AB100-engrossed,2084,1313
9. A public health plan.
AB100-engrossed,2084,1514
10. A health coverage plan under section 5 (e) of the federal Peace Corps Act,
1522 USC 2504 (e).
AB100-engrossed,2084,1716
(b) "Creditable coverage" does not include coverage consisting solely of
17coverage of excepted benefits, as defined in section 2791 (c) of P.L.
104-191.
AB100-engrossed, s. 4817cm
18Section 4817cm. 619.10 (2j) of the statutes, as created by 1997 Wisconsin Act
19.... (this act), is renumbered 149.10 (2j).
AB100-engrossed,2084,2221
619.10
(2t) "Eligible individual" means an individual for whom all of the
22following apply:
AB100-engrossed,2084,2423
(a) The aggregate of the individual's periods of creditable coverage is 18 months
24or more.
AB100-engrossed,2085,3
1(b) The individual's most recent period of creditable coverage was under a
2group health plan, governmental plan, federal governmental plan or church plan, or
3under any health insurance offered in connection with any of those plans.
AB100-engrossed,2085,74
(c) The individual does not have creditable coverage and is not eligible for
5coverage under a group health plan, part A or part B of title XVIII of the federal Social
6Security Act or a state plan under title XIX of the federal Social Security Act or any
7successor program.
AB100-engrossed,2085,108
(d) The individual's most recent period of creditable coverage was not
9terminated for any reason related to fraud or intentional misrepresentation of
10material fact or a failure to pay premiums.
AB100-engrossed,2085,1311
(e) If the individual was offered the option of continuation coverage under a
12federal continuation provision or similar state program, the individual elected the
13continuation coverage.
AB100-engrossed,2085,1414
(f) The individual has exhausted any continuation coverage under par. (e).
AB100-engrossed, s. 4817mm
15Section 4817mm. 619.10 (2t) of the statutes, as created by 1997 Wisconsin Act
16.... (this act), is renumbered 149.10 (2t).
AB100-engrossed,2085,2119
149.10
(3) "Eligible person" means a resident of this state who qualifies under
20s.
619.12 149.12 whether or not the person is legally responsible for the payment of
21medical expenses incurred on the person's behalf.
AB100-engrossed,2085,2323
619.10
(3c) "Federal continuation provision" means any of the following:
AB100-engrossed,2085,2524(a) Section
4980B of the Internal Revenue Code of 1986, except for section
254980B (f) (1) of that code insofar as it relates to pediatric vaccines.
AB100-engrossed,2086,2
1(b) Part 6 of subtitle B of title I of the federal Employee Retirement Income
2Security Act of 1974, except for section 609 of that act.
AB100-engrossed, s. 4818cm
4Section 4818cm. 619.10 (3c) of the statutes, as created by 1997 Wisconsin Act
5.... (this act), is renumbered 149.10 (3c).
AB100-engrossed,2086,97
619.10
(3d) "Federal governmental plan" means a benefit program established
8or maintained for its employes by the government of the United States or by any
9agency or instrumentality of the government of the United States.
AB100-engrossed, s. 4818dm
10Section 4818dm. 619.10 (3d) of the statutes, as created by 1997 Wisconsin Act
11.... (this act), is renumbered 149.10 (3d).
AB100-engrossed,2086,1413
619.10
(3g) "Governmental plan" has the meaning given under section 3 (32)
14of the federal Employee Retirement Income Security Act of 1974.
AB100-engrossed, s. 4818gm
15Section 4818gm. 619.10 (3g) of the statutes, as created by 1997 Wisconsin Act
16.... (this act), is renumbered 149.10 (3g).
AB100-engrossed,2086,1818
619.10
(3j) "Group health plan" means any of the following:
AB100-engrossed,2086,2319
(a) An employe welfare plan, as defined in section 3 (1) of the federal Employee
20Retirement Security Act of 1974, to the extent that the employe welfare plan provides
21medical care, including items and services paid for as medical care, to employes or
22to their dependents, as defined under the terms of the employe welfare plan, directly
23or through insurance, reimbursement or otherwise.
AB100-engrossed,2087,424
(b) Any program that would not otherwise be an employe welfare benefit plan
25and that is established or maintained by a partnership, to the extent that the
1program provides medical care, including items and services paid for as medical care,
2to present or former partners of the partnership or to their dependents, as defined
3under the terms of the program, directly or through insurance, reimbursement or
4otherwise.
AB100-engrossed, s. 4818jm
5Section 4818jm. 619.10 (3j) of the statutes, as created by 1997 Wisconsin Act
6.... (this act), is renumbered 149.10 (3j).
