27,4794c
Section 4794c. 600.01 (1) (b) 9. of the statutes is created to read:
600.01 (1) (b) 9. The publication and clearinghouse activities described in subd. 9. c., the association undertaking those activities, with respect to those activities, and the association's periodic publication resulting from and furthering those activities if all of the following apply:
a. The publication and clearinghouse activities are undertaken by an association that is organized not for profit for religious and charitable purposes.
b. The publication activities of the association are limited to subscribers who are members of the same church or religious denomination.
c. The publication activities of the association function as an organizational clearinghouse that matches subscribers to the publications of the association who have financial, physical or medical needs and subscribers to the publications of the association who desire to financially assist with those needs and who have a present ability to pay.
d. Although the association, through its publications, may suggest voluntary payment levels between subscribers described in subd. 9. c., the association and the subscribers do not assume any risk or make any promise of payment by the association or any subscribers.
e. The association provides to each subscriber a written monthly statement that lists the total dollar amount of qualified needs submitted for publication in the previous month and the total dollar amount of qualified needs submitted that were actually published and assigned for payment.
f. On or accompanying all written materials distributed by or on behalf of the association, including applications, guidelines, promotional or informational materials and periodic publications, the association provides the following written disclaimer:
ATTENTION
This publication is not issued by an insurance company, nor is it offered through an insurance company. This publication does not guarantee or promise that your medical bills will be published or assigned to others for payment. Whether anyone chooses to pay your medical bills is entirely voluntary. This publication should never be considered a substitute for an insurance policy. Whether or not you receive any payments for medical expenses, and whether or not this publication continues to operate, you are responsible for the payment of your own medical bills.
g. No payments between subscribers described in subd. 9. c. are made through the association.
27,4794m
Section 4794m. 600.01 (2) (b) of the statutes, as affected by 1995 Wisconsin Act 289, is amended to read:
600.01 (2) (b) Group or blanket insurance described in sub. (1) (b) 3. and 4. is not exempt from s.
ss. 632.745, 632.747 or to 632.749 or ch. 633 or 635.
27,4795
Section 4795
. 601.41 (1) of the statutes is amended to read:
601.41 (1) Duties. The commissioner shall administer and enforce chs. 153 and 600 to 655 and ss. 59.52 (11) (c), 66.184 and 120.13 (2) (b) to (g) and shall act as promptly as possible under the circumstances on all matters placed before the commissioner.
27,4796
Section 4796
. 601.41 (1) of the statutes, as affected by 1997 Wisconsin Act .... (this act), is amended to read:
601.41 (1) Duties. The commissioner shall administer and enforce chs. 600 to 655 and ss. 59.52 (11) (c), 66.184 and, 120.13 (2) (b) to (g)
, 149.13 and 149.144 and shall act as promptly as possible under the circumstances on all matters placed before the commissioner.
27,4796m
Section 4796m. 601.415 (4) of the statutes is repealed.
27,4797
Section 4797
. 601.415 (12) of the statutes is created to read:
601.415 (12) Health insurance risk-sharing plan. The commissioner shall perform the duties specified to be performed by the commissioner in ss. 149.13 and 149.144. The commissioner, or his or her designee, shall serve as a member of the board under s. 149.15.
27,4798
Section 4798
. 601.429 of the statutes is repealed.
27,4801
Section 4801
. 601.64 (1) of the statutes is amended to read:
601.64 (1) Injunctions and restraining orders. The commissioner may commence an action in circuit court in the name of the state to restrain by temporary or permanent injunction or by temporary restraining order any violation of chs. 600 to 655, s. 149.13 or 149.144, any rule promulgated under chs. 600 to 655 or any order issued under s. 601.41 (4). Except as provided in s. 641.20, the commissioner need not show irreparable harm or lack of an adequate remedy at law in an action commenced under this subsection.
27,4802
Section 4802
. 601.64 (3) (a) of the statutes is amended to read:
601.64 (3) (a) Restitutionary forfeiture. Whoever violates an effective order issued under s. 601.41 (4) or
, any insurance statute or rule or s. 149.13 or 149.144 shall forfeit to the state twice the amount of any profit gained from the violation, in addition to any other forfeiture or penalty imposed.
27,4803
Section 4803
. 601.64 (3) (c) of the statutes is amended to read:
601.64 (3) (c) Forfeiture for violation of statute or rule. Whoever violates an insurance statute or rule or s. 149.13 or 149.144, intentionally aids a person in violating an insurance statute or rule or s. 149.13 or 149.144 or knowingly permits a person over whom he or she has authority to violate an insurance statute or rule or s. 149.13 or 149.144 shall forfeit to the state not more than $1,000 for each violation. If the statute or rule imposes a duty to make a report to the commissioner, each week of delay in complying with the duty is a new violation.
27,4804
Section 4804
. 601.64 (4) of the statutes is amended to read:
601.64 (4) Criminal penalty. Whoever intentionally violates or intentionally permits any person over whom he or she has authority to violate or intentionally aids any person in violating any insurance statute or rule of this state, s. 149.13 or 149.144 or any effective order issued under s. 601.41 (4) may, unless a specific penalty is provided elsewhere in the statutes, be fined not more than $10,000 if a corporation or if a natural person be fined not more than $5,000 or imprisoned for not to exceed 3 years or both. Intent has the meaning expressed under s. 939.23.
27,4804b
Section 4804b. 609.77 of the statutes is created to read:
609.77 Coverage of breast reconstruction. Health maintenance organizations, limited service health organizations and preferred provider plans are subject to s. 632.895 (13).
27,4804c
Section 4804c. 609.78 of the statutes is created to read:
609.78 Coverage of treatment for the correction of temporomandibular disorders. Health maintenance organizations, limited service health organizations and preferred provider plans are subject to s. 632.895 (11).
27,4804e
Section 4804e. 609.79 of the statutes is created to read:
609.79 Coverage of hospital and ambulatory surgery center charges and anesthetics for dental care. Health maintenance organizations, limited service health organizations and preferred provider plans are subject to s. 632.895 (12).
27,4808
Section
4808. 613.03 (3) of the statutes is amended to read:
613.03 (3) Applicability of insurance laws. Except as otherwise specifically provided, service insurance corporations organized or operating under this chapter are subject to subch. II of ch. 619 and ss. 610.01, 610.11, 610.21, 610.23 and 610.24 and chs. 600, 601, 609, 617, 620, 623, 625, 627, 628, 631, 632, 635 and 645 and to no other insurance laws.
27,4809
Section 4809
. 613.03 (4) of the statutes is created to read:
613.03 (4) Mandatory health insurance risk-sharing plan. Service insurance corporations organized or operating under this chapter are subject to ch. 149.
27,4810
Section 4810
. 614.05 (1) of the statutes is amended to read:
614.05 (1) Chapters 611
and 619. No section of ch. 611 or subch. I of ch. 619 applies to fraternals unless it is specifically made applicable by this chapter.
27,4811
Section 4811
. Subchapter I of chapter 619 [precedes 619.001] of the statutes is renumbered chapter 619 [precedes 619.001].
27,4812
Section 4812
. Subchapter I (title) of chapter 619 [precedes 619.01] of the statutes is repealed.
27,4813
Section 4813
. Subchapter II (title) of chapter 619 [precedes 619.10] of the statutes is repealed.
27,4814
Section 4814
. 619.10 (intro.) of the statutes is renumbered 149.10 (intro.) and amended to read:
149.10 Definitions. (intro.) In this subchapter chapter:
27,4815
Section 4815
. 619.10 (1) of the statutes is repealed.
27,4816
Section 4816
. 619.10 (1m) of the statutes is repealed.
27,4817
Section 4817
. 619.10 (2) of the statutes is renumbered 149.10 (2) and amended to read:
149.10 (2) “Board" means the board of governors established under s. 619.15 149.15.
