Amendment SSA1-SB218

LRBs0267/3

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1997 - 1998 LEGISLATURE

SENATE SUBSTITUTE AMENDMENT 1, TO 1997 SENATE BILL 218

October 22, 1997 - Offered by Senator Moen.

SB218-SSA1,2,3 An Act to repeal 185.983 (1g) and chapter 635; to amend 40.51 (8), 40.51 (8m), 60.23 (25), 66.184, 111.91 (2) (k), 120.13 (2) (g), 185.981 (4t), 185.983 (1) (intro.), 600.01 (2) (b), 613.03 (3), 625.12 (2), 628.34 (3) (a), 628.34 (3) (b), 632.745 (intro.), 632.745 (7), 632.745 (18) (intro.), 632.745 (27), 632.746 (title), 632.746 (1) (a), 632.746 (2), 632.746 (3) (a), (b) and (d) 1., 632.746 (6), 632.746 (7) (a) (intro.), (b) (intro.) and 1. and (c) 1., 632.747 (title), 632.748 (title), 632.748 (4) (c), 632.749 (title), 632.749 (2) (e), 632.76 (2) (a) and 632.896 (4); to repeal and recreate 632.745 (25); and to create 632.745 (1m), 632.745 (2m), 632.745 (3m), 632.745 (7m), 632.745 (18m), 632.745 (19m), 632.745 (23m), 632.745 (23p), 632.745 (26m), 632.7465, 632.7491, 632.7492, 632.7494, 632.7497, 632.7498 and 632.7499 of the statutes; relating to: health insurance coverage requirements, including preexisting condition exclusions, guaranteed issue, portability, rating restrictions and fair marketing standards; collective bargaining of certain health care coverage requirements; granting rule-making authority; requiring the exercise of rule-making authority; and providing an exemption from rule-making procedures.

The people of the state of Wisconsin, represented in senate and assembly, do enact as follows:

SB218-SSA1, s. 1 Section 1. 40.51 (8) of the statutes, as affected by 1997 Wisconsin Act 27, section 1324m, is amended to read:

SB218-SSA1,2,9 40.51 (8) Every health care coverage plan offered by the state under sub. (6) shall comply with ss. 631.89, 631.90, 631.93 (2), 632.72 (2), 632.746 (1) to (8) and (10), 632.747, 632.748, 632.7491, 632.87 (3) to (5), 632.895 (5m) and (8) to (13) and 632.896.

SB218-SSA1, s. 2 Section 2. 40.51 (8m) of the statutes, as affected by 1997 Wisconsin Act 27, section 1325m, is amended to read:

SB218-SSA1,2,14 40.51 (8m) Every health care coverage plan offered by the group insurance board under sub. (7) shall comply with ss. 632.746 (1) to (8) and (10), 632.7465, 632.747 and, 632.748, 632.7491, 632.7492, 632.7497 and 632.895 (11) to (13).

SB218-SSA1, s. 3 Section 3. 60.23 (25) of the statutes, as affected by 1997 Wisconsin Act 27, section 2178p, is amended to read:

SB218-SSA1,2,21 60.23 (25) Self-insured health plans. Provide health care benefits to its officers and employes on a self-insured basis if the self-insured plan complies with ss. 631.89, 631.90, 631.93 (2), 632.746 (1), (2), (3) (a), (b), (c), (d) 1. and (e), (6), (7) and (10) (a) 2. and (b) 2., 632.747 (3), 632.87 (4) and (5), 632.895 (9) and (11) to (13) and 632.896.

SB218-SSA1, s. 4 Section 4. 66.184 of the statutes, as affected by 1997 Wisconsin Act 27, section 2210m, is amended to read:

SB218-SSA1,3,7 66.184 Self-insured health plans. If a city, including a 1st class city, or a village provides health care benefits under its home rule power, or if a town provides health care benefits, to its officers and employes on a self-insured basis, the self-insured plan shall comply with ss. 49.493 (3) (d), 631.89, 631.90, 631.93 (2), 632.746 (1), (2), (3) (a), (b), (c), (d) 1. and (e), (6), (7) and (10) (a) 2. and (b) 2., 632.747 (3), 632.87 (4) and (5), 632.895 (9) to (13), 632.896, 767.25 (4m) (d) and 767.51 (3m) (d).

SB218-SSA1, s. 5 Section 5. 111.91 (2) (k) of the statutes, as affected by 1997 Wisconsin Act 27, is amended to read:

SB218-SSA1,3,12 111.91 (2) (k) Compliance with the health benefit plan requirements under ss. 632.746 (1) to (8) and (10), 632.7465, 632.747 and, 632.748, 632.7491, 632.7492 and 632.7497.

