(b) (intro.) The schedule of premiums for coverage under this section shall be promulgated by rule by the commissioner department, as provided in s. 149.143. The rates for coverage under this section shall be set such that they differ from the rates for coverage under s. 619.14 149.14 by the same percentage as the percentage difference between the following:
1. The rate that a standard risk would be charged under an individual policy providing substantially the same coverage and deductibles as provided under s. 619.14 149.14.
27,4861
Section 4861
. 619.15 (title) of the statutes is renumbered 149.15 (title).
27,4862
Section 4862
. 619.15 (1) of the statutes is renumbered 149.15 (1) and amended to read:
149.15 (1) The plan shall operate subject to the supervision and approval of a have a board of governors consisting of representatives of 2 participating insurers which are nonprofit corporations, representatives of 2 other participating insurers, 3 health care provider representatives, including one representative of the State Medical Society of Wisconsin, one representative of the Wisconsin Health and Hospital Association and one representative of an integrated multidisciplinary health system, and 3 public members, including one representative of small businesses in the state, appointed by the commissioner secretary for staggered 3-year terms. In addition, the commissioner, or a designated representative from the office of the commissioner, and the secretary, or a designated representative from the department, shall be a member members of the board. The public members shall not be professionally affiliated with the practice of medicine, a hospital or an insurer. At least 2 of the public members shall be individuals reasonably expected to qualify for coverage under the plan or the parent or spouse of such an individual. The commissioner
secretary or the commissioner's secretary's representative shall be the chairperson of the board. Board members, except the commissioner or the commissioner's representative and the secretary or the secretary's representative, shall be compensated at the rate of $50 per diem plus actual and necessary expenses.
27,4863
Section 4863
. 619.15 (2) of the statutes is renumbered 149.15 (2) and amended to read:
149.15 (2) Annually, the board shall make a report to the members of the plan and to the chief clerk of each house of the legislature, for distribution to the appropriate standing committees under s. 13.172 (3),
and to the members of the plan summarizing the activities of the plan in the preceding calendar year. The annual report shall define the cost burden imposed by the plan on all policyholders in this state.
27,4864
Section 4864
. 619.15 (3) (intro.) of the statutes is renumbered 149.15 (3) (intro.) and amended to read:
149.15 (3) (intro.) The board shall do all of the following:
27,4865
Section 4865
. 619.15 (3) (a) of the statutes is renumbered 149.15 (3) (a).
27,4866
Section 4866
. 619.15 (3) (b) of the statutes is repealed.
27,4867c
Section 4867c. 619.15 (3) (c) of the statutes is renumbered 149.15 (3) (c) and amended to read:
149.15 (3) (c) Collect assessments from all insurers to provide for claims paid under the plan and for administrative expenses incurred or estimated to be incurred during the period for which the assessment is made. The level of payments shall be established by the board
as provided under s. 149.143. Assessment of the insurers shall occur at the end of each calendar year or other fiscal year end established by the board. Assessments are due and payable within 30 days of receipt by the insurer of the assessment notice.
27,4868
Section 4868
. 619.15 (3) (d) of the statutes is renumbered 149.15 (3) (d).
27,4869c
Section 4869c. 619.15 (3) (e) of the statutes is renumbered 149.15 (3) (e) and amended to read:
149.15 (3) (e) Establish for payment of covered expenses, a payment rate that is 10% less than the charges approved by the administering carrier plan administrator for reimbursement of covered expenses under s. 619.14 149.14 (3). A provider of a covered service or article may not bill an eligible person who receives the service or article for any amount by which the charge is reduced under this paragraph.
27,4869d
Section 4869d. 619.15 (3) (f) of the statutes is created to read:
619.15 (3) (f) In consultation with the office and the department of health and family services, establish a choice of coverage under s. 619.146.
27,4869m
Section 4869m. 619.15 (3) (f) of the statutes, as created by 1997 Wisconsin Act .... (this act), is repealed.
27,4870
Section 4870
. 619.15 (4) (intro.) of the statutes is renumbered 149.15 (4) (intro.) and amended to read:
149.15 (4) (intro.) The board may do any of the following:
27,4871
Section 4871
. 619.15 (4) (a) of the statutes is renumbered 149.15 (4) (a).
27,4872
Section 4872
. 619.15 (4) (b) of the statutes is renumbered 149.15 (4) (b).
27,4873c
Section 4873c. 619.15 (4) (c) of the statutes is repealed.
27,4874
Section 4874
. 619.15 (4) (d) of the statutes is repealed.
27,4875
Section 4875
. 619.15 (4) (e) of the statutes is repealed.
27,4876
Section 4876
. 619.15 (5) of the statutes is renumbered 149.15 (5) and amended to read:
149.15 (5) The commissioner
department may, by rule, establish additional powers and duties of the board.
27,4877
Section 4877
. 619.15 (6) of the statutes is renumbered 149.15 (6) and amended to read:
149.15 (6) If any provision of this subchapter chapter conflicts with s. 625.11 or 625.12, this subchapter
chapter prevails.
27,4878
Section 4878
. 619.15 (7) of the statutes is renumbered 149.15 (7).
27,4879
Section 4879
. 619.16 (title) of the statutes is repealed.
27,4880
Section 4880
. 619.16 (1) of the statutes is repealed.
27,4881
Section 4881
. 619.16 (2) of the statutes is repealed.
27,4882
Section 4882
. 619.16 (3) (a) of the statutes is renumbered 149.16 (3) (a) and amended to read:
149.16 (3) (a) The administering carrier plan administrator shall perform all eligibility and administrative claims payment functions relating to the plan.
27,4883
Section
4883. 619.16 (3) (b) of the statutes is renumbered 149.16 (3) (b) and amended to read:
149.16 (3) (b) The administering carrier plan administrator shall establish a premium billing procedure for collection of premiums from insured persons. Billings shall be made on a periodic basis as determined by the board department.
27,4884c
Section 4884c. 619.16 (3) (c) of the statutes is renumbered 149.16 (3) (c), and 149.16 (3) (c) (intro.), as renumbered, is amended to read:
149.16 (3) (c) (intro.) The administering carrier plan administrator shall perform all necessary functions to assure timely payment of benefits to covered persons under the plan, including:
27,4885
Section 4885
. 619.16 (3) (d) of the statutes is repealed.
27,4886
Section 4886
. 619.16 (3) (e) of the statutes is renumbered 149.16 (3) (e) and amended to read:
149.16 (3) (e) The administering carrier plan administrator, under the direction of the department, shall pay claims expenses from the premium payments received from or on behalf of covered persons under the plan. If the administering carrier's plan administrator's payments for claims expenses exceed the portion of premiums allocated by the board for payment of claims expenses premium payments, the board shall forward to the department, and the department shall provide to the carrier plan administrator, additional funds for payment of claims expenses.
27,4887
Section 4887
. 619.16 (3) (em) of the statutes is repealed.
27,4888
Section 4888
. 619.16 (3) (f) of the statutes is repealed.
27,4889
Section 4889
. 619.165 (title) of the statutes is renumbered 149.165 (title).
27,4890
Section 4890
. 619.165 (1) (a) of the statutes is renumbered 149.165 (1) and amended to read:
149.165 (1) The board Except as provided in s. 149.146 (2) (a), the department shall reduce the premiums established by the commissioner under s.
619.11 149.11 in conformity with ss. 619.14 (5) 149.143 and 619.17 149.17, for the eligible persons and in the manner set forth in pars. (b) to (d) subs. (2) and (3).
27,4891
Section 4891
. 619.165 (1) (b) of the statutes is renumbered 149.165 (2), and 149.165 (2) (intro.), as renumbered, is amended to read:
149.165 (2) (intro.) If the household income, as defined in s. 71.52 (5) and as determined under par. (d) sub. (3), of an eligible person is equal to or greater than the first amount and less than the 2nd amount listed in any of the following, the board department shall reduce the premium for the eligible person, as established by the commissioner, to the rate shown after the amounts:
27,4891c
Section 4891c. 619.165 (1) (d) of the statutes is renumbered 619.165 (1) (d) 1. and amended to read:
619.165 (1) (d) 1. The Subject to subd. 2., the board shall establish and implement the method for determining the household income of an eligible person under par. (b).
27,4891r
Section 4891r. 619.165 (1) (d) of the statutes, as affected by 1997 Wisconsin Act .... (this act), is renumbered 149.165 (3), and 149.165 (3) (a) and (b) (intro.), as renumbered, are amended to read:
149.165 (3) (a) Subject to subd. 2., the board par. (b), the department shall establish and implement the method for determining the household income of an eligible person under par. (b) sub. (2).
(b) (intro.) In determining household income under par. (b), the board sub. (2), the department shall consider information submitted by an eligible person on a completed federal profit or loss from farming form, schedule F, if all of the following apply:
27,4891t
Section 4891t. 619.165 (1) (d) 2. of the statutes is created to read:
619.165 (1) (d) 2. In determining household income under par. (b), the board shall consider information submitted by an eligible person on a completed federal profit or loss from farming form, schedule F, if all of the following apply:
a. The person is a farmer, as defined in s. 102.04 (3).
b. The person was not eligible to claim the homestead credit under subch. VIII of ch. 71 in the preceding taxable year.
27,4893
Section 4893
. 619.165 (2) of the statutes is repealed.
27,4894
Section 4894
. 619.165 (3) of the statutes is renumbered 149.165 (4) and amended to read:
149.165 (4) The commissioner shall forward to the board moneys received under s. 20.145 (7) (a) and (g) in an amount sufficient to department shall reimburse the plan for premium reductions under sub. (1) (2) and deductible reductions under s. 619.14 149.14 (5) (a) with moneys from the appropriation under s. 20.435 (5) (ah).
27,4895
Section 4895
. 619.167 of the statutes is repealed.
27,4896
Section 4896
. 619.17 (intro.) of the statutes is renumbered 149.17 (intro.).
27,4897
Section 4897
. 619.17 (1) of the statutes is renumbered 149.17 (1) and amended to read:
149.17 (1) Subject to s. 619.14 (5) (a) ss. 149.143 and 149.146 (2) (b), a rating plan calculated in accordance with generally accepted actuarial principles.
27,4898
Section 4898
. 619.17 (2) of the statutes is renumbered 149.17 (2) and amended to read:
149.17 (2) A schedule of premiums, deductibles and coinsurance payments which complies with all requirements of this subchapter chapter.
27,4899
Section 4899
. 619.17 (3) of the statutes is renumbered 149.17 (3).
27,4900
Section 4900
. 619.17 (4) (a) of the statutes is renumbered 149.17 (4) and amended to read:
149.17 (4) Cost containment provisions established by the commissioner department by rule, including managed care requirements.
27,4901
Section 4901
. 619.175 of the statutes is renumbered 149.175 and amended to read:
149.175 Waiver or exemption from provisions prohibited. Except as provided in s. 619.13 (1) (a) 149.13 (1), the commissioner
department may not waive, or authorize the board to waive, any of the requirements of this subchapter chapter or exempt, or authorize the board to exempt, an individual or a class of individuals from any of the requirements of this subchapter
chapter.
27,4902
Section 4902
. 619.18 of the statutes is renumbered 149.18 and amended to read:
149.18 Chapters 600 to 645 applicable. Except as otherwise provided in this subchapter chapter, the plan shall comply and be administered in compliance with chs. 600 to 645.
27,4910c
Section 4910c. 628.34 (3) (a) of the statutes, as affected by 1995 Wisconsin Act 289, is amended to read:
628.34 (3) (a) No insurer may unfairly discriminate among policyholders by charging different premiums or by offering different terms of coverage except on the basis of classifications related to the nature and the degree of the risk covered or the expenses involved, subject to ss. 632.365 and, 632.745 and 632.748. Rates are not unfairly discriminatory if they are averaged broadly among persons insured under a group, blanket or franchise policy, and terms are not unfairly discriminatory merely because they are more favorable than in a similar individual policy.
27,4910e
Section 4910e. 628.34 (3) (b) of the statutes, as affected by 1995 Wisconsin Act 289, is amended to read:
628.34 (3) (b) No insurer may refuse to insure or refuse to continue to insure, or limit the amount, extent or kind of coverage available to an individual, or charge an individual a different rate for the same coverage because of a mental or physical disability except when the refusal, limitation or rate differential is based on either sound actuarial principles supported by reliable data or actual or reasonably anticipated experience, subject to ss. 632.745, 632.747, 632.749, 635.09 and 635.26
632.746 to 632.7495.
27,4910g
Section 4910g. 628.36 (2) (b) 1. of the statutes is amended to read:
628.36 (2) (b) 1. Except for health maintenance organizations, preferred provider plans, and limited service health organizations and the small employer health insurance plan under subch. II of ch. 635, no health care plan may prevent any person covered under the plan from choosing freely among providers who have agreed to participate in the plan and abide by its terms, except by requiring the person covered to select primary providers to be used when reasonably possible.
27,4910i
Section 4910i. 628.36 (2) (b) 3. of the statutes is amended to read:
628.36 (2) (b) 3. Except as provided in subd. 4., no provider may be denied the opportunity to participate in a health care plan, other than a health maintenance organization, a limited service health organization,
or a preferred provider plan or the small employer health insurance plan under subch. II of ch. 635, under the terms of the plan.
27,4910k
Section 4910k. 628.36 (2) (b) 5. of the statutes is amended to read:
628.36 (2) (b) 5. Except for the small employer health insurance plan under subch. II of ch. 635 to the extent determined by the small employer insurance board under s. 635.23 (1) (b), all All health care plans, including health maintenance organizations, limited service health organizations and preferred provider plans are subject to s. 632.87 (3).
27,4910m
Section 4910m. 631.01 (4) of the statutes is amended to read:
631.01 (4) Annuities and group policies for eleemosynary institutions. This chapter, and ch. 632 and the health insurance mandates under ch. 632 that apply to the plan under subch. II of ch. 635 do not apply to annuities or group policies that are provided on a basis as uniform nationally as state statutes permit to educational, scientific research, religious or charitable institutions organized without profit to any person, for the benefit of employes of such institutions. The commissioner may by order subject such contracts issued by a particular insurer to this chapter, or ch. 632
or the health insurance mandates under ch. 632 that apply to the plan under subch. II of ch. 635 or any portion of those provisions upon a finding, after a hearing, that the interests of Wisconsin insureds or creditors or the public of this state so require.
27,4912
Section 4912
. 631.36 (7) (a) 2. of the statutes is amended to read:
631.36 (7) (a) 2. Unless the notice contains adequate instructions to the policyholder for applying for insurance through a risk-sharing plan under subch. I of ch. 619, if a risk-sharing plan exists under subch. I of ch. 619 for the kind of coverage being canceled or nonrenewed, except as provided in par. (b).
