SB77-SSA1,1817,1510
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].
SB77-SSA1, s. 4859
16Section
4859. 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:
SB77-SSA1,1817,2118
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.
SB77-SSA1,1817,2522
(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.
SB77-SSA1,1818,6
3619.146 Choice of coverage. (1) (a) Beginning on January 1, 1998, in
4addition to the coverage required under s. 619.14, the plan shall offer to all eligible
5persons a choice of coverage, as described in section 2744 (a) (1) (
C) of P.L.
104-191.
6Any such choice of coverage shall be major medical expense coverage.
SB77-SSA1,1818,157
(b) An eligible person may elect once each year, at the time and according to
8procedures established by the board, among the coverages offered under this section
9and s. 619.14. If an eligible person elects new coverage, any preexisting condition
10exclusion imposed under the new coverage is met to the extent that the eligible
11person has been previously and continuously covered under this subchapter. No
12preexisting condition exclusion may be imposed on an eligible person who elects new
13coverage if the person was an eligible individual when first covered under this
14subchapter and the person remained continuously covered under this subchapter up
15to the time of electing new coverage.
SB77-SSA1,1818,19
16(2) (a) Except as specified by the board, the terms of coverage under s. 619.14,
17including deductible reductions under s. 619.14 (5) (a), do not apply to the coverage
18offered under this section. Premium reductions under s. 619.165 do not apply to the
19coverage offered under this section.
SB77-SSA1,1818,2320
(b) The schedule of premiums for coverage under this section shall be
21promulgated by rule by the commissioner. The rates for coverage under this section
22shall be set such that they differ from the rates for coverage under s. 619.14 by the
23same percentage as the percentage difference between the following:
SB77-SSA1,1819,3
11. The rate that a standard risk would be charged under an individual policy
2providing substantially the same coverage and deductibles as provided under s.
3619.14.
SB77-SSA1,1819,64
2. The rate that a standard risk would be charged under an individual policy
5providing substantially the same coverage and deductibles as the coverage offered
6under this section.
SB77-SSA1, s. 4860d
7Section 4860d. 619.146 of the statutes, as created by 1997 Wisconsin Act ....
8(this act), is renumbered 149.146, and 149.146 (1) (a) and (b) and (2) (a) and (b)
9(intro.) and 1., as renumbered, are amended to read:
SB77-SSA1,1819,1310
149.146
(1) (a) Beginning on January 1, 1998, in addition to the coverage
11required under s.
619.14 149.14, the plan shall offer to all eligible persons a choice
12of coverage, as described in section 2744 (a) (1) (
C), P.L.
104-191. Any such choice
13of coverage shall be major medical expense coverage.
SB77-SSA1,1819,2214
(b) An eligible person may elect once each year, at the time and according to
15procedures established by the board, among the coverages offered under this section
16and s.
619.14 149.14. If an eligible person elects new coverage, any preexisting
17condition exclusion imposed under the new coverage is met to the extent that the
18eligible person has been previously and continuously covered under this
subchapter 19chapter. No preexisting condition exclusion may be imposed on an eligible person
20who elects new coverage if the person was an eligible individual when first covered
21under this
subchapter chapter and the person remained continuously covered under
22this
subchapter chapter up to the time of electing the new coverage.
SB77-SSA1,1820,2
23(2) (a) Except as specified by the board, the terms of coverage under s.
619.14 24149.14, including deductible reductions under s.
619.14 149.14 (5) (a), do not apply
1to the coverage offered under this section. Premium reductions under s.
619.165 2149.165 do not apply to the coverage offered under this section.
SB77-SSA1,1820,73
(b) (intro.) The schedule of premiums for coverage under this section shall be
4promulgated by rule by the
commissioner department, as provided in s. 149.143. The
5rates for coverage under this section shall be set such that they differ from the rates
6for coverage under s.
619.14 149.14 by the same percentage as the percentage
7difference between the following:
SB77-SSA1,1820,108
1. The rate that a standard risk would be charged under an individual policy
9providing substantially the same coverage and deductibles as provided under s.
10619.14 149.14.
SB77-SSA1, s. 4861
11Section
4861. 619.15 (title) of the statutes is renumbered 149.15 (title).
SB77-SSA1, s. 4862
12Section
4862. 619.15 (1) of the statutes is renumbered 149.15 (1) and amended
13to read:
SB77-SSA1,1821,614
149.15
(1) The plan shall
operate subject to the supervision and approval of a
15have a board
of governors consisting of representatives of 2 participating insurers
16which are nonprofit corporations,
representatives of 2 other participating insurers,
173 health care provider representatives, including one representative of the State
18Medical Society of Wisconsin, one representative of the Wisconsin Health and
19Hospital Association and one representative of an integrated multidisciplinary
20health system, and 3 public members,
including one representative of small
21businesses in the state, appointed by the
commissioner secretary for staggered
223-year terms. In addition, the commissioner
, or a designated representative from
23the office of the commissioner
, and the secretary, or a designated representative from
24the department, shall be
a member members of the board. The public members shall
25not be professionally affiliated with the practice of medicine, a hospital or an insurer.
1At least 2 of the public members shall be individuals reasonably expected to qualify
2for coverage under the plan or the parent or spouse of such an individual. The
3commissioner secretary or the
commissioner's secretary's representative shall be the
4chairperson of the board. Board members, except the commissioner or the
5commissioner's representative
and the secretary or the secretary's representative,
6shall be compensated at the rate of $50 per diem plus actual and necessary expenses.
SB77-SSA1, s. 4863
7Section
4863. 619.15 (2) of the statutes is renumbered 149.15 (2) and amended
8to read:
SB77-SSA1,1821,149
149.15
(2) Annually, the board shall make a report to the
members of the plan
10and to the chief clerk of each house of the legislature, for distribution to the 11appropriate standing committees under s. 13.172 (3)
,
and to the members of the plan 12summarizing the activities of the plan in the preceding calendar year. The annual
13report shall define the cost burden imposed by the plan on all policyholders in this
14state.
SB77-SSA1, s. 4864
15Section
4864. 619.15 (3) (intro.) of the statutes is renumbered 149.15 (3)
16(intro.) and amended to read:
SB77-SSA1,1821,1717
149.15
(3) (intro.) The board shall
do all of the following:
SB77-SSA1, s. 4865
18Section
4865. 619.15 (3) (a) of the statutes is renumbered 149.15 (3) (a).
SB77-SSA1, s. 4867c
20Section 4867c. 619.15 (3) (c) of the statutes is renumbered 149.15 (3) (c) and
21amended to read:
SB77-SSA1,1822,322
149.15
(3) (c) Collect assessments from all insurers to provide for claims paid
23under the plan and for administrative expenses incurred or estimated to be incurred
24during the period for which the assessment is made. The level of payments shall be
25established
by the board as provided under s. 149.143. Assessment of the insurers
1shall occur at the end of each calendar year or other fiscal year end established
by
2the board. Assessments are due and payable within 30 days of receipt by the insurer
3of the assessment notice.
SB77-SSA1, s. 4868
4Section
4868. 619.15 (3) (d) of the statutes is renumbered 149.15 (3) (d).
SB77-SSA1, s. 4869c
5Section 4869c. 619.15 (3) (e) of the statutes is renumbered 149.15 (3) (e) and
6amended to read:
SB77-SSA1,1822,127
149.15
(3) (e) Establish for payment of covered expenses, a payment rate that
8is 10% less than the charges approved by the
administering carrier plan
9administrator for reimbursement of covered expenses under s.
619.14 149.14 (3).
A
10provider of a covered service or article may not bill an eligible person who receives
11the service or article for any amount by which the charge is reduced under this
12paragraph.
