AB100-ASA1-AA8,440,98 g. No payments between subscribers described in subd. 9. c. are made through
9the association.".
AB100-ASA1-AA8,440,10 101348. Page 1799, line 8: after that line insert:
AB100-ASA1-AA8,440,11 11" Section 4796m. 601.415 (4) of the statutes is repealed.".
AB100-ASA1-AA8,440,12 121349. Page 1800, line 18: after that line insert:
AB100-ASA1-AA8,440,13 13" Section 4804b. 609.77 of the statutes is created to read:
AB100-ASA1-AA8,440,16 14609.77 Coverage of breast reconstruction. Health maintenance
15organizations, limited service health organizations and preferred provider plans are
16subject to s. 632.895 (13).".
AB100-ASA1-AA8,440,17 171350. Page 1800, line 20: delete lines 20 and 21 and substitute:
AB100-ASA1-AA8,440,19 18"609.78 Coverage of treatment for the correction of
19temporomandibular disorders.
Health maintenance organizations,".
AB100-ASA1-AA8,440,21 201351. Page 1801, line 1: delete "services" and substitute "and ambulatory
21surgery center charges
".
AB100-ASA1-AA8,440,22 221352. Page 1809, line 9: delete lines 9 to 13 and substitute:
AB100-ASA1-AA8,440,24 23" Section 4830ec. 619.12 (2) (e) of the statutes, as affected by 1997 Wisconsin
24Act .... (this act), is renumbered 149.12 (2) (e) and amended to read:
AB100-ASA1-AA8,441,4
1149.12 (2) (e) No person who is eligible for health care benefits creditable
2coverage
, other than those benefits specified in s. 632.745 (11) (b) 1. to 12., that are
3is
provided by an employer on a self-insured basis or through health insurance is
4eligible for coverage under the plan.
AB100-ASA1-AA8, s. 4830em 5Section 4830em. 619.12 (2) (e) 1. of the statutes is renumbered 619.12 (2) (e)
6and amended to read:
AB100-ASA1-AA8,441,107 619.12 (2) (e) Except as provided in subd. 2., no No person who is eligible for
8health care benefits, other than those benefits specified in s. 632.745 (11) (b) 1. to 12.,
9that are
provided by an employer on a self-insured basis or through health insurance
10is eligible for coverage under the plan.".
AB100-ASA1-AA8,441,11 111353. Page 1811, line 14: delete "(2) (a) 2." and substitute "(2) (a) 3.".
AB100-ASA1-AA8,441,12 121354. Page 1812, line 1: delete that line and substitute:
AB100-ASA1-AA8,441,14 13"149.144 (title) Insurer Adjustments to insurer assessments and
14provider payment rates
for".
AB100-ASA1-AA8,441,15 151355. Page 1812, line 12: delete "increase" and substitute "increase adjust".
AB100-ASA1-AA8,441,16 161356. Page 1812, line 14: delete "(2) (a) 2." and substitute "(2) (a) 3.".
AB100-ASA1-AA8,441,18 171357. Page 1812, line 14: delete "charges discount" and substitute
18"payment".
AB100-ASA1-AA8,441,19 191358. Page 1812, line 15: delete "(2) (a) 3." and substitute "(2) (a) 4.".
AB100-ASA1-AA8,441,21 201359. Page 1812, line 18: delete "the increase in the insurer" and substitute
21"any increase in insurer".
AB100-ASA1-AA8,441,22 221360. Page 1813, line 17: on lines 17 and 22, delete "(2) (a) 3. or (3)".
AB100-ASA1-AA8,442,2
11361. Page 1813, line 19: after "446" insert "and certified under s. 49.45 (2)
2(a) 11
".
AB100-ASA1-AA8,442,3 31362. Page 1813, line 24: after "physician" insert "who is".
AB100-ASA1-AA8,442,5 41363. Page 1813, line 24: delete "when" and substitute "when if the service
5or article is
".
AB100-ASA1-AA8,442,8 61364. Page 1813, line 25: after "state" insert "and who is certified under s.
749.45 (2) (a) 11. and if the service or article is provided by a provider certified under
8s. 49.45 (2) (a) 11.
".
AB100-ASA1-AA8,442,9 91365. Page 1814, line 5: after "(intro.)" insert ", (a)".
AB100-ASA1-AA8,442,10 101366. Page 1814, line 7: after that line insert:
AB100-ASA1-AA8,442,13 11"(a) Any charge for treatment for cosmetic purposes other than surgery for the
12repair or treatment of an injury or a congenital bodily defect. Breast reconstruction
13incident to a mastectomy shall not be considered treatment for cosmetic purposes.
".
AB100-ASA1-AA8,442,15 141367. Page 1818, line 15: on lines 15 and 23, delete "board" and substitute
15"board department".
AB100-ASA1-AA8,442,16 161368. Page 1821, line 1: delete "by" and substitute "by".
AB100-ASA1-AA8,442,17 171369. Page 1821, line 16: delete lines 16 to 20 and substitute:
AB100-ASA1-AA8,442,19 18" Section 4869m. 619.15 (3) (f) of the statutes, as created by 1997 Wisconsin
19Act .... (this act), is repealed.".
AB100-ASA1-AA8,442,20 201370. Page 1824, line 8: delete lines 8 to 11 and substitute:
AB100-ASA1-AA8,442,22 21" Section 4891c. 619.165 (1) (d) of the statutes is renumbered 619.165 (1) (d)
221. and amended to read:
AB100-ASA1-AA8,443,3
1619.165 (1) (d) 1. The Subject to subd. 2., the board shall establish and
2implement the method for determining the household income of an eligible person
3under par. (b).
AB100-ASA1-AA8, s. 4891r 4Section 4891r. 619.165 (1) (d) of the statutes, as affected by 1997 Wisconsin
5Act .... (this act), is renumbered 149.165 (3), and 149.165 (3) (a) and (b) (intro.), as
6renumbered, are amended to read:
AB100-ASA1-AA8,443,97 149.165 (3) (a) Subject to subd. 2., the board par. (b), the department shall
8establish and implement the method for determining the household income of an
9eligible person under par. (b) sub. (2).
AB100-ASA1-AA8,443,1310 (b) (intro.) In determining household income under par. (b), the board sub. (2),
11the department
shall consider information submitted by an eligible person on a
12completed federal profit or loss from farming form, schedule F, if all of the following
13apply:
AB100-ASA1-AA8, s. 4891m 14Section 4891m. 619.165 (1) (d) 2. of the statutes is created to read:
AB100-ASA1-AA8,443,1715 619.165 (1) (d) 2. In determining household income under par. (b), the board
16shall consider information submitted by an eligible person on a completed federal
17profit or loss from farming form, schedule F, if all of the following apply:
AB100-ASA1-AA8,443,1818 a. The person is a farmer, as defined in s. 102.04 (3).
AB100-ASA1-AA8,443,2019 b. The person was not eligible to claim the homestead credit under subch. VIII
20of ch. 71 in the preceding taxable year.".
AB100-ASA1-AA8,443,21 211371. Page 1825, line 21: after that line insert:
AB100-ASA1-AA8,443,23 22" Section 4910c. 628.34 (3) (a) of the statutes, as affected by 1995 Wisconsin
23Act 289
, is amended to read:
AB100-ASA1-AA8,444,7
1628.34 (3) (a) No insurer may unfairly discriminate among policyholders by
2charging different premiums or by offering different terms of coverage except on the
3basis of classifications related to the nature and the degree of the risk covered or the
4expenses involved, subject to ss. 632.365 and, 632.745 and 632.748. Rates are not
5unfairly discriminatory if they are averaged broadly among persons insured under
6a group, blanket or franchise policy, and terms are not unfairly discriminatory
7merely because they are more favorable than in a similar individual policy.
AB100-ASA1-AA8, s. 4910e 8Section 4910e. 628.34 (3) (b) of the statutes, as affected by 1995 Wisconsin Act
9289
, is amended to read:
AB100-ASA1-AA8,444,1610 628.34 (3) (b) No insurer may refuse to insure or refuse to continue to insure,
11or limit the amount, extent or kind of coverage available to an individual, or charge
12an individual a different rate for the same coverage because of a mental or physical
13disability except when the refusal, limitation or rate differential is based on either
14sound actuarial principles supported by reliable data or actual or reasonably
15anticipated experience, subject to ss. 632.745, 632.747, 632.749, 635.09 and 635.26
16632.746 to 632.7495.
AB100-ASA1-AA8, s. 4910g 17Section 4910g. 628.36 (2) (b) 1. of the statutes is amended to read:
AB100-ASA1-AA8,444,2318 628.36 (2) (b) 1. Except for health maintenance organizations, preferred
19provider plans, and limited service health organizations and the small employer
20health insurance plan under subch. II of ch. 635
, no health care plan may prevent
21any person covered under the plan from choosing freely among providers who have
22agreed to participate in the plan and abide by its terms, except by requiring the
23person covered to select primary providers to be used when reasonably possible.
AB100-ASA1-AA8, s. 4910i 24Section 4910i. 628.36 (2) (b) 3. of the statutes is amended to read:
AB100-ASA1-AA8,445,5
1628.36 (2) (b) 3. Except as provided in subd. 4., no provider may be denied the
2opportunity to participate in a health care plan, other than a health maintenance
3organization, a limited service health organization, or a preferred provider plan or
4the small employer health insurance plan under subch. II of ch. 635
, under the terms
5of the plan.
AB100-ASA1-AA8, s. 4910k 6Section 4910k. 628.36 (2) (b) 5. of the statutes is amended to read:
AB100-ASA1-AA8,445,117 628.36 (2) (b) 5. Except for the small employer health insurance plan under
8subch. II of ch. 635 to the extent determined by the small employer insurance board
9under s. 635.23 (1) (b), all
All health care plans, including health maintenance
10organizations, limited service health organizations and preferred provider plans are
11subject to s. 632.87 (3).
AB100-ASA1-AA8, s. 4910m 12Section 4910m. 631.01 (4) of the statutes is amended to read:
AB100-ASA1-AA8,445,2313 631.01 (4) Annuities and group policies for eleemosynary institutions. This
14chapter, and ch. 632 and the health insurance mandates under ch. 632 that apply to
15the plan under subch. II of ch. 635
do not apply to annuities or group policies that
16are provided on a basis as uniform nationally as state statutes permit to educational,
17scientific research, religious or charitable institutions organized without profit to
18any person, for the benefit of employes of such institutions. The commissioner may
19by order subject such contracts issued by a particular insurer to this chapter, or ch.
20632 or the health insurance mandates under ch. 632 that apply to the plan under
21subch. II of ch. 635
or any portion of those provisions upon a finding, after a hearing,
22that the interests of Wisconsin insureds or creditors or the public of this state so
23require.".
AB100-ASA1-AA8,445,24 241372. Page 1826, line 3: delete lines 3 to 22 and substitute:
AB100-ASA1-AA8,446,1
1" Section 4915m. 632.70 of the statutes is repealed.
AB100-ASA1-AA8, s. 4916m 2Section 4916m. 632.745 of the statutes, as affected by 1995 Wisconsin Acts
3289
and 453, is repealed and recreated to read:
AB100-ASA1-AA8,446,5 4632.745 Coverage requirements for group and individual health
5benefit plans; definitions.
In this section and ss. 632.746 to 632.7495:
AB100-ASA1-AA8,446,8 6(1) "Affiliation period" means the period which, under the terms of health
7insurance coverage offered by a health maintenance organization, must expire
8before the health insurance coverage becomes effective.
AB100-ASA1-AA8,446,10 9(2) "Beneficiary" has the meaning given in section 3 (8) of the federal Employee
10Retirement Income Security Act of 1974.
AB100-ASA1-AA8,446,12 11(3) "Bona fide association" means an association that satisfies all of the
12following:
AB100-ASA1-AA8,446,1313 (a) The association has been actively in existence for at least 5 years.
AB100-ASA1-AA8,446,1514 (b) The association has been formed and maintained in good faith for purposes
15other than obtaining insurance.
AB100-ASA1-AA8,446,1816 (c) The association does not condition membership in the association on any
17health status-related factor of an individual, including an employe of an employer
18or a dependent of an employe.
AB100-ASA1-AA8,446,2119 (d) The association makes health insurance coverage offered through the
20association available to all members, regardless of any health status-related factor
21of those members or individuals eligible for coverage through a member.
AB100-ASA1-AA8,446,2322 (e) The association does not make health insurance coverage offered through
23the association available other than in connection with a member of the association.
AB100-ASA1-AA8,447,3
1(f) The association meets any additional requirements that are imposed by a
2rule of the commissioner designed to prevent the use of an association for risk
3segmentation.
AB100-ASA1-AA8,447,5 4(4) (a) Except as provided in par. (b), "creditable coverage" means coverage
5under any of the following:
AB100-ASA1-AA8,447,66 1. A group health plan.
AB100-ASA1-AA8,447,77 2. Health insurance.
AB100-ASA1-AA8,447,88 3. Part A or part B of title XVIII of the federal Social Security Act.
AB100-ASA1-AA8,447,109 4. Title XIX of the federal Social Security Act, except for coverage consisting
10solely of benefits under section 1928 of that act.
AB100-ASA1-AA8,447,1111 5. Chapter 55 of title 10 of the United States Code.
AB100-ASA1-AA8,447,1312 6. A medical care program of the federal Indian health service or of an
13American Indian tribal organization.
AB100-ASA1-AA8,447,1414 7. A state health benefits risk pool.
AB100-ASA1-AA8,447,1515 8. A health plan offered under chapter 89 of title 5 of the United States Code.
AB100-ASA1-AA8,447,1716 9. A public health plan, as defined in regulations issued by the federal
17department of health and human services.
AB100-ASA1-AA8,447,1918 10. A health coverage plan under section 5 (e) of the federal Peace Corps Act,
1922 USC 2504 (e).
AB100-ASA1-AA8,447,2120 (b) "Creditable coverage" does not include coverage consisting solely of
21coverage of excepted benefits, as defined in section 2791 (c) of P.L. 104-191.
AB100-ASA1-AA8,448,3 22(5) (a) Except as provided in par. (b), "eligible employe" means an employe who
23works on a permanent basis and has a normal work week of 30 or more hours. The
24term includes a sole proprietor, a business owner, including the owner of a farm
25business, a partner of a partnership and a member of a limited liability company if

1the sole proprietor, business owner, partner or member is included as an employe
2under a health benefit plan of an employer, but the term does not include an employe
3who works on a temporary or substitute basis.
AB100-ASA1-AA8,448,64 (b) For purposes of a group health benefit plan, or a self-insured health plan,
5that is offered by the state under s. 40.51 (6) or by the group insurance board under
6s. 40.51 (7), "eligible employe" has the meaning given in s. 40.02 (25).
AB100-ASA1-AA8,448,7 7(6) (a) "Employer" means any of the following:
AB100-ASA1-AA8,448,108 1. An individual, firm, corporation, partnership, limited liability company or
9association that is actively engaged in a business enterprise in this state, including
10a farm business.
AB100-ASA1-AA8,448,1111 2. A municipality, as defined in s. 16.70 (8).
AB100-ASA1-AA8,448,1212 3. The state.
AB100-ASA1-AA8,448,1313 (b) For purposes of this definition, all of the following apply:
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