AB100-engrossed,2087,2312
149.10
(5) "Insurer" means any person or association of persons, including a
13health maintenance organization, limited service health organization or preferred
14provider plan offering or insuring health services on a prepaid basis, including, but
15not limited to, policies of health insurance issued by a currently licensed insurer,
as
16defined in s. 600.03 (27), nonprofit hospital or medical service plans under ch. 613,
17cooperative medical service plans under s. 185.981, or other entity whose primary
18function is to provide diagnostic, therapeutic or preventive services to a defined
19population in return for a premium paid on a periodic basis. "Insurer" includes any
20person providing health services coverage for individuals on a self-insurance basis
21without the intervention of other entities, as well as any person providing health
22insurance coverage under a medical reimbursement plan to persons. "Insurer" does
23not include a plan under ch. 613 which offers only dental care.
AB100-engrossed,2088,43
149.10
(8) "Plan" means the health care insurance plan established
and
4administered under this
subchapter chapter.
AB100-engrossed,2088,177
149.10
(9) "Resident" means a person who has been legally domiciled in this
8state for a period of at least 30 days
or, with respect to an eligible individual, an
9individual who resides in this state. For purposes of this
subchapter chapter, legal
10domicile is established by living in this state and obtaining a Wisconsin motor vehicle
11operator's license, registering to vote in Wisconsin or filing a Wisconsin income tax
12return. A child is legally domiciled in this state if the child lives in this state and if
13at least one of the child's parents or the child's guardian is legally domiciled in this
14state. A person with a developmental disability or another disability which prevents
15the person from obtaining a Wisconsin motor vehicle operator's license, registering
16to vote in Wisconsin, or filing a Wisconsin income tax return, is legally domiciled in
17this state by living in this state
for 30 days.
AB100-engrossed,2088,23
20149.11 (title) Establishment
Operation of plan. The
commissioner 21department shall promulgate rules
establishing for the operation of a plan of health
22insurance coverage for an eligible person which satisfies the requirements of this
23chapter.
AB100-engrossed,2089,5
1619.115 Rules relating to creditable coverage. The commissioner shall
2promulgate rules that specify how creditable coverage is to be aggregated for
3purposes of s. 619.10 (2t) (a) and that determine the creditable coverage to which s.
4619.10 (2t) (b) and (d) applies. The rules shall comply with section 2701 (c) of P.L.
5104-191.
AB100-engrossed, s. 4825f
6Section 4825f. 619.115 of the statutes, as created by 1997 Wisconsin Act ....
7(this act), is renumbered 149.115 and amended to read:
AB100-engrossed,2089,12
8149.115 Rules relating to creditable coverage. The commissioner
, in
9consultation with the department, shall promulgate rules that specify how
10creditable coverage is to be aggregated for purposes of s.
619.10 149.10 (2t) (a) and
11that determine the creditable coverage to which s.
619.10 149.10 (2t) (b) and (d)
12applies. The rules shall comply with section 2701 (c) of P.L.
104-191.
AB100-engrossed, s. 4827
14Section
4827. 619.12 (1) of the statutes is renumbered 149.12 (1), and 149.12
15(1) (intro.), as renumbered, is amended to read:
AB100-engrossed,2089,2316
149.12
(1) (intro.) Except as provided in subs. (1m) and (2), the board or
17administering carrier plan administrator shall certify as eligible a person who is
18covered by medicare because he or she is disabled under
42 USC 423, a person who
19submits evidence that he or she has tested positive for the presence of HIV, antigen
20or nonantigenic products of HIV or an antibody to HIV,
a person who is an eligible
21individual, and any person who receives and submits any of the following based
22wholly or partially on medical underwriting considerations within 9 months prior to
23making application for coverage by the plan:
AB100-engrossed, s. 4828
24Section
4828. 619.12 (1m) (intro) and (a) of the statutes are consolidated,
25renumbered 149.12 (1m) and amended to read:
AB100-engrossed,2090,4
1149.12
(1m) The board or
administering carrier plan administrator may not
2certify a person as eligible under circumstances requiring notice under sub. (1) (a)
3to (d) if the required notices were issued by
one of the following: (a) An an insurance
4intermediary who is not acting as an administrator, as defined in s. 633.01.
AB100-engrossed,2090,118
149.12
(2) (b) 1. Except as provided in subd. 2., no person who is covered under
9the plan and
who voluntarily terminates the coverage under the plan
, is again
10eligible for coverage unless 12 months have elapsed since the person's latest
11voluntary termination of coverage under the plan.
AB100-engrossed,2090,1412
2. Subdivision 1. does not apply
to any person who is an eligible individual or 13to any person who terminates coverage under the plan because he or she
is receiving, 14or is eligible to receive
, medical assistance benefits.
