or more individual health benefit plans to a small employer, covering eligible employes of the small employer. The term includes a health maintenance organization, as defined in s. 609.01 (2), a preferred provider plan, as defined in s. 609.01 (4), and an insurer operating as a cooperative association organized under ss. 185.981 to 185.985, but does not include a limited service health organization, as defined in s. 609.01 (3).

SB201, s. 84 Section 84. 635.21 of the statutes is amended to read:

SB201,34,9 635.21 Establishment of plan. There is established a plan of health insurance coverage for individuals employed by small employers. The plan board shall formulate, supervise and modify the plan as needed, and shall promulgate rules regarding the establishment and administration of the plan.

SB201, s. 85 Section 85. 635.23 (title) and (1) (intro.) of the statutes are amended to read:

SB201,34,11 635.23 (title) Duties of plan board. (1) (intro.) The plan board shall:

SB201, s. 86 Section 86. 635.23 (1) (a), (d), (dp), (dr) and (e) (intro.), 1., 2. and 3. of the statutes are amended to read:

SB201,34,16 635.23 (1) (a) By rule determine the basic benefits that small employer insurers may offer to eligible small employers for providing coverage to eligible employes and their dependents.

SB201,34,18 (d) By rule establish small employer eligibility requirements for participation in the plan the purchase of a policy providing the basic benefits.

SB201,34,23 (dp) By rule determine whether small employers participating in the plan that purchase a policy providing the basic benefits may impose a probationary or waiting period on employes who become eligible for coverage after the commencement of the small employer's coverage. The plan board may not allow for a probationary or waiting period that exceeds 90 days.

SB201,34,25 (dr) By rule determine enrollment periods, if any, for small employer or employe coverage under the plan.

SB201,35,5 (e) (intro.) Annually submit a report to the chief clerk of each house of the legislature, for distribution under s. 13.172 (3) to the appropriate standing committees, under s. 13.172 (3) summarizing the activities of the plan board and the operation of the plan in the preceding year, and including but not limited to all of the following:

SB201,35,7 1. The number of small employers participating in the plan purchasing a policy providing the basic benefits.

SB201,35,9 2. The number of employes and dependents participating in the plan covered under a policy providing the basic benefits.

SB201,35,10 3. An evaluation of the plan's operation and, effectiveness and availability.

SB201, s. 87 Section 87. 635.23 (1m) of the statutes is amended to read:

SB201,35,13 635.23 (1m) The plan board may by rule establish plan features in addition to those specified in sub. (1).

SB201, s. 88 Section 88. 635.23 (1r) of the statutes is amended to read:

SB201,35,16 635.23 (1r) All aspects of the composition and operation of the plan that are established by the plan board shall be established by rule.

SB201, s. 89 Section 89. 635.23 (2) of the statutes is amended to read:

SB201,35,19 635.23 (2) All rules promulgated by the plan board are subject to approval by the commissioner.

SB201, s. 90 Section 90. 635.23 (3) of the statutes is repealed.

SB201, s. 91 Section 91. 635.23 (4) and (5) of the statutes are amended to read:

SB201,36,3 635.23 (4) In the formulation of the plan, for the purpose of cost containment the plan board shall encourage the use, to the extent possible, of the services of health care providers other than physicians. The plan board shall report any recommendations on ways to encourage the use of the services of health care providers other than physicians to the chief clerk of each house of the legislature for distribution under s. 13.172 (3) to the standing committees with jurisdiction over health insurance under s. 13.172 (3).

SB201,36,7 (5) The plan board may submit any recommendations for legislation to improve the plan to the chief clerk of each house of the legislature for distribution under s. 13.172 (3) to the standing committees with jurisdiction over health insurance under s. 13.172 (3).

SB201, s. 92 Section 92. 635.25 (title) of the statutes is amended to read:

SB201,36,9 635.25 (title) Eligibility for participation in plan.

SB201, s. 93 Section 93. 635.25 (1) (a) (intro.) of the statutes is amended to read:

SB201,36,12 635.25 (1) (a) (intro.) To be eligible to participate in the plan by purchasing purchase a policy under this subchapter containing the basic benefits, an employer:

SB201, s. 94 Section 94. 635.25 (1) (a) 2. of the statutes is amended to read:

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: