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).
SB77-SSA1,1827,135
632.745
(1) (d) "Health benefit plan" means any hospital or medical policy or
6certificate. "Health benefit plan" does not include accident-only, credit accident or
7health, dental, vision, medicare supplement, medicare replacement, long-term care,
8disability income or short-term insurance, coverage issued as a supplement to
9liability insurance, worker's compensation or similar insurance, automobile medical
10payment insurance, individual conversion policies, specified disease policies,
11hospital indemnity policies, as defined in s. 632.895 (1) (c), policies or certificates
12issued under the health insurance risk-sharing plan
or an alternative plan under
13subch. II of ch.
619 149 or other insurance exempted by rule of the commissioner.
SB77-SSA1,1827,2216
632.745
(1) (f) 2. Notwithstanding subd. 1. b. and c., "qualifying coverage" does
17not include a high cost-share health plan, as defined in s. 632.898 (1) (c),
1995 stats., 18that is linked to a medical savings account, as described in s. 632.898,
1995 stats., 19if the employer that provides the individual's new coverage offers its eligible
20employes a choice of health benefit plan options that includes a high cost-share
21health plan, as defined in s. 632.898 (1) (c),
1995 stats., and the individual's new
22coverage is not a high cost-share health plan.
SB77-SSA1, s. 4930
23Section
4930. 632.785 (1) (intro.) of the statutes is amended to read:
SB77-SSA1,1828,524
632.785
(1) (intro.) If an insurer issues one or more of the following or takes any
25other action based wholly or partially on medical underwriting considerations which
1is likely to render any person eligible under s.
619.12 149.12 for coverage under
2subch. II of ch.
619 149, the insurer shall notify all persons affected of the existence
3of the mandatory health insurance risk-sharing plan under
subch. II of ch.
619 149,
4as well as the eligibility requirements and method of applying for coverage under the
5plan:
SB77-SSA1,1828,107
632.89
(2) (a) 2. Except as provided in pars. (b) to (e), coverage of conditions
8under subd. 1. by a policy may
not be subject to exclusions or limitations
, including
9deductibles, that are
not generally applicable to other conditions covered under the
10policy.
SB77-SSA1,1828,1212
632.89
(2) (c) 2. a. The expenses of
the first 30 days as an inpatient in a hospital.
SB77-SSA1,1828,1714
632.89
(2) (c) 2. b.
The first $7,000
Seven thousand dollars minus a copayment
15of up to 10% for inpatient hospital services or, if the coverage is provided by a health
16maintenance organization, as defined in s. 609.01 (2),
the first $6,300 or the
17equivalent benefits measured in services rendered.
SB77-SSA1,1828,2319
632.89
(2) (d) 2. Except as provided in par. (b), a policy under subd. 1. shall
20provide coverage in every policy year for not less than
the first $2,000 $7,000 minus
21a copayment of up to 10% for outpatient services or, if the coverage is provided by a
22health maintenance organization, as defined in s. 609.01 (2),
the first $1,800 $6,300 23or the equivalent benefits measured in services rendered.
SB77-SSA1,1829,5
1632.89
(2) (dm) 2. Except as provided in par. (b), a policy under subd. 1. shall
2provide coverage in every policy year for not less than
the first $3,000 $7,000 minus
3a copayment of up to 10% for transitional treatment arrangements or, if the coverage
4is provided by a health maintenance organization, as defined in s. 609.01 (2),
the first
5$2,700 $6,300 or the equivalent benefits measured in services rendered.
SB77-SSA1,1829,147
632.895
(11) Procedures involving a bone, joint, muscle or tissue and
8intraoral splint therapy devices. (a) Every disability insurance policy, and every
9self-insured health plan of the state or a county, city, village, town or school district,
10that provides coverage of any diagnostic or surgical procedure involving a bone, joint,
11muscle or tissue shall provide coverage for diagnostic and surgical procedures
12involving a bone, joint, muscle or tissue of the face, neck, head or skeletal structure,
13and for prescribed intraoral splint therapy devices, for the treatment of a condition,
14if all of the following apply:
SB77-SSA1,1829,1615
1. The condition is caused by congenital, developmental or acquired deformity,
16disease or injury.
