SB201, s. 74
17Section
74. 635.18 (5) of the statutes is amended to read:
SB201,31,2118
635.18
(5) A small employer An insurer or an intermediary may not induce or
19otherwise encourage
a small an employer to separate or otherwise exclude an
20employe from health coverage or benefits provided in connection with the employe's
21employment.
SB201, s. 75
22Section
75. 635.18 (6) of the statutes is amended to read:
SB201,31,2523
635.18
(6) Denial by
a small employer
an insurer of an application for coverage
24from a small employer under a health benefit plan subject to this subchapter shall
25be in writing and shall state the reason or reasons for the denial.
SB201, s. 76
1Section
76. 635.18 (7) of the statutes is amended to read:
SB201,32,62
635.18
(7) A 3rd-party administrator that enters into a contract, agreement
3or other arrangement with
a small employer an insurer to provide administrative,
4marketing or other services related to the offering of health benefit plans
subject to
5this subchapter to
small employers
or individuals in this state is subject to this
6subchapter as if it were
a small employer an insurer.
SB201, s. 77
7Section
77. 635.18 (8) of the statutes is amended to read:
SB201,32,118
635.18
(8) The commissioner may by rule establish additional standards to
9provide for the fair marketing and broad availability of health benefit plans
subject
10to this subchapter to
small employers
and individuals in this state
, including
11requirements designed to prevent evasion of the purposes of this chapter.
SB201, s. 78
12Section
78. 635.18 (9), (9m) and (10) of the statutes are created to read:
SB201,32,1613
635.18
(9) An insurer that has in force one or more health benefit plans that
14are included in a category under sub. (1) (a) to (c) and that are subject to this
15subchapter shall actively market and issue health benefit plans in that category, as
16provided in s. 635.15, unless the insurer complies with all of the following:
SB201,32,1817
(a) Files notice with the commissioner that the insurer is ceasing to issue health
18benefit plans in that category.
SB201,32,2019
(b) Except as provided in sub. (9m), ceases to issue health benefit plans in that
20category for not less than 5 years.
SB201,32,2321
(c) Except as provided in sub. (9m), does not commence marketing or issuing
22health benefit plans in that category until the insurer files notice with the
23commissioner that the insurer intends to market and issue such health benefit plans.
SB201,33,2
24(9m) If an insurer ceases to issue health benefit plans in the category under
25sub. (1) (c) but continues to issue health benefit plans in a category under sub. (1) (a)
1or (b), the insurer shall continue to issue individual conversion policies, as provided
2in s. 635.15, and sub. (9) (b) and (c) does not apply to those policies.
SB201,33,5
3(10) An insurer may not cease to actively market or issue health benefit plans
4in all categories under sub. (1) (a) to (c) unless the insurer complies with s. 635.07
5(2).
SB201, s. 79
6Section
79. 635.20 (1) of the statutes is amended to read:
SB201,33,117
635.20
(1) "Basic benefits" means the minimum benefits established by the
8plan board
under s. 635.21, 1993 stats., and s. 635.23 (1) (a), 1993 stats., or the board 9under ss. 635.21 and 635.23 (1) (a), and includes all health insurance mandates to
10the extent determined by the plan board
under s. 635.23 (1) (b), 1993 stats., or the
11board under s. 635.23 (1) (b).
SB201, s. 80
12Section
80. 635.20 (1b) of the statutes is created to read:
SB201,33,1313
635.20
(1b) "Board" means the comprehensive health care board.
SB201, s. 81
14Section
81. 635.20 (2) of the statutes is amended to read:
SB201,33,1615
635.20
(2) "Eligible
small employer" means an employer that satisfies the
16requirements of s. 635.25 (1).
SB201, s. 82
17Section
82. 635.20 (11) of the statutes is amended to read:
SB201,33,1918
635.20
(11) "Plan board" means the small employer insurance board
created
19under s. 15.735 (1), 1993 stats.
SB201, s. 83
20Section
83. 635.20 (13) of the statutes is repealed and recreated to read:
SB201,34,421
635.20
(13) "Small employer insurer" means an insurer that is authorized to
22do business in this state, in one or more lines of insurance that includes health
23insurance, and that offers group health benefit plans covering eligible employes of
24one or more small employers in this state, or that sells 3 or more individual health
25benefit plans to a small employer, covering eligible employes of the small employer.
