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.
AB100-ASA1, s. 4839c 22Section 4839c. 619.13 (2) of the statutes is repealed.
AB100-ASA1, s. 4840c 23Section 4840c. 619.135 (title) of the statutes is renumbered 149.144 (title) and
24amended to read:
AB100-ASA1,1813,2
1149.144 (title) Insurer assessments and provider discounts for
2premium and deductible reductions.
AB100-ASA1, s. 4841c 3Section 4841c. 619.135 (1) of the statutes is repealed.
AB100-ASA1, s. 4845c 4Section 4845c. 619.135 (2) of the statutes is renumbered 149.144 and
5amended to read:
AB100-ASA1,1813,19 6149.144 If the moneys under s. 20.145 (7) (a) and (g) 20.435 (5) (ah) are
7insufficient to reimburse the plan for premium reductions under s. 619.165 149.165
8and deductible reductions under s. 619.14 149.14 (5) (a), or the commissioner
9department determines that the moneys under s. 20.145 (7) (a) and (g) 20.435 (5) (ah)
10will be insufficient to reimburse the plan for premium reductions under s. 619.165
11149.165 and deductible reductions under s. 619.14 149.14 (5) (a), the commissioner
12department shall, by rule, increase in equal proportions the amount of the
13assessment under sub. (1) (a) or levy an assessment against every insurer, or a
14combination of both,
set under s. 149.143 (2) (a) 2. and the provider charges discount
15rate set under s. 149.143 (2) (a) 3., subject to s. 149.143 (1) (b) 1.,
sufficient to
16reimburse the plan for premium reductions under s. 619.165 149.165 and deductible
17reductions under s. 619.14 149.14 (5) (a). The department shall notify the
18commissioner so that the commissioner may levy the increase in the insurer
19assessments.
AB100-ASA1, s. 4846b 20Section 4846b. 619.135 (3) of the statutes is repealed.
AB100-ASA1, s. 3424 21Section 3424. 619.14 (title) of the statutes is renumbered 149.14 (title).
AB100-ASA1, s. 3425 22Section 3425. 619.14 (1) of the statutes is renumbered 149.14 (1), and 149.14
23(1) (b), as renumbered, is amended to read:
AB100-ASA1,1814,324 149.14 (1) (b) If an individual terminates medical assistance coverage and
25applies for coverage under the plan within 45 days after the termination and is

1subsequently found to be eligible under s. 619.12 149.12, the effective date of
2coverage for the eligible person under the plan shall be the date of termination of
3medical assistance coverage.
AB100-ASA1, s. 3426 4Section 3426. 619.14 (2) of the statutes is renumbered 149.14 (2), and 149.14
5(2) (a), as renumbered, is amended to read:
AB100-ASA1,1814,126 149.14 (2) (a) The plan shall provide every eligible person who is not eligible
7for medicare with major medical expense coverage. Major medical expense coverage
8offered under the plan under this section shall pay an eligible person's covered
9expenses, subject to sub. (3) and deductible and coinsurance payments authorized
10under sub. (5), up to a lifetime limit of $500,000 $1,000,000 per covered individual.
11The maximum limit under this paragraph shall not be altered by the board, and no
12actuarially equivalent benefit may be substituted by the board.
AB100-ASA1, s. 3427 13Section 3427. 619.14 (3) of the statutes is renumbered 149.14 (3), and 149.14
14(3) (intro.) and (c) 3., as renumbered, are amended to read:
AB100-ASA1,1814,2515 149.14 (3) Covered expenses. (intro.) Except as restricted by cost containment
16provisions under s. 619.17 149.17 (4) and except as reduced by the board under s.
17619.15 149.15 (3) (e) or by the department under s. 149.143 (2) (a) 3. or (3) or 149.144,
18covered expenses for the coverage under this section shall be the usual and
19customary charges for the services provided by persons licensed under ch. 446.
20Except as restricted by cost containment provisions under s. 619.17 149.17 (4) and
21except as reduced by the board under s. 619.15 149.15 (3) (e) or by the department
22under s. 149.143 (2) (a) 3. or (3) or 149.144
, covered expenses for the coverage under
23this section
shall also be the usual and customary charges for the following services
24and articles when prescribed by a physician licensed under ch. 448 or in another
25state:
AB100-ASA1,1815,3
1 (c) 3. Subject to the limits under subd. 2. and to rules promulgated by the
2commissioner department, services for the chronically mentally ill in community
3support programs operated under s. 51.421.
AB100-ASA1, s. 3428 4Section 3428. 619.14 (4) of the statutes is renumbered 149.14 (4), and 149.14
5(4) (intro.) and (m), as renumbered, are amended to read:
AB100-ASA1,1815,76 149.14 (4) Exclusions. (intro.) Covered expenses for the coverage under this
7section
shall not include the following:
AB100-ASA1,1815,98 (m) Experimental treatment, as determined by the board or its designee
9department.
AB100-ASA1, s. 4852c 10Section 4852c. 619.14 (5) (title) of the statutes is renumbered 149.14 (5) (title)
11and amended to read:
AB100-ASA1,1815,1212 149.14 (5) (title) Premiums, deductibles Deductibles and coinsurance.
