AB100-ASA1,1803,1515 2. Health insurance.
AB100-ASA1,1803,1616 3. Part A or part B of title XVIII of the federal Social Security Act.
AB100-ASA1,1803,1817 4. Title XIX of the federal Social Security Act, except for coverage consisting
18solely of benefits under section 1928 of that act.
AB100-ASA1,1803,1919 5. Chapter 55 of title 10 of the United States Code.
AB100-ASA1,1803,2120 6. A medical care program of the federal Indian health service or of an
21American Indian tribal organization.
AB100-ASA1,1803,2222 7. A state health benefits risk pool.
AB100-ASA1,1803,2323 8. A health plan offered under chapter 89 of title 5 of the United States Code.
AB100-ASA1,1803,2424 9. A public health plan.
AB100-ASA1,1804,2
110. A health coverage plan under section 5 (e) of the federal Peace Corps Act,
222 USC 2504 (e).
AB100-ASA1,1804,43 (b) "Creditable coverage" does not include coverage consisting solely of
4coverage of excepted benefits, as defined in section 2791 (c) of P.L. 104-191.
AB100-ASA1, s. 4817cm 5Section 4817cm. 619.10 (2j) of the statutes, as created by 1997 Wisconsin Act
6.... (this act), is renumbered 149.10 (2j).
AB100-ASA1, s. 4817m 7Section 4817m. 619.10 (2t) of the statutes is created to read:
AB100-ASA1,1804,98 619.10 (2t) "Eligible individual" means an individual for whom all of the
9following apply:
AB100-ASA1,1804,1110 (a) The aggregate of the individual's periods of creditable coverage is 18 months
11or more.
AB100-ASA1,1804,1412 (b) The individual's most recent period of creditable coverage was under a
13group health plan, governmental plan, federal governmental plan or church plan, or
14under any health insurance offered in connection with any of those plans.
AB100-ASA1,1804,1815 (c) The individual does not have creditable coverage and is not eligible for
16coverage under a group health plan, part A or part B of title XVIII of the federal Social
17Security Act or a state plan under title XIX of the federal Social Security Act or any
18successor program.
AB100-ASA1,1804,2119 (d) The individual's most recent period of creditable coverage was not
20terminated for any reason related to fraud or intentional misrepresentation of
21material fact or a failure to pay premiums.
AB100-ASA1,1804,2422 (e) If the individual was offered the option of continuation coverage under a
23federal continuation provision or similar state program, the individual elected the
24continuation coverage.
AB100-ASA1,1804,2525 (f) The individual has exhausted any continuation coverage under par. (e).
AB100-ASA1, s. 4817mm
1Section 4817mm. 619.10 (2t) of the statutes, as created by 1997 Wisconsin Act
2.... (this act), is renumbered 149.10 (2t).
AB100-ASA1, s. 3405 3Section 3405. 619.10 (3) of the statutes is renumbered 149.10 (3) and amended
4to read:
AB100-ASA1,1805,75 149.10 (3) "Eligible person" means a resident of this state who qualifies under
6s. 619.12 149.12 whether or not the person is legally responsible for the payment of
7medical expenses incurred on the person's behalf.
AB100-ASA1, s. 4818c 8Section 4818c. 619.10 (3c) of the statutes is created to read:
AB100-ASA1,1805,99 619.10 (3c) "Federal continuation provision" means any of the following:
AB100-ASA1,1805,1110(a) Section 4980B of the Internal Revenue Code of 1986, except for section
114980B (f) (1) of that code insofar as it relates to pediatric vaccines.
AB100-ASA1,1805,1312 (b) Part 6 of subtitle B of title I of the federal Employee Retirement Income
13Security Act of 1974, except for section 609 of that act.
AB100-ASA1,1805,1414(c) Title XXII of P.L. 104-191.
AB100-ASA1, s. 4818cm 15Section 4818cm. 619.10 (3c) of the statutes, as created by 1997 Wisconsin Act
16.... (this act), is renumbered 149.10 (3c).
AB100-ASA1, s. 4818d 17Section 4818d. 619.10 (3d) of the statutes is created to read:
AB100-ASA1,1805,2018 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, s. 4818dm 21Section 4818dm. 619.10 (3d) of the statutes, as created by 1997 Wisconsin Act
22.... (this act), is renumbered 149.10 (3d).
AB100-ASA1, s. 4818g 23Section 4818g. 619.10 (3g) of the statutes is created to read:
AB100-ASA1,1805,2524 619.10 (3g) "Governmental plan" has the meaning given under section 3 (32)
25of the federal Employee Retirement Income Security Act of 1974.
AB100-ASA1, s. 4818gm
1Section 4818gm. 619.10 (3g) of the statutes, as created by 1997 Wisconsin Act
2.... (this act), is renumbered 149.10 (3g).
AB100-ASA1, s. 4818j 3Section 4818j. 619.10 (3j) of the statutes is created to read:
AB100-ASA1,1806,44 619.10 (3j) "Group health plan" means any of the following:
AB100-ASA1,1806,95 (a) An employe welfare plan, as defined in section 3 (1) of the federal Employee
6Retirement Security Act of 1974, to the extent that the employe welfare plan provides
7medical care, including items and services paid for as medical care, to employes or
8to their dependents, as defined under the terms of the employe welfare plan, directly
9or through insurance, reimbursement or otherwise.
AB100-ASA1,1806,1510 (b) Any program that would not otherwise be an employe welfare benefit plan
11and that is established or maintained by a partnership, to the extent that the
12program provides medical care, including items and services paid for as medical care,
13to present or former partners of the partnership or to their dependents, as defined
14under the terms of the program, directly or through insurance, reimbursement or
15otherwise.
AB100-ASA1, s. 4818jm 16Section 4818jm. 619.10 (3j) of the statutes, as created by 1997 Wisconsin Act
17.... (this act), is renumbered 149.10 (3j).
AB100-ASA1, s. 3406 18Section 3406. 619.10 (3m) and (4) of the statutes are renumbered 149.10 (3m)
19and (4).
AB100-ASA1, s. 3407 20Section 3407. 619.10 (4m) of the statutes is renumbered 149.10 (4m).
AB100-ASA1, s. 3408 21Section 3408. 619.10 (5) of the statutes is renumbered 149.10 (5) and amended
22to read:
AB100-ASA1,1807,923 149.10 (5) "Insurer" means any person or association of persons, including a
24health maintenance organization, limited service health organization or preferred
25provider plan offering or insuring health services on a prepaid basis, including, but

1not limited to, policies of health insurance issued by a currently licensed insurer, as
2defined in s. 600.03 (27),
nonprofit hospital or medical service plans under ch. 613,
3cooperative medical service plans under s. 185.981, or other entity whose primary
4function is to provide diagnostic, therapeutic or preventive services to a defined
5population in return for a premium paid on a periodic basis. "Insurer" includes any
6person providing health services coverage for individuals on a self-insurance basis
7without the intervention of other entities, as well as any person providing health
8insurance coverage under a medical reimbursement plan to persons. "Insurer" does
9not include a plan under ch. 613 which offers only dental care.
AB100-ASA1, s. 3409 10Section 3409. 619.10 (6) and (7) of the statutes are renumbered 149.10 (6) and
11(7).
AB100-ASA1, s. 3410 12Section 3410. 619.10 (8) of the statutes is renumbered 149.10 (8) and amended
13to read:
AB100-ASA1,1807,1514 149.10 (8) "Plan" means the health care insurance plan established and
15administered
under this subchapter chapter.
AB100-ASA1, s. 3411 16Section 3411. 619.10 (9) of the statutes is renumbered 149.10 (9) and amended
17to read:
AB100-ASA1,1808,318 149.10 (9) "Resident" means a person who has been legally domiciled in this
19state for a period of at least 30 days or, with respect to an eligible individual, an
20individual who resides in this state
. For purposes of this subchapter chapter, legal
21domicile is established by living in this state and obtaining a Wisconsin motor vehicle
22operator's license, registering to vote in Wisconsin or filing a Wisconsin income tax
23return. A child is legally domiciled in this state if the child lives in this state and if
24at least one of the child's parents or the child's guardian is legally domiciled in this
25state. A person with a developmental disability or another disability which prevents

1the person from obtaining a Wisconsin motor vehicle operator's license, registering
2to vote in Wisconsin, or filing a Wisconsin income tax return, is legally domiciled in
3this state by living in this state for 30 days.
AB100-ASA1, s. 3412 4Section 3412. 619.11 of the statutes is renumbered 149.11 and amended to
5read:
AB100-ASA1,1808,9 6149.11 (title) Establishment Operation of plan. The commissioner
7department shall promulgate rules establishing for the operation of a plan of health
8insurance coverage for an eligible person which satisfies the requirements of this
9chapter.
AB100-ASA1, s. 4825c 10Section 4825c. 619.115 of the statutes is created to read:
AB100-ASA1,1808,15 11619.115 Rules relating to creditable coverage. The commissioner shall
12promulgate rules that specify how creditable coverage is to be aggregated for
13purposes of s. 619.10 (2t) (a) and that determine the creditable coverage to which s.
14619.10 (2t) (b) and (d) applies. The rules shall comply with section 2701 (c) of P.L.
15104-191.
AB100-ASA1, s. 4825f 16Section 4825f. 619.115 of the statutes, as created by 1997 Wisconsin Act ....
17(this act), is renumbered 149.115 and amended to read:
AB100-ASA1,1808,22 18149.115 Rules relating to creditable coverage. The commissioner, in
19consultation with the department,
shall promulgate rules that specify how
20creditable coverage is to be aggregated for purposes of s. 619.10 149.10 (2t) (a) and
21that determine the creditable coverage to which s. 619.10 149.10 (2t) (b) and (d)
22applies. The rules shall comply with section 2701 (c) of P.L. 104-191.
AB100-ASA1, s. 3413 23Section 3413. 619.12 (title) of the statutes is renumbered 149.12 (title).
AB100-ASA1, s. 3414 24Section 3414. 619.12 (1) of the statutes is renumbered 149.12 (1), and 149.12
25(1) (intro.), as renumbered, is amended to read:
AB100-ASA1,1809,8
1149.12 (1) (intro.) Except as provided in subs. (1m) and (2), the board or
2administering carrier plan administrator shall certify as eligible a person who is
3covered by medicare because he or she is disabled under 42 USC 423, a person who
4submits evidence that he or she has tested positive for the presence of HIV, antigen
5or nonantigenic products of HIV or an antibody to HIV, a person who is an eligible
6individual,
and any person who receives and submits any of the following based
7wholly or partially on medical underwriting considerations within 9 months prior to
8making application for coverage by the plan:
AB100-ASA1, s. 3415 9Section 3415. 619.12 (1m) (intro) and (a) of the statutes are consolidated,
10renumbered 149.12 (1m) and amended to read:
AB100-ASA1,1809,1411 149.12 (1m) The board or administering carrier plan administrator may not
12certify a person as eligible under circumstances requiring notice under sub. (1) (a)
13to (d) if the required notices were issued by one of the following: (a) An an insurance
14intermediary who is not acting as an administrator, as defined in s. 633.01.
AB100-ASA1, s. 3416 15Section 3416. 619.12 (1m) (b) of the statutes is repealed.
AB100-ASA1, s. 4830b 16Section 4830b. 619.12 (2) (b) of the statutes is renumbered 149.12 (2) (b) and
17amended to read:
AB100-ASA1,1809,2118 149.12 (2) (b) 1. Except as provided in subd. 2., no person who is covered under
19the plan and who voluntarily terminates the coverage under the plan, is again
20eligible for coverage unless 12 months have elapsed since the person's latest
21voluntary termination of coverage under the plan.
AB100-ASA1,1809,2422 2. Subdivision 1. does not apply to any person who is an eligible individual or
23to any person who terminates coverage under the plan because he or she is receiving,
24or is eligible to receive, medical assistance benefits.
AB100-ASA1, s. 4830c
1Section 4830c. 619.12 (2) (c) of the statutes is renumbered 149.12 (2) (c) and
2amended to read:
AB100-ASA1,1810,43 149.12 (2) (c) No person on whose behalf the plan has paid out $500,000
4$1,000,000 or more is eligible for coverage under the plan.
AB100-ASA1, s. 4830d 5Section 4830d. 619.12 (2) (d) of the statutes is renumbered 149.12 (2) (d) and
6amended to read:
AB100-ASA1,1810,87 149.12 (2) (d) No Except for a person who is an eligible individual, no person
8who is 65 years of age or older is eligible for coverage under the plan.
AB100-ASA1, s. 4830e 9Section 4830e. 619.12 (2) (e) 1. of the statutes is renumbered 149.12 (2) (e) and
10amended to read:
AB100-ASA1,1810,1311 149.12 (2) (e) Except as provided in subd. 2., no No person who is eligible for
12health care benefits creditable coverage provided by an employer on a self-insured
13basis or through health insurance is eligible for coverage under the plan.
AB100-ASA1, s. 4830f 14Section 4830f. 619.12 (2) (e) 2. of the statutes is repealed.
AB100-ASA1, s. 4830g 15Section 4830g. 619.12 (2) (e) 3. of the statutes is repealed.
AB100-ASA1, s. 3417 16Section 3417. 619.12 (3) of the statutes, as affected by 1997 Wisconsin Act ....
17(this act), is renumbered 149.12 (3), and 149.12 (3) (c), as renumbered, is amended
18to read:
AB100-ASA1,1810,2219 149.12 (3) (c) The commissioner, in consultation with the board, department
20may promulgate rules specifying other deductible or coinsurance amounts that, if
21paid or reimbursed for persons, will not make the persons ineligible for coverage
22under the plan.
AB100-ASA1, s. 4831c 23Section 4831c. 619.12 (3) (a) of the statutes is amended to read:
AB100-ASA1,1811,424 619.12 (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, s. 4831e 5Section 4831e. 619.12 (3) (bm) of the statutes is created to read:
AB100-ASA1,1811,86 619.12 (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, s. 4832b 9Section 4832b. 619.123 of the statutes is repealed.
AB100-ASA1, s. 3418 10Section 3418. 619.125 of the statutes is renumbered 149.125 and amended to
11read:
AB100-ASA1,1811,14 12149.125 Health insurance risk-sharing plan fund. There is created a
13health insurance risk-sharing plan fund, under the management of the board
14department, to fund administrative expenses.
AB100-ASA1, s. 3419 15Section 3419. 619.13 (title) of the statutes is renumbered 149.13 (title).
AB100-ASA1, s. 3420 16Section 3420. 619.13 (1) (a) of the statutes is renumbered 149.13 (1) and
17amended to read:
AB100-ASA1,1811,2218 149.13 (1) Every insurer shall participate in the cost of administering the plan,
19except the commissioner may by rule exempt as a class those insurers whose share
20as determined under par. (b) sub. (2) would be so minimal as to not exceed the
21estimated cost of levying the assessment. The commissioner shall advise the
22department of the insurers participating in the cost of administering the plan.
AB100-ASA1, s. 3421 23Section 3421. 619.13 (1) (b) of the statutes is renumbered 149.13 (2) and
24amended to read:
AB100-ASA1,1812,6
1149.13 (2) Except as provided by a rule promulgated under s. 619.145 (4), every
2Every participating insurer shall share in the operating, administrative and subsidy
3expenses of the plan in proportion to the ratio of the insurer's total health care
4coverage revenue for residents of this state during the preceding calendar year to the
5aggregate health care coverage revenue of all participating insurers for residents of
6this state during the preceding calendar year, as determined by the commissioner.
AB100-ASA1, s. 3422 7Section 3422. 619.13 (1) (c) of the statutes is repealed.
AB100-ASA1, s. 3423 8Section 3423. 619.13 (1) (d) of the statutes is renumbered 149.13 (3) and
9amended to read:
AB100-ASA1,1812,1410 149.13 (3) (a) Each insurer's proportion of participation under par. (b) sub. (2)
11shall be determined annually by the commissioner based on annual statements and
12other reports filed by the insurer with the commissioner. The commissioner shall
13assess an insurer for the insurer's proportion of participation based on the total
14assessments estimated by the department under s. 149.143 (2) (a) 2.
AB100-ASA1,1812,2115 (b) If the department or the commissioner finds that the commissioner's
16authority to require insurers to report under chs. 600 to 646 and 655 is not adequate
17to permit the department, the commissioner or the board to carry out the
18department's, commissioner's or the board's responsibilities under this subchapter
19chapter, the commissioner may shall promulgate rules requiring insurers to report
20the information necessary for the department, commissioner and the board to make
21the determinations required under this subchapter chapter.
Loading...
Loading...