SB218-SSA1, s. 6 Section 6. 120.13 (2) (g) of the statutes, as affected by 1997 Wisconsin Act 27, section 2860f, is amended to read:

SB218-SSA1,3,18 120.13 (2) (g) Every self-insured plan under par. (b) shall comply with ss. 49.493 (3) (d), 631.89, 631.90, 631.93 (2), 632.746 (1), (2), (3) (a), (b), (c), (d) 1. and (e), (6), (7) and (10) (a) 2. and (b) 2., 632.747 (3), 632.87 (4) and (5), 632.895 (9) to (13), 632.896, 767.25 (4m) (d) and 767.51 (3m) (d).

SB218-SSA1, s. 7 Section 7. 185.981 (4t) of the statutes, as affected by 1997 Wisconsin Act 27, section 3133m, is amended to read:

SB218-SSA1,3,24 185.981 (4t) A sickness care plan operated by a cooperative association is subject to ss. 252.14, 631.89, 632.72 (2), 632.745 to 632.749 632.7492, 632.7497 to 632.7499, 632.87 (2m), (3), (4) and (5), 632.895 (10) to (13) and 632.897 (10) and chs. 149 and 155.

SB218-SSA1, s. 8 Section 8. 185.983 (1) (intro.) of the statutes, as affected by 1997 Wisconsin Act 27, section 3134m, is amended to read:

SB218-SSA1,4,8 185.983 (1) (intro.)  Every such voluntary nonprofit sickness care plan shall be exempt from chs. 600 to 646, with the exception of ss. 601.04, 601.13, 601.31, 601.41, 601.42, 601.43, 601.44, 601.45, 611.67, 619.04, 628.34 (10), 631.89, 631.93, 632.72 (2), 632.745 to 632.749 632.7492, 632.7497 to 632.7499, 632.775, 632.79, 632.795, 632.87 (2m), (3), (4) and (5), 632.895 (5) and (9) to (13), 632.896 and 632.897 (10) and chs. 609, 630, 635, 645 and 646, but the sponsoring association shall:

SB218-SSA1, s. 9 Section 9. 185.983 (1g) of the statutes is repealed.

SB218-SSA1, s. 10 Section 10. 600.01 (2) (b) of the statutes, as affected by 1997 Wisconsin Act 27, is amended to read:

SB218-SSA1,4,14 600.01 (2) (b) Group or blanket insurance described in sub. (1) (b) 3. and 4. is not exempt from ss. 632.745 to 632.749 632.7492 or 632.7497 to 632.7499 or ch. 633 or 635.

SB218-SSA1, s. 11 Section 11. 613.03 (3) of the statutes, as affected by 1997 Wisconsin Act 27, is amended to read:

SB218-SSA1,4,20 613.03 (3) Applicability of insurance laws. Except as otherwise specifically provided, service insurance corporations organized or operating under this chapter are subject to ss. 610.01, 610.11, 610.21, 610.23 and 610.24 and chs. 600, 601, 609, 617, 620, 623, 625, 627, 628, 631, 632, 635 and 645 and to no other insurance laws.

SB218-SSA1, s. 12 Section 12. 625.12 (2) of the statutes is amended to read:

SB218-SSA1,5,5 625.12 (2) Classification. Risks Subject to s. 632.7497, risks may be classified in any reasonable way for the establishment of rates and minimum premiums, except that no classifications may be based on race, color, creed or national origin, and classifications in automobile insurance may not be based on physical condition or developmental disability as defined in s. 51.01 (5). Subject to s. ss. 632.365 and 632.7497, rates thus produced may be modified for individual risks in accordance with rating plans or schedules that establish reasonable standards for measuring probable variations in hazards, expenses, or both. Rates may also be modified for individual risks under s. 625.13 (2).

SB218-SSA1, s. 13 Section 13. 628.34 (3) (a) of the statutes, as affected by 1997 Wisconsin Act 27, is amended to read:

SB218-SSA1,5,15 628.34 (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, 632.745 and 632.746, 632.748, 632.7494 and 632.7497. 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.

SB218-SSA1, s. 14 Section 14. 628.34 (3) (b) of the statutes, as affected by 1997 Wisconsin Act 27, is amended to read:

SB218-SSA1,5,24 628.34 (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. 632.746 to 632.749, 632.7494, 632.7495 and 632.7497.