AB100-ASA1, s. 3429 13Section 3429. 619.14 (5) (a) of the statutes is renumbered 149.14 (5) (a) and
14amended to read:
AB100-ASA1,1816,615 149.14 (5) (a) The plan shall offer a deductible in combination with appropriate
16premiums determined under this subchapter chapter for major medical expense
17coverage required under this section. For coverage offered to those persons eligible
18for medicare, the plan shall offer a deductible equal to the deductible charged by part
19A of title XVIII of the federal social security act, as amended. The deductible
20amounts for all other eligible persons shall be dependent upon household income as
21determined under s. 619.165 149.165. For eligible persons under s. 619.165 (1) (b)
221.
149.165 (2) (a), the deductible shall be $500. For eligible persons under s. 619.165
23(1) (b) 2.
149.165 (2) (b), the deductible shall be $600. For eligible persons under s.
24619.165 (1) (b) 3. 149.165 (2) (c), the deductible shall be $700. For eligible persons
25under s. 619.165 (1) (b) 4. 149.165 (2) (d), the deductible shall be $800. For all other

1eligible persons who are not eligible for medicare, the deductible shall be $1,000.
2With respect to all eligible persons, expenses used to satisfy the deductible during
3the last 90 days of a calendar year shall also be applied to satisfy the deductible for
4the following calendar year. The schedule of premiums shall be promulgated by rule
5by the commissioner. The commissioner shall set rates at 60% of the operating and
6administrative costs of the plan.
AB100-ASA1, s. 4854c 7Section 4854c. 619.14 (5) (b) of the statutes is renumbered 149.14 (5) (b).
AB100-ASA1, s. 4855c 8Section 4855c. 619.14 (5) (c) of the statutes is renumbered 149.14 (5) (c)
AB100-ASA1, s. 3430 9Section 3430. 619.14 (5) (d) of the statutes is renumbered 149.14 (5) (d) and
10amended to read:
AB100-ASA1,1816,1611 149.14 (5) (d) Notwithstanding pars. (a) to (c), the board department may
12establish different deductible amounts, a different coinsurance percentage and
13different covered costs and deductible aggregate amounts from those specified in
14pars. (a) to (c) in accordance with cost containment provisions established by the
15commissioner department under s. 619.17 (4) (a) and for individuals who enroll in
16an alternative plan under s. 619.145
149.17 (4).
AB100-ASA1, s. 4856v 17Section 4856v. 619.14 (5) (e) of the statutes is amended to read:
AB100-ASA1,1816,2318 619.14 (5) (e) Using the procedure under s. 227.24, the commissioner may
19promulgate rules under par. (a) or s. 619.146 (2) (b) for the schedule of premiums for
20the period before the effective date of any permanent rules promulgated under par.
21(a) or s. 619.146 (2) (b) for the schedule of premiums, but not to exceed the period
22authorized under s. 227.24 (1) (c) and (2). Notwithstanding s. 227.24 (1) and (3), the
23commissioner is not required to make a finding of emergency.
AB100-ASA1, s. 4857c 24Section 4857c. 619.14 (5) (e) of the statutes, as affected by 1997 Wisconsin Act
25.... (this act), is repealed.
AB100-ASA1, s. 4858b
1Section 4858b. 619.14 (6) of the statutes is renumbered 619.14 (6) (a) and
2amended to read:
AB100-ASA1,1817,63 619.14 (6) (a) No Except as provided in par. (b), no person who obtains coverage
4under the plan may be covered for any preexisting condition during the first 6 months
5of coverage under the plan if the person was diagnosed or treated for that condition
6during the 6 months immediately preceding the filing of an application with the plan.
AB100-ASA1, s. 4858c 7Section 4858c. 619.14 (6) of the statutes, as affected by 1997 Wisconsin Act
8.... (this act), is renumbered 149.14 (6).
AB100-ASA1, s. 4858d 9Section 4858d. 619.14 (6) (b) of the statutes is created to read:
AB100-ASA1,1817,1510 619.14 (6) (b) An eligible individual who obtains coverage under the plan on
11or after the effective date of this paragraph .... [revisor inserts date], may not be
12subject to any preexisting condition exclusion under the plan. An eligible individual
13who is covered under the plan on the effective date of this paragraph .... [revisor
14inserts date], may not be subject to any preexisting condition exclusion on or after
15the effective date of this paragraph .... [revisor inserts date].
AB100-ASA1, s. 3431 16Section 3431. 619.14 (7) of the statutes is renumbered 149.14 (7), and 149.14
17(7) (b) and (c), as renumbered, are amended to read:
AB100-ASA1,1817,2118 149.14 (7) (b) The board department has a cause of action against an eligible
19participant for the recovery of the amount of benefits paid which are not for covered
20expenses under the plan. Benefits under the plan may be reduced or refused as a
21setoff against any amount recoverable under this paragraph.
AB100-ASA1,1817,2522 (c) The board department is subrogated to the rights of an eligible person to
23recover special damages for illness or injury to the person caused by the act of a 3rd
24person to the extent that benefits are provided under the plan. Section 814.03 (3)
25applies to the department under this paragraph.
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