1The term includes a health maintenance organization, as defined in s. 609.01 (2), a
2preferred provider plan, as defined in s. 609.01 (4), and an insurer operating as a
3cooperative association organized under ss. 185.981 to 185.985, but does not include
4a limited service health organization, as defined in s. 609.01 (3).
SB201, s. 84
5Section
84. 635.21 of the statutes is amended to read:
SB201,34,9
6635.21 Establishment of plan. There is established a plan of health
7insurance coverage for individuals employed by small employers. The
plan board
8shall formulate, supervise and modify the plan as needed, and shall promulgate
9rules regarding the establishment and administration of the plan.
SB201, s. 85
10Section
85. 635.23 (title) and (1) (intro.) of the statutes are amended to read:
SB201,34,11
11635.23 (title)
Duties of plan board. (1) (intro.) The
plan board shall:
SB201, s. 86
12Section
86. 635.23 (1) (a), (d), (dp), (dr) and (e) (intro.), 1., 2. and 3. of the
13statutes are amended to read:
SB201,34,1614
635.23
(1) (a) By rule determine the basic benefits that small employer insurers
15may offer to eligible
small employers for providing coverage to eligible employes and
16their dependents.
SB201,34,1817
(d) By rule establish
small employer eligibility requirements for
participation
18in the plan the purchase of a policy providing the basic benefits.
SB201,34,2319
(dp) By rule determine whether
small employers
participating in the plan that
20purchase a policy providing the basic benefits may impose a probationary or waiting
21period on employes who become eligible for coverage after the commencement of the
22small employer's coverage. The
plan board may not allow for a probationary or
23waiting period that exceeds 90 days.
SB201,34,2524
(dr) By rule determine enrollment periods, if any, for
small employer or
25employe coverage under the plan.
SB201,35,5
1(e) (intro.) Annually submit a report
to the chief clerk of each house of the
2legislature, for distribution under s. 13.172 (3) to the appropriate standing
3committees
, under s. 13.172 (3) summarizing the activities of the
plan board and the
4operation of the plan in the preceding year, and including but not limited to all of the
5following:
SB201,35,76
1. The number of small employers
participating in the plan purchasing a policy
7providing the basic benefits.
SB201,35,98
2. The number of employes and dependents
participating in the plan covered
9under a policy providing the basic benefits.
SB201,35,1010
3. An evaluation of the plan's operation
and, effectiveness
and availability.
SB201, s. 87
11Section
87. 635.23 (1m) of the statutes is amended to read:
SB201,35,1312
635.23
(1m) The
plan board may by rule establish plan features in addition to
13those specified in sub. (1).
SB201, s. 88
14Section
88. 635.23 (1r) of the statutes is amended to read:
SB201,35,1615
635.23
(1r) All aspects of the composition and operation of the plan that are
16established by the
plan board shall be established by rule.
SB201, s. 89
17Section
89. 635.23 (2) of the statutes is amended to read:
SB201,35,1918
635.23
(2) All rules promulgated by the
plan board are subject to approval by
19the commissioner.
SB201, s. 90
20Section
90. 635.23 (3) of the statutes is repealed.
SB201, s. 91
21Section
91. 635.23 (4) and (5) of the statutes are amended to read:
SB201,36,322
635.23
(4) In the formulation of the plan, for the purpose of cost containment
23the
plan board shall encourage the use, to the extent possible, of the services of health
24care providers other than physicians. The
plan board shall report any
25recommendations on ways to encourage the use of the services of health care
1providers other than physicians
to the chief clerk of each house of the legislature for
2distribution under s. 13.172 (3) to the standing committees with jurisdiction over
3health insurance
under s. 13.172 (3).
SB201,36,7
4(5) The
plan board may submit any recommendations for legislation to improve
5the plan
to the chief clerk of each house of the legislature for distribution under s.
613.172 (3) to the standing committees with jurisdiction over health insurance
under
7s. 13.172 (3).
SB201, s. 92
8Section
92. 635.25 (title) of the statutes is amended to read:
SB201,36,9
9635.25 (title)
Eligibility for participation in plan.
SB201, s. 93
10Section
93. 635.25 (1) (a) (intro.) of the statutes is amended to read:
SB201,36,1211
635.25
(1) (a) (intro.) To be eligible to
participate in the plan by purchasing 12purchase a policy under this subchapter containing the basic benefits, an employer:
SB201, s. 94
13Section
94. 635.25 (1) (a) 2. of the statutes is amended to read:
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).
SB201,40,15
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: