AB100-ASA1-AA8-AA8,2,1915
20.145
(7) (g)
Premium and deductible reduction subsidy; insurer assessments
16and penalties. All moneys received from insurer assessments and penalties under
17s. 619.135
and under 1997 Wisconsin Act .... (this act), section 9127 (5xt), for
18subsidizing premium reductions under s. 619.165 and deductible reductions under
19s. 619.14 (5) (a).".".
AB100-ASA1-AA8-AA8,3,5
4"1083c. Page 1353, line 7: delete the material beginning with that line and
5ending with page 1358, line 11.".
AB100-ASA1-AA8-AA8,3,13
12"1348c. Page 1799, line 15: delete the material beginning with that line and
13ending with page 1800, line 18.".
AB100-ASA1-AA8-AA8,3,17
16"1352c. Page 1801, line 4: delete the material beginning with that line and
17ending with page 1825, line 21, and substitute:
AB100-ASA1-AA8-AA8,3,2120
619.10
(2c) "Church plan" has the meaning given in section 3 (33) of the federal
21Employee Retirement Income Security Act of 1974.
AB100-ASA1-AA8-AA8,3,2423
619.10
(2j) (a) Except as provided in par. (b), "creditable coverage" means
24coverage under any of the following:
AB100-ASA1-AA8-AA8,4,1
11. A group health plan.
AB100-ASA1-AA8-AA8,4,22
2. Health insurance.
AB100-ASA1-AA8-AA8,4,33
3. Part A or part B of title XVIII of the federal Social Security Act.
AB100-ASA1-AA8-AA8,4,54
4. Title XIX of the federal Social Security Act, except for coverage consisting
5solely of benefits under section 1928 of that act.
AB100-ASA1-AA8-AA8,4,66
5. Chapter 55 of title 10 of the United States Code.
AB100-ASA1-AA8-AA8,4,87
6. A medical care program of the federal Indian health service or of an
8American Indian tribal organization.
AB100-ASA1-AA8-AA8,4,99
7. A state health benefits risk pool.
AB100-ASA1-AA8-AA8,4,1010
8. A health plan offered under chapter 89 of title 5 of the United States Code.
AB100-ASA1-AA8-AA8,4,1111
9. A public health plan.
AB100-ASA1-AA8-AA8,4,1312
10. A health coverage plan under section 5 (e) of the federal Peace Corps Act,
1322 USC 2504 (e).
AB100-ASA1-AA8-AA8,4,1514
(b) "Creditable coverage" does not include coverage consisting solely of
15coverage of excepted benefits, as defined in section 2791 (c) of P.L.
104-191.
AB100-ASA1-AA8-AA8,4,1817
619.10
(2t) "Eligible individual" means an individual for whom all of the
18following apply:
AB100-ASA1-AA8-AA8,4,2019
(a) The aggregate of the individual's periods of creditable coverage is 18 months
20or more.
AB100-ASA1-AA8-AA8,4,2321
(b) The individual's most recent period of creditable coverage was under a
22group health plan, governmental plan, federal governmental plan or church plan, or
23under any health insurance offered in connection with any of those plans.
AB100-ASA1-AA8-AA8,5,224
(c) The individual does not have creditable coverage and is not eligible for
25coverage under a group health plan, part A or part B of title XVIII of the federal Social
1Security Act or a state plan under title XIX of the federal Social Security Act or any
2successor program.
AB100-ASA1-AA8-AA8,5,53
(d) The individual's most recent period of creditable coverage was not
4terminated for any reason related to fraud or intentional misrepresentation of
5material fact or a failure to pay premiums.
AB100-ASA1-AA8-AA8,5,86
(e) If the individual was offered the option of continuation coverage under a
7federal continuation provision or similar state program, the individual elected the
8continuation coverage.
AB100-ASA1-AA8-AA8,5,99
(f) The individual has exhausted any continuation coverage under par. (e).
AB100-ASA1-AA8-AA8,5,1111
619.10
(3c) "Federal continuation provision" means any of the following:
AB100-ASA1-AA8-AA8,5,1312(a) Section
4980B of the Internal Revenue Code of 1986, except for section
134980B (f) (1) of that code insofar as it relates to pediatric vaccines.
AB100-ASA1-AA8-AA8,5,1514
(b) Part 6 of subtitle B of title I of the federal Employee Retirement Income
15Security Act of 1974, except for section 609 of that act.
AB100-ASA1-AA8-AA8,5,2018
619.10
(3d) "Federal governmental plan" means a benefit program established
19or maintained for its employes by the government of the United States or by any
20agency or instrumentality of the government of the United States.
AB100-ASA1-AA8-AA8,5,2322
619.10
(3g) "Governmental plan" has the meaning given under section 3 (32)
23of the federal Employee Retirement Income Security Act of 1974.
AB100-ASA1-AA8-AA8,5,2525
619.10
(3j) "Group health plan" means any of the following:
AB100-ASA1-AA8-AA8,6,5
1(a) An employe welfare plan, as defined in section 3 (1) of the federal Employee
2Retirement Security Act of 1974, to the extent that the employe welfare plan provides
3medical care, including items and services paid for as medical care, to employes or
4to their dependents, as defined under the terms of the employe welfare plan, directly
5or through insurance, reimbursement or otherwise.
AB100-ASA1-AA8-AA8,6,116
(b) Any program that would not otherwise be an employe welfare benefit plan
7and that is established or maintained by a partnership, to the extent that the
8program provides medical care, including items and services paid for as medical care,
9to present or former partners of the partnership or to their dependents, as defined
10under the terms of the program, directly or through insurance, reimbursement or
11otherwise.
AB100-ASA1-AA8-AA8,6,1713
619.10
(8j) "Preexisting condition exclusion" means, with respect to coverage,
14a limitation or exclusion of benefits relating to a condition of an individual that
15existed before the individual's date of enrollment for coverage, whether or not the
16individual received any medical advice or recommendation, diagnosis, care or
17treatment related to the condition before that date.
AB100-ASA1-AA8-AA8,7,419
619.10
(9) "Resident" means a person who has been legally domiciled in this
20state for a period of at least 30 days
or, with respect to an eligible individual, an
21individual who resides in this state. For purposes of this subchapter, legal domicile
22is established by living in this state and obtaining a Wisconsin motor vehicle
23operator's license, registering to vote in Wisconsin or filing a Wisconsin income tax
24return. A child is legally domiciled in this state if the child lives in this state and if
25at least one of the child's parents or the child's guardian is legally domiciled in this
1state. A person with a developmental disability or another disability which prevents
2the person from obtaining a Wisconsin motor vehicle operator's license, registering
3to vote in Wisconsin, or filing a Wisconsin income tax return, is legally domiciled in
4this state by living in this state for 30 days.
AB100-ASA1-AA8-AA8,7,10
6619.115 Rules relating to creditable coverage. The commissioner shall
7promulgate rules that specify how creditable coverage is to be aggregated for
8purposes of s. 619.10 (2t) (a) and that determine the creditable coverage to which s.
9619.10 (2t) (b) and (d) applies. The rules shall comply with section 2701 (c) of P.L.
10104-191.
AB100-ASA1-AA8-AA8,7,1912
619.12
(1) (intro.) Except as provided in subs. (1m) and (2), the board or
13administering carrier shall certify as eligible a person who is covered by medicare
14because he or she is disabled under
42 USC 423, a person who submits evidence that
15he or she has tested positive for the presence of HIV, antigen or nonantigenic
16products of HIV or an antibody to HIV,
a person who is an eligible individual, and any
17person who receives and submits any of the following based wholly or partially on
18medical underwriting considerations within 9 months prior to making application
19for coverage by the plan:
AB100-ASA1-AA8-AA8,7,2321
619.12
(2) (b) 2. Subdivision 1. does not apply
to any person who is an eligible
22individual or to any person who terminates coverage under the plan because he or
23she is receiving, or is eligible to receive, medical assistance benefits.
AB100-ASA1-AA8-AA8,8,2
1619.12
(2) (c) No person on whose behalf the plan has paid out
$500,000 2$1,000,000 or more is eligible for coverage under the plan.
AB100-ASA1-AA8-AA8,8,54
619.12
(2) (d)
No Except for a person who is an eligible individual, no person
5who is 65 years of age or older is eligible for coverage under the plan.
AB100-ASA1-AA8-AA8, s. 4830km
6Section 4830km. 619.12 (2) (e) of the statutes, as affected by 1997 Wisconsin
7Act .... (this act), is amended to read:
AB100-ASA1-AA8-AA8,8,118
619.12
(2) (e) No person who is eligible for
health care benefits creditable
9coverage, other than those benefits specified in s. 632.745 (11) (b) 1. to 12., that
are 10is provided by an employer on a self-insured basis or through health insurance is
11eligible for coverage under the plan.
AB100-ASA1-AA8-AA8,8,1714
619.12
(2) (e)
Except as provided in subd. 2., no No person who is eligible for
15health care benefits
, other than those benefits specified in s. 632.745 (11) (b) 1. to 12.,
16that are provided by an employer on a self-insured basis or through health insurance
17is eligible for coverage under the plan.
AB100-ASA1-AA8-AA8,8,2221
619.12
(2) (f) No person who is eligible for medical assistance is eligible for
22coverage under the plan.
AB100-ASA1-AA8-AA8,9,424
619.12
(3) (a) Except as provided in pars. (b)
and to (c), no person is eligible for
25coverage under the plan for whom a premium, deductible or coinsurance amount is
1paid or reimbursed by a federal, state, county or municipal government or agency as
2of the first day of any term for which a premium amount is paid or reimbursed and
3as of the day after the last day of any term during which a deductible or coinsurance
4amount is paid or reimbursed.
AB100-ASA1-AA8-AA8,9,86
619.12
(3) (bm) Persons for whom premium costs for health insurance coverage
7are subsidized under s. 252.16 are not ineligible for coverage under the plan by
8reason of such payments.
AB100-ASA1-AA8-AA8,9,1512
619.13
(1) Every insurer shall participate in the cost of administering the plan,
13except the commissioner may by rule exempt as a class those insurers whose share
14as determined under
par. (b) sub. (2) would be so minimal as to not exceed the
15estimated cost of levying the assessment.
AB100-ASA1-AA8-AA8,9,2318
619.13
(2) Except as provided by a rule promulgated under s. 619.145 (4), every 19Every participating insurer shall share in the operating, administrative and subsidy
20expenses of the plan in proportion to the ratio of the insurer's total health care
21coverage revenue for residents of this state during the preceding calendar year to the
22aggregate health care coverage revenue of all participating insurers for residents of
23this state during the preceding calendar year, as determined by the commissioner.
AB100-ASA1-AA8-AA8, s. 4838m
1Section 4838m. 619.13 (1) (d) of the statutes is renumbered 619.13 (3), and
2619.13 (3) (a), as renumbered, is amended to read:
AB100-ASA1-AA8-AA8,10,73
619.13
(3) (a) Each insurer's proportion of participation under
par. (b) sub. (2) 4shall be determined annually by the commissioner based on annual statements and
5other reports filed by the insurer with the commissioner.
The commissioner shall
6assess an insurer for the insurer's proportion of participation based on the total
7assessments estimated under s. 619.143 (2) (a) 2.