SB77-SSA1,1822,1514
619.15
(3) (f) In consultation with the office and the department of health and
15family services, establish a choice of coverage under s. 619.146.
SB77-SSA1, s. 4869f
16Section 4869f. 619.15 (3) (f) of the statutes, as created by 1997 Wisconsin Act
17.... (this act), is renumbered 149.15 (3) (f) and amended to read:
SB77-SSA1,1822,2018
149.15
(3) (f) In consultation with the office
of the commissioner of insurance 19and the department
of health and family services, establish a choice of coverage
20under s.
619.146 149.146.
SB77-SSA1, s. 4870
21Section
4870. 619.15 (4) (intro.) of the statutes is renumbered 149.15 (4)
22(intro.) and amended to read:
SB77-SSA1,1822,2323
149.15
(4) (intro.) The board may
do any of the following:
SB77-SSA1, s. 4871
24Section
4871. 619.15 (4) (a) of the statutes is renumbered 149.15 (4) (a).
SB77-SSA1, s. 4872
25Section
4872. 619.15 (4) (b) of the statutes is renumbered 149.15 (4) (b).
SB77-SSA1, s. 4876
4Section
4876. 619.15 (5) of the statutes is renumbered 149.15 (5) and amended
5to read:
SB77-SSA1,1823,76
149.15
(5) The
commissioner department may, by rule, establish additional
7powers and duties of the board.
SB77-SSA1, s. 4877
8Section
4877. 619.15 (6) of the statutes is renumbered 149.15 (6) and amended
9to read:
SB77-SSA1,1823,1110
149.15
(6) If any provision of this
subchapter chapter conflicts with s. 625.11
11or 625.12, this
subchapter chapter prevails.
SB77-SSA1, s. 4882
16Section
4882. 619.16 (3) (a) of the statutes is renumbered 149.16 (3) (a) and
17amended to read:
SB77-SSA1,1823,1918
149.16
(3) (a) The
administering carrier plan administrator shall perform all
19eligibility and administrative claims payment functions relating to the plan.
SB77-SSA1, s. 4883
20Section
4883. 619.16 (3) (b) of the statutes is renumbered 149.16 (3) (b) and
21amended to read:
SB77-SSA1,1823,2422
149.16
(3) (b) The
administering carrier plan administrator shall establish a
23premium billing procedure for collection of premiums from insured persons. Billings
24shall be made on a periodic basis as determined by the
board department.
SB77-SSA1, s. 4884c
1Section 4884c. 619.16 (3) (c) of the statutes is renumbered 149.16 (3) (c), and
2149.16 (3) (c) (intro.), as renumbered, is amended to read:
SB77-SSA1,1824,53
149.16
(3) (c) (intro.) The
administering carrier plan administrator shall
4perform all necessary functions to assure timely payment of benefits to covered
5persons under the plan, including:
SB77-SSA1, s. 4886
7Section
4886. 619.16 (3) (e) of the statutes is renumbered 149.16 (3) (e) and
8amended to read:
SB77-SSA1,1824,169
149.16
(3) (e) The
administering carrier plan administrator, under the
10direction of the department, shall pay claims expenses from the premium payments
11received from or on behalf of covered persons under the plan. If the
administering
12carrier's plan administrator's payments for claims expenses exceed
the portion of
13premiums allocated by the board for payment of claims expenses
premium
14payments, the board
shall forward to the department, and the department shall
15provide to the
carrier plan administrator, additional funds for payment of claims
16expenses.
SB77-SSA1, s. 4889
19Section
4889. 619.165 (title) of the statutes is renumbered 149.165 (title).
SB77-SSA1, s. 4890
20Section
4890. 619.165 (1) (a) of the statutes is renumbered 149.165 (1) and
21amended to read:
SB77-SSA1,1824,2522
149.165
(1) The board Except as provided in s. 149.146 (2) (a), the department 23shall reduce the premiums established
by the commissioner under s.