27,4817b
Section 4817b. 619.10 (2c) of the statutes is created to read:
619.10 (2c) “Church plan" has the meaning given in section 3 (33) of the federal Employee Retirement Income Security Act of 1974.
27,4817bm
Section 4817bm. 619.10 (2c) of the statutes, as created by 1997 Wisconsin Act .... (this act), is renumbered 149.10 (2c).
27,4817c
Section 4817c. 619.10 (2j) of the statutes is created to read:
619.10 (2j) (a) Except as provided in par. (b), “creditable coverage" means coverage under any of the following:
1. A group health plan.
2. Health insurance.
3. Part A or part B of title XVIII of the federal Social Security Act.
4. Title XIX of the federal Social Security Act, except for coverage consisting solely of benefits under section 1928 of that act.
5. Chapter 55 of title 10 of the United States Code.
6. A medical care program of the federal Indian health service or of an American Indian tribal organization.
7. A state health benefits risk pool.
8. A health plan offered under chapter 89 of title 5 of the United States Code.
9. A public health plan.
10. A health coverage plan under section 5 (e) of the federal Peace Corps Act, 22 USC 2504 (e).
(b) “Creditable coverage" does not include coverage consisting solely of coverage of excepted benefits, as defined in section 2791 (c) of P.L. 104-191.
27,4817cm
Section 4817cm. 619.10 (2j) of the statutes, as created by 1997 Wisconsin Act .... (this act), is renumbered 149.10 (2j).
27,4817m
Section 4817m. 619.10 (2t) of the statutes is created to read:
619.10 (2t) “Eligible individual" means an individual for whom all of the following apply:
(a) The aggregate of the individual's periods of creditable coverage is 18 months or more.
(b) The individual's most recent period of creditable coverage was under a group health plan, governmental plan, federal governmental plan or church plan, or under any health insurance offered in connection with any of those plans.
(c) The individual does not have creditable coverage and is not eligible for coverage under a group health plan, part A or part B of title XVIII of the federal Social Security Act or a state plan under title XIX of the federal Social Security Act or any successor program.
(d) The individual's most recent period of creditable coverage was not terminated for any reason related to fraud or intentional misrepresentation of material fact or a failure to pay premiums.
(e) If the individual was offered the option of continuation coverage under a federal continuation provision or similar state program, the individual elected the continuation coverage.
(f) The individual has exhausted any continuation coverage under par. (e).
27,4817mm
Section 4817mm. 619.10 (2t) of the statutes, as created by 1997 Wisconsin Act .... (this act), is renumbered 149.10 (2t).
27,4818
Section 4818
. 619.10 (3) of the statutes is renumbered 149.10 (3) and amended to read:
149.10 (3) “Eligible person" means a resident of this state who qualifies under s. 619.12 149.12 whether or not the person is legally responsible for the payment of medical expenses incurred on the person's behalf.
27,4818c
Section 4818c. 619.10 (3c) of the statutes is created to read:
619.10 (3c) “Federal continuation provision" means any of the following:
(a) Section 4980B of the Internal Revenue Code of 1986, except for section 4980B (f) (1) of that code insofar as it relates to pediatric vaccines.
(b) Part 6 of subtitle B of title I of the federal Employee Retirement Income Security Act of 1974, except for section 609 of that act.
(c) Title XXII of P.L. 104-191.
27,4818cm
Section 4818cm. 619.10 (3c) of the statutes, as created by 1997 Wisconsin Act .... (this act), is renumbered 149.10 (3c).
27,4818d
Section 4818d. 619.10 (3d) of the statutes is created to read:
619.10 (3d) “Federal governmental plan" means a benefit program established or maintained for its employes by the government of the United States or by any agency or instrumentality of the government of the United States.
27,4818dm
Section 4818dm. 619.10 (3d) of the statutes, as created by 1997 Wisconsin Act .... (this act), is renumbered 149.10 (3d).
27,4818g
Section 4818g. 619.10 (3g) of the statutes is created to read:
619.10 (3g) “Governmental plan" has the meaning given under section 3 (32) of the federal Employee Retirement Income Security Act of 1974.