SB77-SSA1,1829,1917
2. Under the accepted standards of the profession of the health care provider
18rendering the service, the procedure or device is reasonable and appropriate for the
19diagnosis or treatment of the condition.
SB77-SSA1,1829,2120
3. The purpose of the procedure or device is to control or eliminate infection,
21pain, disease or facial disfigurement or to restore functional swallowing or chewing.
SB77-SSA1,1829,2422
(b) The coverage required under this subsection may be subject to any
23limitations, exclusions or cost-sharing provisions that apply generally under the
24disability insurance policy or self-insured health plan.
SB77-SSA1,1830,5
1632.895
(12) Hospital services and anesthetics for dental care. (a) Every
2disability insurance policy, and every self-insured health plan of the state or a
3county, city, village, town or school district, shall cover hospital services and
4anesthetics that are provided in conjunction with dental care that is provided to a
5covered individual in a hospital, if any of the following applies:
SB77-SSA1,1830,66
1. The individual is a child under the age of 5.
SB77-SSA1,1830,87
2. The individual has a chronic disability that meets all of the conditions under
8s. 230.04 (9r) (a) 2. a., b. and c.
SB77-SSA1,1830,109
3. The individual has a medical condition that requires hospitalization or
10general anesthesia for dental care.
SB77-SSA1,1830,1311
(b) The coverage required under par. (a) may be subject to any limitations,
12exclusions or cost-sharing provisions that apply generally under the disability
13insurance policy or self-insured plan.
SB77-SSA1, s. 4932
14Section
4932. 632.897 (10) (am) 2. of the statutes is amended to read:
SB77-SSA1,1830,1915
632.897
(10) (am) 2. Provide family coverage under the group policy or
16individual policy for the individual's child, if eligible for coverage, upon application
17by the individual, the child's other parent, the department of
health and family
18services workforce development or the county
designee child support agency under
19s. 59.53 (5).
SB77-SSA1, s. 4932m
20Section 4932m. 632.898 (1), (2), (3), (4), (5) and (6) of the statutes are repealed.
SB77-SSA1, s. 4932n
21Section 4932n. 632.898 (7) of the statutes is renumbered 632.745 (1m) and
22amended to read:
SB77-SSA1,1831,1223
632.745
(1m) (title)
Repeal of exception to qualifying coverage. If the federal
24government enacts legislation providing for a federal income tax exemption for
25amounts deposited in
an a medical savings account established under
this section s.
1632.898, 1995 stats., and for any interest, dividends or other gain that accrues in the
2account if redeposited in the account, the commissioner shall conduct a study, to be
3completed within 4 years after the enactment of the federal legislation, of individuals
4and groups that had coverage under a high cost-share health plan
, as defined in s.
5632.898 (1) (c), 1995 stats., and that terminated that coverage in order to enroll in
6a health benefit plan that was not a high cost-share health plan
, as defined in s.
7632.898 (1) (c), 1995 stats. If as a result of the study the commissioner determines
8that s. 632.745 (1) (f) 2. is not necessary for the purpose for which it was intended,
9the commissioner shall certify that determination to the revisor of statutes. Upon
10the certification, the revisor of statutes shall publish notice in the Wisconsin
11administrative register of the determination, the date of the certification and that
12after 30 days after the date of the certification
s. 632.745 sub. (1) (f) 2. is not effective.
SB77-SSA1,1831,15
15700.38 Access to landlocked land. (1) In this section:
SB77-SSA1,1831,1616
(a) "Acquiring entity" means any of the following:
SB77-SSA1,1831,1717
1. The state or a state agency.
SB77-SSA1,1831,1818
2. A local governmental unit.
SB77-SSA1,1831,2019
3. An organization that has received a grant or loan from a state agency or a
20local governmental unit.
SB77-SSA1,1831,2121
(b) "Local governmental unit" has the meaning given in s. 30.94 (1) (c).