619.11 149.11 24in conformity with ss.
619.14 (5) 149.143 and
619.17 149.17, for the eligible persons
25and in the manner set forth in
pars. (b) to (d) subs. (2) and (3).
SB77-SSA1, s. 4891
1Section
4891. 619.165 (1) (b) of the statutes is renumbered 149.165 (2), and
2149.165 (2) (intro.), as renumbered, is amended to read:
SB77-SSA1,1825,73
149.165
(2) (intro.) If the household income, as defined in s. 71.52 (5) and as
4determined under
par. (d) sub. (3), of an eligible person is equal to or greater than
5the first amount and less than the 2nd amount listed in any of the following, the
6board department shall reduce the premium for the eligible person
, as established
7by the commissioner, to the rate shown after the amounts:
SB77-SSA1, s. 4892
8Section
4892. 619.165 (1) (d) of the statutes is renumbered 149.165 (3) and
9amended to read:
SB77-SSA1,1825,1110
149.165
(3) The
board department shall establish and implement the method
11for determining the household income of an eligible person under
par. (b) sub. (2).
SB77-SSA1, s. 4894
13Section
4894. 619.165 (3) of the statutes is renumbered 149.165 (4) and
14amended to read:
SB77-SSA1,1825,1815
149.165
(4) The
commissioner shall forward to the board moneys received
16under s. 20.145 (7) (a) and (g) in an amount sufficient to department shall reimburse
17the plan for premium reductions under sub.
(1) (2) and deductible reductions under
18s.
619.14 149.14 (5) (a)
with moneys from the appropriation under s. 20.435 (5) (ah).
SB77-SSA1, s. 4896
20Section
4896. 619.17 (intro.) of the statutes is renumbered 149.17 (intro.).
SB77-SSA1, s. 4897
21Section
4897. 619.17 (1) of the statutes is renumbered 149.17 (1) and amended
22to read:
SB77-SSA1,1825,2423
149.17
(1) Subject to
s. 619.14 (5) (a) ss. 149.143 and 149.146 (2) (b), a rating
24plan calculated in accordance with generally accepted actuarial principles.
SB77-SSA1, s. 4898
1Section
4898. 619.17 (2) of the statutes is renumbered 149.17 (2) and amended
2to read:
SB77-SSA1,1826,43
149.17
(2) A schedule of premiums, deductibles and coinsurance payments
4which complies with all requirements of this
subchapter chapter.
SB77-SSA1, s. 4900
6Section
4900. 619.17 (4) (a) of the statutes is renumbered 149.17 (4) and
7amended to read:
SB77-SSA1,1826,98
149.17
(4) Cost containment provisions established by the
commissioner 9department by rule
, including managed care requirements.
SB77-SSA1, s. 4901
10Section
4901. 619.175 of the statutes is renumbered 149.175 and amended to
11read:
SB77-SSA1,1826,16
12149.175 Waiver or exemption from provisions prohibited. Except as
13provided in s.
619.13 (1) (a) 149.13 (1), the
commissioner department may not waive,
14or authorize the board to waive, any of the requirements of this
subchapter chapter 15or exempt, or authorize the board to exempt, an individual or a class of individuals
16from any of the requirements of this
subchapter chapter.
SB77-SSA1, s. 4902
17Section
4902. 619.18 of the statutes is renumbered 149.18 and amended to
18read:
SB77-SSA1,1826,21
19149.18 Chapters 600 to 645 applicable. Except as otherwise provided in this
20subchapter chapter, the plan shall comply and be administered in compliance with
21chs. 600 to 645.
SB77-SSA1,1827,223
631.36
(7) (a) 2. Unless the notice contains adequate instructions to the
24policyholder for applying for insurance through a risk-sharing plan under
subch. I
1of ch. 619, if a risk-sharing plan exists under
subch. I of ch. 619 for the kind of
2coverage being canceled or nonrenewed, except as provided in par. (b).