AB100-engrossed, s. 4830c
15Section 4830c. 619.12 (2) (c) of the statutes is renumbered 149.12 (2) (c) and
16amended to read:
AB100-engrossed,2090,1817
149.12
(2) (c) No person on whose behalf the plan has paid out
$500,000 18$1,000,000 or more is eligible for coverage under the plan.
AB100-engrossed, s. 4830d
19Section 4830d. 619.12 (2) (d) of the statutes is renumbered 149.12 (2) (d) and
20amended to read:
AB100-engrossed,2090,2221
149.12
(2) (d)
No Except for a person who is an eligible individual, no person
22who is 65 years of age or older is eligible for coverage under the plan.
AB100-engrossed, s. 4830ec
23Section 4830ec. 619.12 (2) (e) of the statutes, as affected by 1997 Wisconsin
24Act .... (this act), is renumbered 149.12 (2) (e) and amended to read:
AB100-engrossed,2091,4
1149.12
(2) (e) No person who is eligible for
health care benefits creditable
2coverage, other than those benefits specified in s. 632.745 (11) (b) 1. to 12., that
are
3is provided by an employer on a self-insured basis or through health insurance is
4eligible for coverage under the plan.
AB100-engrossed,2091,107
619.12
(2) (e)
Except as provided in subd. 2., no No person who is eligible for
8health care benefits
, other than those benefits specified in s. 632.745 (11) (b) 1. to 12.,
9that are provided by an employer on a self-insured basis or through health insurance
10is eligible for coverage under the plan.
AB100-engrossed, s. 4831
13Section
4831. 619.12 (3) of the statutes, as affected by 1997 Wisconsin Act ....
14(this act), is renumbered 149.12 (3), and 149.12 (3) (c), as renumbered, is amended
15to read:
AB100-engrossed,2091,1916
149.12
(3) (c) The
commissioner, in consultation with the board, department 17may promulgate rules specifying other deductible or coinsurance amounts that, if
18paid or reimbursed for persons, will not make the persons ineligible for coverage
19under the plan.
AB100-engrossed,2092,221
619.12
(3) (a) Except as provided in pars. (b)
and to (c), no person is eligible for
22coverage under the plan for whom a premium, deductible or coinsurance amount is
23paid or reimbursed by a federal, state, county or municipal government or agency as
24of the first day of any term for which a premium amount is paid or reimbursed and
1as of the day after the last day of any term during which a deductible or coinsurance
2amount is paid or reimbursed.
AB100-engrossed,2092,64
619.12
(3) (bm) Persons for whom premium costs for health insurance coverage
5are subsidized under s. 252.16 are not ineligible for coverage under the plan by
6reason of such payments.
AB100-engrossed,2092,12
10149.125 Health insurance risk-sharing plan fund. There is created a
11health insurance risk-sharing plan fund, under the management of the
board 12department, to fund administrative expenses.
AB100-engrossed,2092,2016
149.13
(1) Every insurer shall participate in the cost of administering the plan,
17except the commissioner may by rule exempt as a class those insurers whose share
18as determined under
par. (b) sub. (2) would be so minimal as to not exceed the
19estimated cost of levying the assessment.
The commissioner shall advise the
20department of the insurers participating in the cost of administering the plan.
AB100-engrossed,2093,323
149.13
(2) Except as provided by a rule promulgated under s. 619.145 (4), every 24Every participating insurer shall share in the operating, administrative and subsidy
25expenses of the plan in proportion to the ratio of the insurer's total health care
1coverage revenue for residents of this state during the preceding calendar year to the
2aggregate health care coverage revenue of all participating insurers for residents of
3this state during the preceding calendar year, as determined by the commissioner.
AB100-engrossed,2093,117
149.13
(3) (a) Each insurer's proportion of participation under
par. (b) sub. (2) 8shall be determined annually by the commissioner based on annual statements and
9other reports filed by the insurer with the commissioner.
The commissioner shall
10assess an insurer for the insurer's proportion of participation based on the total
11assessments estimated by the department under s. 149.143 (2) (a) 3.
AB100-engrossed,2093,1812
(b) If the
department or the commissioner finds that the commissioner's
13authority to require insurers to report under chs. 600 to 646 and 655 is not adequate
14to permit the
department, the commissioner or the board to carry out the
15department's, commissioner's or
the board's responsibilities under this
subchapter 16chapter, the commissioner
may shall promulgate rules requiring insurers to report
17the information necessary for the
department, commissioner and
the board to make
18the determinations required under this
subchapter
chapter.
AB100-engrossed, s. 4840c
20Section 4840c. 619.135 (title) of the statutes is renumbered 149.144 (title) and
21amended to read:
AB100-engrossed,2093,23
22149.144 (title)
Insurer Adjustments to insurer assessments and
23provider payment rates for premium and deductible reductions.