SB218-SSA1, s. 15 Section 15. 632.745 (intro.) of the statutes, as affected by 1997 Wisconsin Act 27, is amended to read:

SB218-SSA1,6,5 632.745 Coverage requirements for group and individual health benefit plans; definitions. (intro.) In this section and ss. 632.746 to 632.7495 632.7499:

SB218-SSA1, s. 16 Section 16. 632.745 (1m) of the statutes is created to read:

SB218-SSA1,6,9 632.745 (1m) "Base premium rate" means the lowest premium rate chargeable under a rating system to employers or individuals with similar case characteristics and the same or similar benefit design characteristics.

SB218-SSA1, s. 17 Section 17. 632.745 (2m) of the statutes is created to read:

SB218-SSA1,6,13 632.745 (2m) "Benefit design characteristics" means covered services, cost sharing, utilization management, managed care networks and other features that differentiate plan or coverage designs.

SB218-SSA1, s. 18 Section 18. 632.745 (3m) of the statutes is created to read:

SB218-SSA1,6,16 632.745 (3m) "Case characteristics" means the age, gender, geographic location and tobacco use of the individuals covered under a health benefit plan.

SB218-SSA1, s. 19 Section 19. 632.745 (7) of the statutes, as affected by 1997 Wisconsin Act 27, is amended to read:

SB218-SSA1,6,22 632.745 (7) "Enrollment date" means, with respect to an individual covered under a self-insured health plan, group health plan or health insurance, the date of enrollment of the individual under the plan or insurance or, if earlier, the first day of the waiting period for such enrollment.

SB218-SSA1, s. 20 Section 20. 632.745 (7m) of the statutes is created to read:

SB218-SSA1,7,3 632.745 (7m) "Established geographic service area" means a geographic area within which an insurer provides coverage and that has been approved by the commissioner.

SB218-SSA1, s. 21 Section 21. 632.745 (18) (intro.) of the statutes, as affected by 1997 Wisconsin Act 27, is amended to read:

SB218-SSA1,7,9 632.745 (18) (intro.) "Late enrollee" means, with respect to coverage under a self-insured health plan, a group health plan or health insurance coverage, a participant, beneficiary or individual who enrolls under the plan or coverage at any time other than during any of the following:

SB218-SSA1, s. 22 Section 22. 632.745 (18m) of the statutes is created to read:

SB218-SSA1,7,12 632.745 (18m) "Midpoint rate" means the arithmetic average of the base premium rate and the corresponding highest premium rate.

SB218-SSA1, s. 23 Section 23. 632.745 (19m) of the statutes is created to read:

SB218-SSA1,7,16 632.745 (19m) "New business premium rate" means the premium rate charged or offered to employers or individuals with similar case characteristics for newly issued health insurance with the same or similar benefit design characteristics.

SB218-SSA1, s. 24 Section 24. 632.745 (23m) of the statutes is created to read:

SB218-SSA1,7,19 632.745 (23m) "Rating period" means the period, determined by an insurer, during which a premium rate established by the insurer remains in effect.

SB218-SSA1, s. 25 Section 25. 632.745 (23p) of the statutes is created to read:

SB218-SSA1,7,24 632.745 (23p) "Restricted network provision" means a provision of a health benefit plan that conditions the payment of benefits, in whole or in part, on obtaining services or articles from health care providers that have contracted with the insurer to provide health care services or articles to covered individuals.

SB218-SSA1, s. 26 Section 26. 632.745 (25) of the statutes, as affected by 1997 Wisconsin Act 27, is repealed and recreated to read:

SB218-SSA1,8,9 632.745 (25) "Small employer" means, with respect to a calendar year and a plan year, an employer that employed an average of at least 2 but not more than 50 employes on business days during the preceding calendar year, or that is reasonably expected to employ an average of at least 2 but not more than 50 employes on business days during the current calendar year if the employer was not in existence during the preceding calendar year, and that employs at least 2 employes on the first day of the plan year.

SB218-SSA1, s. 27 Section 27. 632.745 (26m) of the statutes is created to read:

SB218-SSA1,8,15 632.745 (26m) "Student-only medical plan" means a limited nonmedically underwritten individual or group health benefit plan that is guaranteed renewable while the covered person is enrolled as a regular, full-time undergraduate or graduate student at an accredited technical or trade school, college or university and to which any of the following applied at issuance:

SB218-SSA1,8,16 (a) The student was not insured under a health benefit plan.

SB218-SSA1,8,19 (b) The student was eligible for coverage under a health benefit plan of his or her parent, stepparent or guardian but was unable to access the full health benefits of the plan due to limitations in the plan's geographic service area.